Minnesota Legislature
HF 887
as introduced - 90th Legislature (2017 - 2018) Posted on 05/22/2017 01:34am
Current Version - as introduced
3.4 3.5
3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 5.33 5.34 5.35 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16
6.17
6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 6.33 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24
8.25 8.26
8.27 8.28 8.29 8.30 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17
9.18 9.19
9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33
10.1
10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20
10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11
11.12
11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22
11.23
11.24 11.25 11.26 11.27 11.28 11.29 11.30 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 13.33 14.1 14.2 14.3 14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 14.30 14.31 15.1 15.2 15.3 15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9
16.10
16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27
17.28
17.29 17.30 17.31 17.32 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9
18.10
18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33 18.34 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8
19.9
19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9
20.10
20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10
21.11
21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 21.33 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8
23.9
23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17
23.18
23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28
25.29
26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 27.1 27.2 27.3 27.4
27.5 27.6
27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 33.1 33.2 33.3
33.4
33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28
34.29
34.30 34.31 34.32 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32 36.1 36.2 36.3 36.4 36.5 36.6
36.7
36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 36.32 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22 37.23 37.24 37.25 37.26 37.27 37.28 37.29 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 39.1 39.2
39.3
39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18
40.19
40.20 40.21 40.22 40.23
40.24
40.25 40.26 40.27 40.28
40.29
41.1 41.2 41.3 41.4 41.5 41.6
41.7
41.8 41.9 41.10 41.11 41.12
41.13
41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25
41.26
41.27 41.28 41.29 41.30 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10
42.11
42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29
42.30
43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9
43.10
43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27
45.28
45.29 45.30 45.31 45.32 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10
46.11
46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 47.1 47.2 47.3 47.4
47.5
47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22
47.23
47.24 47.25 47.26 47.27 47.28 47.29 47.30 48.1 48.2
48.3
48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24
48.25
48.26 48.27 48.28 48.29 48.30 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9
49.10 49.11 49.12 49.13
49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21
49.22
49.23 49.24 49.25 49.26 49.27
49.28 49.29 49.30 49.31
50.1 50.2
50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13
53.14 53.15 53.16 53.17 53.18 53.19
53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30
53.31
54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18
56.19 56.20 56.21
56.22 56.23 56.24 56.25 56.26 56.27
56.28
56.29 56.30 56.31 56.32 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18
57.19
57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 57.32 57.33 58.1 58.2 58.3 58.4 58.5 58.6 58.7
58.8
58.9 58.10 58.11 58.12
58.13
58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 58.32 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 59.31 59.32 59.33 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12
60.13
60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 60.31 60.32 60.33 60.34 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14
61.15
61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20
62.21
62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18
63.19
63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28
63.29
64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14
64.15
64.16 64.17 64.18 64.19 64.20 64.21 64.22
64.23
64.24 64.25 64.26 64.27 64.28 64.29 64.30
64.31
65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14
65.15
65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25
65.26
65.27 65.28 65.29 65.30 65.31 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 66.32 66.33 66.34 66.35 66.36 66.37 66.38 66.39 66.40 66.41 66.42 66.43 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 67.33 67.34 67.35 67.36
67.37
67.38 67.39
67.40 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16
68.17
68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 69.32 69.33 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16
70.17 70.18
70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27
70.28
70.29 70.30 70.31 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17
71.18
71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 71.32 71.33 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19
73.20
73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 75.33 75.34 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 76.33 76.34 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9
77.10
77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18
77.19
77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32 77.33 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9
78.10 78.11
78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20
79.21 79.22
79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 79.33 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26
81.27
81.28 81.29 81.30 81.31 81.32 81.33 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17
82.18
82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 82.34 82.35 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 83.32 83.33 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 84.34 85.1 85.2 85.3 85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 86.1 86.2 86.3 86.4 86.5 86.6 86.7
86.8
86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19
86.20
86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 87.1 87.2
87.3
87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11
87.12
87.13 87.14 87.15 87.16 87.17 87.18
87.19
87.20 87.21 87.22 87.23 87.24
87.25
87.26 87.27 87.28 87.29 87.30 88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20
88.21
88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8
89.9
89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 89.33 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16
90.17
90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28
90.29
91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23
91.24
91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 91.33 91.34 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27
93.28
93.29 93.30 93.31 93.32 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 97.1 97.2 97.3 97.4 97.5 97.6
97.7
97.8 97.9 97.10 97.11 97.12
97.13
97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 99.1 99.2 99.3 99.4 99.5 99.6 99.7
99.8
99.9 99.10 99.11 99.12 99.13
99.14
99.15 99.16
99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15
100.16
100.17 100.18 100.19 100.20 100.21 100.22
100.23
100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24
101.25
101.26 101.27 101.28 101.29 101.30 101.31 101.32 101.33 101.34
102.1
102.2 102.3 102.4 102.5 102.6 102.7 102.8
102.9
102.10 102.11 102.12 102.13
102.14
102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22
102.23
102.24 102.25 102.26 102.27 102.28 102.29 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 103.32 103.33 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 105.32 105.33 105.34 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15
106.16
106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 106.31 106.32 106.33 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 107.32 107.33 107.34 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 108.31 108.32 108.33 109.1 109.2 109.3
109.4
109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 110.1 110.2 110.3 110.4 110.5 110.6
110.7
110.8 110.9 110.10 110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21
110.22
110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10
111.11
111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21
111.22
111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31 112.32 112.33 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17
113.18
113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 114.1 114.2 114.3 114.4 114.5 114.6
114.7
114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25
114.26
114.27 114.28 114.29 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 117.33 117.34 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19
118.20
118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 118.33 118.34 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24
119.25
119.26 119.27 119.28 119.29 119.30 119.31
120.1 120.2 120.3
120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13
120.14
120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22 120.23 120.24
120.25
120.26 120.27 120.28 120.29 120.30
120.31
121.1 121.2 121.3 121.4 121.5 121.6
121.7
121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 121.33 122.1 122.2 122.3 122.4 122.5 122.6 122.7
122.8
122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 123.1 123.2 123.3 123.4 123.5 123.6 123.7
123.8
123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26
123.27
123.28 123.29 123.30 123.31 123.32 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16
124.17
124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31
126.32
127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15
127.16
127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29
127.30
128.1 128.2 128.3
128.4
128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16
128.17
128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 129.34 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 130.31 130.32 130.33 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 131.33 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 132.33 133.1 133.2 133.3 133.4 133.5 133.6
133.7
133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 134.32 134.33 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 137.1 137.2 137.3 137.4
137.5
137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17
137.18
137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 139.34 139.35 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16
140.17
140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20
142.21
142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 143.1 143.2
143.3
143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23
143.24
143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10
144.11
144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20
144.21
144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 145.34 145.35 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 147.32 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31
148.32
149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 149.32 149.33 149.34 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20
150.21 150.22 150.23
150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 151.33 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25
152.26 152.27 152.28
152.29 152.30 152.31 152.32 152.33 152.34 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28
153.29 153.30 153.31
154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26
154.27
154.28 154.29 154.30 154.31 154.32 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 155.33 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13
156.14
156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 157.33 157.34 157.35 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11
158.12
158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 159.32 159.33 159.34 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11
160.12
160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 160.33 160.34 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31
162.1
162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13
162.14
162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 162.31 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18
163.19
163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29
163.30 163.31
164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 164.33 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 165.33 165.34 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8
166.9
166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16
167.17
167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31
167.32
168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10
168.11
168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17
169.18
169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28
169.29
170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14
170.15
170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29
170.30
171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31
171.32
172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 172.33 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 174.1 174.2
174.3 174.4
174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15
174.16 174.17 174.18
174.19 174.20
174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 175.32 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 176.33 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 179.32 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 180.31 180.32 180.33 181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 183.31 183.32 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 184.33 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 185.32 185.33 185.34 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 186.33 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 188.32 188.33 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 196.29 196.30 196.31 196.32 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 197.32 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16 198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 199.33 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18 201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28 201.29 201.30 201.31 201.32 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30 203.31 203.32 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14 204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15 209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 209.32 209.33 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8 210.9 210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 211.33 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 212.32 212.33 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 215.33 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 216.32 216.33 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 220.32 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 222.32 222.33 222.34 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 228.32 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 229.32 229.33 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 233.33 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32 234.33 234.34 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 235.33 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20 238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 239.33 239.34 239.35 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 240.33 240.34 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 241.32 241.33 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26 243.27 243.28 243.29 243.30 243.31 243.32 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30 245.31 245.32 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 246.33 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 247.34 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 249.1 249.2 249.3 249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23 249.24 249.25 249.26 249.27 249.28 249.29 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 250.31 250.32 250.33 250.34 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 251.33 251.34 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29 252.30 252.31 252.32 253.1 253.2 253.3 253.4 253.5 253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 254.32 254.33 254.34 254.35 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 255.33 255.34 256.1 256.2 256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 256.32 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 257.33 257.34 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 258.33 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 259.31
260.1 260.2 260.3 260.4
260.5 260.6 260.7 260.8
260.9 260.10
260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 261.1 261.2 261.3 261.4 261.5 261.6
261.7
261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 261.33 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21
262.22
262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9
263.10 263.11 263.12
263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27
263.28 263.29
264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21
264.22 264.23
264.24 264.25
264.26
264.27 264.28
264.29 264.30 264.31 265.1 265.2 265.3 265.4 265.5 265.6
265.7
265.8 265.9 265.10 265.11
265.12
265.13 265.14 265.15 265.16 265.17 265.18 265.19
265.20
265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28
265.29
266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8
266.9
266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26
266.27
267.1 267.2 267.3 267.4
267.5
267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16
267.17
267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28
267.29
268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24
268.25
268.26 268.27 268.28 268.29
268.30
268.31 268.32 268.33 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 269.32 269.33 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13
270.14 270.15
270.16 270.17 270.18 270.19 270.20 270.21 270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 270.31 270.32 270.33 271.1 271.2 271.3 271.4 271.5
271.6
271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29 271.30
271.31 271.32
272.1 272.2 272.3 272.4 272.5 272.6 272.7
272.8
272.9 272.10 272.11 272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30
272.31
273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28
273.29
274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 274.32
275.1 275.2 275.3
275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21
275.22 275.23
275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 275.32 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27
276.28
276.29 276.30 276.31 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14
278.15
278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29
278.30
279.1 279.2 279.3 279.4 279.5 279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 279.32 280.1 280.2 280.3
280.4 280.5
280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19 280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 280.32 280.33 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9
281.10
281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 281.32 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10
282.11
282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 282.30 282.31 282.32 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 283.33 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15
284.16
284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33 284.34
285.1
285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 285.32 286.1 286.2 286.3 286.4
286.5
286.6 286.7 286.8 286.9 286.10 286.11 286.12
286.13
286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8
287.9
287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17
287.18
287.19 287.20 287.21 287.22 287.23
287.24
287.25 287.26 287.27 287.28 287.29 287.30 287.31 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12
288.13
288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32 288.33 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12
289.13 289.14
289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22
291.23 291.24
291.25 291.26 291.27 291.28 291.29 291.30 291.31 291.32 291.33 292.1 292.2 292.3 292.4 292.5
292.6
292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10
293.11
293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20
293.21
293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 294.1 294.2 294.3
294.4
294.5 294.6 294.7 294.8 294.9 294.10
294.11
294.12 294.13 294.14 294.15 294.16
294.17
294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 295.32 295.33 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9
296.10
296.11 296.12 296.13 296.14 296.15 296.16
296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12
297.13 297.14 297.15 297.16 297.17
297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27 298.28 298.29 298.30 298.31 298.32 298.33 298.34 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9 300.10 300.11
300.12
300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 300.32 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21
301.22
301.23 301.24 301.25 301.26
301.27
301.28 301.29 301.30 301.31 301.32 302.1 302.2 302.3 302.4 302.5 302.6
302.7
302.8 302.9 302.10 302.11 302.12 302.13 302.14 302.15 302.16
302.17
302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23
303.24
303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 304.1 304.2 304.3
304.4
304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18
304.19
304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30
304.31
305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28
305.29
306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16
306.17
306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29
307.30
308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22
308.23
308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 309.1 309.2 309.3 309.4 309.5 309.6 309.7
309.8
309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24 309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 310.1 310.2 310.3 310.4 310.5 310.6 310.7 310.8 310.9 310.10 310.11 310.12 310.13 310.14 310.15 310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27 310.28 310.29 310.30 310.31 310.32 310.33 310.34 310.35 311.1 311.2 311.3 311.4 311.5 311.6
311.7
311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15
311.16
311.17 311.18 311.19 311.20 311.21 311.22 311.23
311.24
311.25 311.26 311.27 311.28 311.29 311.30 311.31 312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18
312.19
312.20 312.21 312.22 312.23 312.24 312.25 312.26
312.27
312.28 312.29 312.30 312.31 312.32 312.33 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30
313.31
314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14
314.15
314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26
314.27 314.28 314.29 314.30 314.31 315.1 315.2
315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 316.32 316.33 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 317.32 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8
319.9
319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8
320.9
320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14
321.15
321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12
322.13
322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30 323.31 323.32 323.33 323.34
324.1
324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15
324.16
324.17 324.18 324.19 324.20 324.21 324.22 324.23
324.24 324.25
324.26 324.27 324.28 324.29 324.30 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24
325.25
326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17 326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11
327.12
327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19
330.20
330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 331.34 332.1 332.2 332.3 332.4 332.5 332.6 332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32 332.33 332.34 332.35 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16
333.17
333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32 334.1 334.2 334.3
334.4
334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 337.1 337.2 337.3 337.4 337.5 337.6
337.7
337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27
337.28
337.29 337.30 337.31 337.32 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27
338.28
338.29 338.30 338.31 339.1 339.2 339.3 339.4 339.5 339.6 339.7
339.8
339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 339.32 339.33 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20
342.21
342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 342.33 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10 343.11 343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 343.32 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 344.32 345.1 345.2 345.3 345.4 345.5 345.6 345.7
345.8
345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30 345.31 345.32 346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 346.31 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16 347.17 347.18 347.19
347.20
347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 348.33 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 350.1 350.2 350.3 350.4
350.5
350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9
351.10
351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 352.1 352.2 352.3 352.4 352.5 352.6
352.7
352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 352.32 352.33 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19
355.20
355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 356.1 356.2 356.3 356.4 356.5 356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14 356.15
356.16
356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29
358.30
359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10
360.11
360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 361.1 361.2 361.3 361.4 361.5 361.6 361.7
361.8
361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25
361.26
361.27 361.28 361.29 361.30 362.1 362.2
362.3
362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29
362.30
363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29
363.30
364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22
364.23
364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16
366.17
366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 367.31 367.32 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31 369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 369.32 370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13 370.14 370.15 370.16 370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29 370.30 370.31 370.32 370.33 371.1 371.2 371.3 371.4 371.5 371.6 371.7 371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16 371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 371.31 371.32 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22 372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30 372.31 372.32 372.33 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9 373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 373.31 373.32 373.33 374.1 374.2 374.3 374.4 374.5 374.6 374.7 374.8 374.9 374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 374.33 375.1 375.2 375.3 375.4 375.5 375.6 375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24
375.25
375.26 375.27 375.28 375.29 375.30 375.31 375.32 375.33 376.1 376.2 376.3 376.4 376.5 376.6
376.7
376.8 376.9 376.10 376.11 376.12
376.13
376.14 376.15 376.16 376.17
376.18
376.19 376.20 376.21 376.22 376.23
376.24
376.25 376.26 376.27
376.28
377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8
377.9
377.10 377.11 377.12
377.13
377.14 377.15 377.16 377.17 377.18 377.19
377.20
377.21 377.22 377.23 377.24
377.25
377.26 377.27 377.28 377.29 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 378.32 378.33 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 379.31 379.32 379.33 379.34 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30
380.31
381.1 381.2 381.3 381.4 381.5 381.6
381.7
381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20
381.21
381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 382.1 382.2 382.3 382.4 382.5 382.6 382.7 382.8
382.9
382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 382.32 382.33 382.34 383.1 383.2 383.3
383.4
383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 384.1 384.2
384.3
384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14
384.15
384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23
384.24
384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 385.1 385.2 385.3 385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 385.32 385.33
385.34
386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 386.31
386.32
387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9 387.10 387.11 387.12 387.13 387.14 387.15 387.16
387.17
387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 387.32 387.33 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11
388.12
388.13 388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12
389.13
389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 390.32 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 391.31 391.32 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23
392.24
392.25 392.26 392.27 392.28 392.29 392.30 392.31 392.32 393.1 393.2
393.3
393.4 393.5 393.6 393.7
393.8
393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18
393.19
393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19
394.20
394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29
394.30
395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21
395.22
395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 396.1 396.2
396.3 396.4
396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 397.1 397.2 397.3 397.4
397.5 397.6
397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16
397.17
397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 397.32 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13
398.14
398.15 398.16 398.17 398.18 398.19
398.20
398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28
398.29
399.1 399.2
399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26 399.27
399.28
400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 400.33 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29
402.30
403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 403.31 403.32
403.33
404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31
405.1
405.2 405.3 405.4 405.6 405.5 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 405.31 405.32 405.33 405.34 405.35 405.36 405.37 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11 406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 406.31 406.32 406.33 406.34 406.35 406.36 406.37 406.38 406.39 406.40 406.41 406.42 406.43 406.44 406.45 406.46 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 407.32 407.33 407.34 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 408.32 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17
409.18
409.19 409.20 409.21 409.22 409.23
409.24
409.25 409.26 409.27 409.28 409.29 409.30 409.31 409.32 410.1 410.2 410.3
410.4
410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28
411.29
412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11
412.12
412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20 412.21 412.22 412.23 412.24 412.25
412.26
412.27 412.28 412.29 412.30 412.31 413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15
413.16
413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28
413.29
414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20
414.21
414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18 417.19 417.20 417.21 417.22 417.23
417.24
417.25 417.26 417.27 417.28 417.29 417.30
417.31
418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28 418.29 418.30 418.31 418.32 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 420.1 420.2 420.3 420.4 420.5 420.6 420.7
420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31
420.32
421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32 421.33 422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14
422.15
422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 422.32 423.1 423.2 423.3
423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30 423.31 423.32 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16
424.17
424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28
424.29
425.1 425.2 425.3 425.4 425.5 425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24
425.25 425.26 425.27 425.28
426.1 426.2 426.3 426.4 426.5
426.6
426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 427.32 427.33 427.34 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16
428.17
428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 428.31 428.32 429.1 429.2 429.3
429.4
429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14
429.15
429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 429.31 430.1 430.2 430.3
430.4
430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33 431.1 431.2 431.3 431.4 431.5 431.6 431.7
431.8
431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 432.1 432.2 432.3
432.4
432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23
433.24
433.25 433.26 433.27 433.28 433.29 433.30 433.31 434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12
434.13
434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 434.32
435.1
435.2 435.3 435.4 435.5 435.6
435.7
435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15
435.16
435.17 435.18 435.19 435.20 435.21 435.22 435.23
435.24 435.25 435.26 435.27 435.28 435.29
435.30
436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8 436.9 436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19 436.20 436.21 436.22 436.23 436.24 436.25 436.26 436.27 436.28 436.29 436.30 436.31 436.32 436.33 436.34 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 437.33 437.34 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 438.31 438.32 438.33 438.34 438.35 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 439.33 439.34 439.35 439.36 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32 440.33 440.34 440.35 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 441.32 441.33 441.34 442.1 442.2 442.3
442.4
442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 442.31 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9
443.10
443.11 443.12 443.13 443.14 443.15 443.16
443.17
443.18 443.19 443.20 443.21 443.22
443.23
443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24
444.25
444.26 444.27 444.28 444.29 444.30 444.31 444.32 445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25 445.26 445.27 445.28 445.29 445.30 445.31 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13
446.14
446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 446.32 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 447.31 447.32 447.33 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10
448.11
448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31 448.32 448.33 448.34 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23
449.24
449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 449.33 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12 450.13 450.14
450.15
450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29
450.30
451.1 451.2 451.3 451.4 451.5 451.6 451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21
451.22
451.23 451.24 451.25 451.26 451.27
451.28
452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17
452.18
452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 453.1 453.2
453.3
453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11
453.12
453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 454.1 454.2 454.3 454.4 454.5 454.6 454.7 454.8 454.9
454.10
454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21
454.22
454.23 454.24 454.25 454.26 454.27 454.28 454.29 454.30 454.31 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24
455.25
455.26 455.27 455.28 455.29 455.30 455.31 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16 456.17
456.18
456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26
456.27
456.28 456.29 456.30 457.1 457.2
457.3
457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30 458.31 458.32 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12
459.13
459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 459.32 460.1 460.2 460.3 460.4 460.5 460.6 460.7 460.8 460.9 460.10 460.11 460.12 460.13
460.14
460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 460.30 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8
461.9
461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19
461.20
461.21 461.22 461.23
461.24
461.25 461.26 461.27
461.28
462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 462.28 462.29 462.30 462.31 462.32 462.33 462.34 463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14 463.15 463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 463.31
463.32
464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 464.31 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 465.32 465.33 466.1 466.2 466.3 466.4 466.5 466.6 466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28 466.29 466.30 466.31 466.32 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24 467.25 467.26 467.27 467.28 467.29 467.30 467.31 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26 468.27 468.28 468.29 468.30 468.31 468.32 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21
470.22
470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 470.32 470.33 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23
471.24
471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8 472.9 472.10
472.11
472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 472.32 472.33 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8
473.9
473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 473.33 473.34 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 474.31
474.32
475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 475.32 475.33 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 476.31 476.32 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11
477.12
477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 477.31 477.32 477.33 477.34 478.1 478.2 478.3 478.4 478.5 478.6
478.7
478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 478.32 478.33 478.34 478.35 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 479.32 479.33 479.34 479.35 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 480.32 480.33 480.34
481.1
481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23 481.24 481.25
481.26
481.27 481.28 481.29 481.30
481.31
482.1 482.2
482.3 482.4 482.5 482.6
482.7 482.8 482.9 482.10
482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29
483.1 483.2 483.3 483.4
483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15
483.16 483.17 483.18 483.19 483.20
483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 484.1 484.2
484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16
484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10
485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25 485.26 485.27 485.28 485.29 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14 486.15
486.16 486.17 486.18 486.19
486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 487.1 487.2 487.3 487.4 487.5 487.6 487.7 487.8 487.9 487.10 487.11 487.12 487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23 487.24 487.25
487.26 487.27 487.28 487.29 487.30 487.31
488.1 488.2 488.3 488.4 488.5 488.6
488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 488.30 488.31 488.32 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14
489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23
489.24 489.25 489.26 489.27 489.28 489.29
490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11 490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11
491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19
491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28
491.29 491.30 491.31 492.1 492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13 492.14 492.15
492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22
493.23 493.24 493.25 493.26 493.27
493.28 493.29 493.30 493.31 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8
494.9 494.10 494.11 494.12 494.13 494.14
494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23
494.24 494.25 494.26 494.27 494.28 494.29 495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8
495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19
495.20 495.21 495.22 495.23
495.24 495.25 495.26
495.27 495.28 495.29 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8
496.9 496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18
496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28
496.29 496.30 496.31
497.1 497.2 497.3 497.4 497.5 497.6 497.7 497.8 497.9 497.10 497.11 497.12
497.13 497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23
497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9
498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19
498.20 498.21
498.22 498.23 498.24 498.25
498.26 498.27 498.28 498.29
499.1 499.2 499.3 499.4 499.5 499.6 499.7
499.8 499.9 499.10 499.11 499.12 499.13 499.14
499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25
499.26 499.27 499.28 499.29 499.30
500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10
500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21
500.22 500.23 500.24 500.25 500.26 500.27 500.28
501.1 501.2 501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16
501.17 501.18 501.19 501.20 501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28 501.29
502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9 502.10 502.11 502.12 502.13 502.14 502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27
502.28 502.29 502.30 502.31 502.32 503.1 503.2 503.3 503.4 503.5 503.6 503.7
503.8 503.9 503.10 503.11 503.12 503.13 503.14 503.15 503.16 503.17
503.18 503.19 503.20 503.21 503.22 503.23 503.24 503.25
503.26 503.27 503.28 503.29 503.30 503.31 503.32 504.1 504.2 504.3 504.4 504.5 504.6 504.7 504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17 504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 504.31 504.32 505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12 505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20 505.21 505.22
505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 505.32 505.33 505.34 506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27 506.28 506.29 506.30 506.31 506.32 506.33 506.34 506.35 506.36 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13 507.14 507.15 507.16 507.17 507.18 507.19 507.20
507.21 507.22 507.23 507.24 507.25 507.26
507.27
507.28 507.29 507.30 507.31 507.32 507.33 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 508.32 508.33 508.34 508.35 508.36 508.37 508.38 508.39 508.40 508.41 509.1 509.2 509.3 509.4 509.5 509.6 509.7 509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20 509.21 509.22 509.23 509.24 509.25 509.26 509.27 509.28 509.29 509.30 509.31 509.32 509.33 509.34 509.35 509.36 510.1 510.2 510.3
510.4 510.5 510.6 510.7 510.8 510.9 510.10 510.11 510.12 510.13 510.14 510.15 510.16 510.17 510.18 510.19
510.20 510.21 510.22 510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30
511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15
511.16 511.17 511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26
511.27 511.28 511.29 511.30 511.31 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10 512.11 512.12 512.13 512.14 512.15 512.16 512.17 512.18
512.19 512.20 512.21 512.22 512.23 512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 512.32
513.1 513.2 513.3 513.4
513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20
513.21 513.22 513.23 513.24 513.25 513.26 513.27 513.28 513.29 513.30 513.31 514.1 514.2
514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29
515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17
515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26 515.27 515.28 515.29 515.30 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8
516.9 516.10 516.11 516.12
516.13 516.14 516.15 516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24 516.25 516.26
516.27 516.28 516.29 516.30 517.1
517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 518.1 518.2
518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16 518.17 518.18 518.19 518.20 518.21 518.22
518.23 518.24 518.25 518.26 518.27 518.28
518.29 518.30 518.31 519.1 519.2 519.3 519.4
519.5 519.6 519.7
519.8 519.9 519.10 519.11 519.12 519.13 519.14
519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22
519.23 519.24 519.25 519.26 519.27
519.28 519.29 519.30 520.1 520.2 520.3 520.4 520.5 520.6 520.7 520.8 520.9 520.10 520.11 520.12 520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20 520.21 520.22 520.23 520.24 520.25 520.26 520.27 520.28 520.29 520.30 520.31 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16
521.17 521.18 521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28 521.29 521.30 521.31 521.32 522.1 522.2 522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10 522.11 522.12 522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24 522.25
522.26 522.27 522.28 522.29 522.30 522.31 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12 523.13 523.14 523.15 523.16 523.17 523.18 523.19
523.20 523.21 523.22 523.23 523.24
523.25 523.26 523.27 523.28
523.29 523.30
524.1 524.2 524.3 524.4 524.5 524.6
524.7 524.8 524.9
524.10 524.11 524.12 524.13 524.14 524.15 524.16 524.17 524.18 524.19 524.20 524.21 524.22 524.23 524.24 524.25 524.26 524.27 524.28 524.29 525.1 525.2
525.3 525.4 525.5 525.6 525.7 525.8 525.9 525.10 525.11 525.12 525.13 525.14 525.15
525.16 525.17 525.18 525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29 525.30 525.31 526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11 526.12 526.13 526.14 526.15
526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31
527.1 527.2 527.3 527.4 527.5 527.6 527.7 527.8 527.9 527.10 527.11 527.12 527.13 527.14 527.15 527.16 527.17 527.18 527.19 527.20 527.21 527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29 527.30 527.31 528.1 528.2 528.3 528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22 528.23 528.24 528.25 528.26 528.27 528.28 528.29 528.30 528.31 529.1 529.2 529.3 529.4 529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12 529.13 529.14 529.15 529.16 529.17 529.18 529.19 529.20 529.21 529.22 529.23 529.24 529.25 529.26 529.27 529.28 529.29 529.30 529.31 530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16 530.17 530.18 530.20 530.19 530.21 530.22 530.23 530.24 530.25 530.26 530.27 530.28 530.29 530.30 530.31 530.32 530.33 530.34 530.35 531.1 531.2 531.3 531.4 531.5 531.6 531.7 531.9 531.8 531.10 531.11 531.12 531.13 531.14 531.15 531.16 531.17 531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 531.29
531.30 531.31 531.32 531.33 531.34 532.1 532.2 532.3
532.4 532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12
532.13 532.14 532.15 532.16 532.17 532.18 532.19 532.20 532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29 532.30 533.1 533.2 533.3 533.4 533.5 533.6 533.7 533.8 533.9 533.10 533.11 533.12 533.13 533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21 533.22 533.23 533.24
533.25 533.26 533.27 533.28 533.29 533.30 533.31 534.1 534.2 534.3 534.4 534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14 534.15 534.16 534.17 534.18 534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28 534.29 534.30 535.1 535.2 535.3
535.4 535.5 535.6
535.7 535.8
535.9 535.10 535.11 535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19
535.20 535.21 535.22 535.23 535.24 535.25 535.26 535.27 535.28 535.29 535.30 536.1 536.2 536.3 536.4 536.5 536.6 536.7 536.8 536.9 536.10 536.11
536.12 536.13 536.14 536.15 536.16 536.17 536.18 536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26 536.27 536.28 536.29 536.30 536.31 537.1 537.2 537.3 537.4 537.5 537.6 537.7 537.8 537.9 537.10 537.11 537.12 537.13 537.14 537.15 537.16 537.17 537.18 537.19 537.20 537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 537.32 538.1 538.2 538.3 538.4 538.5 538.6 538.7
538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19 538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 538.30 538.31 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17
539.18 539.19 539.20 539.21 539.22 539.23 539.24 539.25 539.26 539.27 539.28 539.29 539.30 540.1 540.2 540.3
540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16 540.17 540.18 540.19
540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 541.1 541.2 541.3 541.4 541.5 541.6 541.7 541.8
541.9 541.10 541.11 541.12 541.13 541.14 541.15 541.16 541.17 541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26
541.27 541.28 542.1 542.2 542.3 542.4 542.5 542.6 542.7 542.8 542.9 542.10 542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 543.1 543.2 543.3 543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28
544.1 544.2 544.3 544.4
544.5 544.6
544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18
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A bill for an act
relating to state government; establishing the health and human services budget;
modifying provisions governing children and family services, chemical and mental
health services, community supports, direct care and treatment, operations, health
care, continuing care, managed care, housing, health licensing boards, and
Department of Health programs; requiring reports; modifying fees; making technical
changes; appropriating money; amending Minnesota Statutes 2016, sections 13.69,
subdivision 1; 103I.005, subdivisions 2, 2a, 12, 20a, 21, by adding subdivisions;
103I.101, subdivisions 2, 5, 6; 103I.105; 103I.111, subdivisions 6, 8; 103I.205,
subdivisions 1, 2, 3, 4, 5, 6; 103I.208, subdivisions 1, 2; 103I.235, by adding a
subdivision; 103I.301, subdivisions 1, 2; 103I.315, subdivision 1; 103I.501;
103I.505, subdivisions 1, 2; 103I.515; 103I.525, subdivisions 1, 2, 5, 6, 8; 103I.531,
subdivisions 2, 5; 103I.535, subdivisions 2, 6; 103I.541, subdivisions 1, 2, 2a, 2b,
2c, 2e, 3, 4, 5; 103I.545; 103I.601, subdivisions 2, 4; 103I.711, subdivision 1;
103I.715, subdivision 2; 119B.011, subdivisions 6, 19, 20, 20a, by adding
subdivisions; 119B.02, subdivisions 1, 5; 119B.025, subdivision 1, by adding
subdivisions; 119B.03, subdivisions 3, 9; 119B.05, subdivision 1; 119B.09,
subdivisions 1, 4, 9a; 119B.10, subdivision 1, by adding a subdivision; 119B.11,
subdivision 2a; 119B.12, subdivision 2; 119B.125, subdivisions 1b, 4, 6, by adding
subdivisions; 119B.13, subdivisions 1, 6; 119B.16, subdivisions 1, 1a, 1b, by
adding subdivisions; 144.0724, subdivision 6; 144.122; 144.218, subdivision 5;
144.226, subdivision 1; 144.3831, subdivision 1; 144A.071, subdivision 4d;
144A.472, subdivision 7; 144D.03, by adding a subdivision; 144E.35, subdivision
1; 144G.02, subdivision 2; 146B.02, subdivisions 2, 3, 5, 8, by adding subdivisions;
146B.03, subdivisions 6, 7; 146B.07, subdivisions 2, 4; 146B.10, subdivisions 1,
2, by adding a subdivision; 147.01, subdivision 7; 147.02, subdivision 1; 147.03,
subdivision 1; 147B.08, by adding a subdivision; 147C.40, by adding a subdivision;
148.514, subdivision 1; 148.519, subdivisions 1, 2; 148.5194, subdivisions 2, 3,
4, 7, by adding a subdivision; 148.5195, subdivision 2; 148.59; 148.6405; 148.6420,
subdivisions 1, 5; 148.6445, subdivisions 1, 2, 3, by adding a subdivision; 148.997,
subdivision 1; 148E.180; 153A.14, subdivisions 1, 2; 153A.17; 157.16, subdivisions
1, 3, 3a; 245.4661, subdivision 9; 245.4889, subdivision 1; 245.814, by adding a
subdivision; 245A.03, subdivisions 2, 7; 245A.04, subdivisions 1, 4; 245A.07,
subdivision 3; 245A.09, subdivision 7; 245A.10, subdivisions 2, 4; 245A.14, by
adding a subdivision; 245A.151; 245A.16, subdivision 1, by adding a subdivision;
245A.18, subdivision 2; 245A.191; 245A.40, subdivisions 1, 2, 3, 4, 7, by adding
a subdivision; 245A.50, subdivisions 2, 7, 9; 245C.02, by adding a subdivision;
245C.03, subdivision 1, by adding a subdivision; 245C.04, subdivisions 1, 8;
245C.05, subdivisions 2b, 4, 5, 7; 245C.08, subdivisions 1, 2, 4; 245C.09, by
adding a subdivision; 245C.10, subdivision 9, by adding subdivisions; 245C.11,
subdivision 3; 245C.15; 245C.16, subdivision 1; 245C.17, subdivision 6; 245C.21,
subdivision 1; 245C.22, subdivisions 5, 7; 245C.23; 245C.24, subdivision 3;
245C.25; 245C.30, subdivision 2; 245D.03, subdivision 1; 245E.01, by adding a
subdivision; 245E.02, subdivisions 1, 3, 4; 245E.03, subdivisions 2, 4; 245E.04;
245E.05, subdivision 1; 245E.06, subdivisions 1, 2, 3; 245E.07, subdivision 1;
246.014; 246B.05; 246B.10; 252.41, subdivision 3; 253B.19, subdivision 1, by
adding a subdivision; 254A.01; 254A.02, subdivisions 2, 3, 5, 6, 8, 10, by adding
subdivisions; 254A.03; 254A.035, subdivision 1; 254A.04; 254A.08; 254A.09;
254A.19, subdivision 3; 254B.01, subdivision 3, by adding a subdivision; 254B.03,
subdivision 2; 254B.04, subdivisions 1, 2b; 254B.05, subdivisions 1, 1a, 5;
254B.051; 254B.07; 254B.08; 254B.09; 254B.12, subdivision 2; 254B.13,
subdivision 2a; 256.01, by adding a subdivision; 256.045, subdivision 3a; 256.962,
subdivision 5, by adding a subdivision; 256.9686, subdivision 8; 256.969,
subdivisions 1, 2b, 3a, 3c, 4b, 8, 8c, 9, 12; 256.975, subdivision 7, by adding a
subdivision; 256.98, subdivision 8; 256B.04, subdivisions 21, 22; 256B.055,
subdivisions 2, 7, by adding a subdivision; 256B.056, subdivisions 1b, 3b, 3c, 3d,
by adding subdivisions; 256B.057, subdivision 9; 256B.059, subdivision 6;
256B.0625, subdivisions 3a, 6a, 7, 18h, 30, 45a, 57, by adding a subdivision;
256B.0651, subdivision 17; 256B.0652, subdivision 4; 256B.0653; 256B.0659,
subdivisions 11, 21; 256B.0755, subdivisions 1, 2, 3, 4, 7; 256B.0915, subdivision
1; 256B.092, subdivision 4; 256B.0943, subdivision 9; 256B.0945, subdivisions
2, 4; 256B.15, subdivisions 1, 1a, 2; 256B.199; 256B.431, subdivisions 10, 16,
30; 256B.434, subdivisions 4, 4f; 256B.49, subdivision 11; 256B.4912, by adding
a subdivision; 256B.4913, subdivision 4a, by adding a subdivision; 256B.4914,
subdivisions 2, 3, 5, 6, 8, 10; 256B.50, subdivision 1b; 256B.75; 256B.76,
subdivisions 1, 2, 4, by adding a subdivision; 256B.761; 256B.766; 256B.85,
subdivision 16; 256C.21; 256C.23, subdivisions 1, 2, by adding subdivisions;
256C.233, subdivisions 1, 2, 4; 256C.24; 256C.25, subdivision 1; 256C.261;
256C.30; 256D.44, subdivisions 4, 5; 256I.03, subdivision 8; 256I.04, subdivisions
1, 2d, 2g, 3; 256I.05, subdivisions 1a, 1c, 1e, 1j, 1m, 8; 256I.06, subdivisions 2,
8; 256L.03, subdivisions 1, 1a, 5; 256L.04, by adding a subdivision; 256L.05, by
adding a subdivision; 256L.11, subdivision 7; 256L.15, subdivision 2; 256N.26,
subdivision 5; 256N.27, subdivisions 2, 4; 256P.05, subdivision 1; 256P.07,
subdivisions 3, 6; 256R.02, subdivisions 4, 18; 256R.10, by adding a subdivision;
256R.40, subdivision 5; 256R.41; 256R.47; 256R.49, subdivision 1; 257.73,
subdivision 1, by adding a subdivision; 327.15, subdivision 3; 364.09; 518.68,
subdivision 2; 518A.40, subdivision 4, by adding a subdivision; 626.556,
subdivisions 2, 3, 3c, 4, 10b, 10d, 10e, 10f, 10i; 626.557, subdivisions 4, 9, 12b,
18; 626.5572, subdivisions 2, 4; 626.559, subdivision 1; Laws 2012, chapter 247,
article 6, section 2, subdivision 2; proposing coding for new law in Minnesota
Statutes, chapters 103I; 119B; 144; 147A; 245A; 256B; 256I; 256L; 256R;
proposing coding for new law as Minnesota Statutes, chapter 245G; repealing
Minnesota Statutes 2016, sections 103I.005, subdivisions 8, 14, 15; 103I.451;
119B.07; 119B.125, subdivision 5; 119B.16, subdivision 2; 144.0571; 147A.21;
147B.08, subdivisions 1, 2, 3; 147C.40, subdivisions 1, 2, 3, 4; 245A.1915;
245A.192; 245C.11, subdivision 4; 245C.16, subdivision 3; 245C.17, subdivision
4; 245E.03, subdivision 3; 245E.06, subdivisions 4, 5; 246B.06; 252.41, subdivision
8; 252.451; 254A.02, subdivision 4; 256.9692; 256B.0625, subdivision 25a;
256B.0659, subdivision 22; 256B.4914, subdivision 16; 256B.64; 256B.69,
subdivisions 1, 2, 3, 3a, 3b, 4, 4b, 5, 5a, 5b, 5c, 5d, 5f, 5g, 5h, 5i, 5j, 5k, 6, 6a, 6b,
6d, 7, 8, 9, 9a, 9c, 9d, 9e, 10, 11, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 28, 29,
30, 31, 32a, 33, 34, 35; 256C.23, subdivision 3; 256C.25, subdivision 2; Minnesota
Rules, parts 3400.0185, subpart 5; 5600.2500; 9503.0145, subpart 6; 9530.6405,
subparts 1, 1a, 2, 3, 4, 5, 6, 7, 7a, 8, 9, 10, 11, 12, 13, 14, 14a, 15, 15a, 16, 17, 17a,
17b, 17c, 18, 20, 21; 9530.6410; 9530.6415; 9530.6420; 9530.6422; 9530.6425;
9530.6430; 9530.6435; 9530.6440; 9530.6445; 9530.6450; 9530.6455; 9530.6460;
9530.6465; 9530.6470; 9530.6475; 9530.6480; 9530.6485; 9530.6490; 9530.6495;
9530.6500; 9530.6505.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
COMMUNITY SUPPORTS
Section 1.
Minnesota Statutes 2016, section 245A.03, subdivision 7, is amended to read:
Subd. 7.
Licensing moratorium.
(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);
(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;
(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
deleted text begin or
deleted text end
(5) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner for the transition of people from personal care assistance to
the home and community-based servicesdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(6) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner for the transition of people from the residential care waiver
service to foster care services. This exception applies only when:
new text end
new text begin
(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service to help the person make an informed choice;
and
new text end
new text begin
(ii) the person's foster care services are less than or equal to the cost of the person's
services delivered in the residential care waiver service setting as determined by the lead
agency; or
new text end
new text begin
(7) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner for people receiving services under chapter 245D while residing
in an unlicensed setting before May 1, 2017, and for which a license is required, as
determined by the commissioner. The exception is available until June 30, 2018. This
exception is available when:
new text end
new text begin
(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
new text end
new text begin
(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agency.
new text end
(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.
(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department shall decrease
the statewide licensed capacity for adult foster care settings where the physical location is
not the primary residence of the license holder, or for adult community residential settings,
if the voluntary changes described in paragraph (e) are not sufficient to meet the savings
required by reductions in licensed bed capacity under Laws 2011, First Special Session
chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide long-term care
residential services capacity within budgetary limits. Implementation of the statewide
licensed capacity reduction shall begin on July 1, 2013. The commissioner shall delicense
up to 128 beds by June 30, 2014, using the needs determination process. Prior to any
involuntary reduction of licensed capacity, the commissioner shall consult with lead agencies
and license holders to determine which adult foster care settings, where the physical location
is not the primary residence of the license holder, or community residential settings, are
licensed for up to five beds, but have operated at less than full capacity for 12 or more
months as of March 1, 2014. The settings that meet these criteria must be the first to be
considered for an involuntary decrease in statewide licensed capacity, up to a maximum of
35 beds. If more than 35 beds are identified that meet these criteria, the commissioner shall
prioritize the selection of those beds to be closed based on the length of time the beds have
been vacant. The longer a bed has been vacant, the higher priority it must be given for
closure. Under this paragraph, the commissioner has the authority to reduce unused licensed
capacity of a current foster care program, or the community residential settings, to accomplish
the consolidation or closure of settings. Under this paragraph, the commissioner has the
authority to manage statewide capacity, including adjusting the capacity available to each
county and adjusting statewide available capacity, to meet the statewide needs identified
through the process in paragraph (e). A decreased licensed capacity according to this
paragraph is not subject to appeal under this chapter.
(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.
(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity required under paragraph (c) will be implemented.
The commissioner shall consult with the stakeholders described in section 144A.351, and
employ a variety of methods to improve the state's capacity to meet long-term care service
needs within budgetary limits, including seeking proposals from service providers or lead
agencies to change service type, capacity, or location to improve services, increase the
independence of residents, and better meet needs identified by the long-term care services
reports and statewide data and information. By February 1, 2013, and August 1, 2014, and
each following year, the commissioner shall provide information and data on the overall
capacity of licensed long-term care services, actions taken under this subdivision to manage
statewide long-term care services and supports resources, and any recommendations for
change to the legislative committees with jurisdiction over health and human services budget.
(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.
(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under section 256B.0915, 256B.092, or 256B.49, must inform the human services
licensing division that the license holder provides or intends to provide these waiver-funded
services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2016, section 245D.03, subdivision 1, is amended to read:
Subdivision 1.
Applicability.
(a) The commissioner shall regulate the provision of home
and community-based services to persons with disabilities and persons age 65 and older
pursuant to this chapter. The licensing standards in this chapter govern the provision of
basic support services and intensive support services.
(b) Basic support services provide the level of assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
person. Basic support services include:
(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental disability, and elderly waiver plans, excluding
out-of-home respite care provided to children in a family child foster care home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8,
or successor provisions; and section 245D.061 or successor provisions, which must be
stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000,
subpart 4;
(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
(3) personal support as defined under the developmental disability waiver plan;
(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental disability waiver plans;
(5) night supervision services as defined under the brain injury waiver plan; and
(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental disability, and elderly waiver plans,
excluding providers licensed by the Department of Health under chapter 144A and those
providers providing cleaning services only.
(c) Intensive support services provide assistance, supervision, and care that is necessary
to ensure the health and welfare of the person and services specifically directed toward the
training, habilitation, or rehabilitation of the person. Intensive support services include:
(1) intervention services, including:
(i) behavioral support services as defined under the brain injury and community access
for disability inclusion waiver plans;
(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and
(iii) specialist services as defined under the current developmental disability waiver
plan;
(2) in-home support services, including:
(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;
(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans; and
(iii) semi-independent living services;
(3) residential supports and services, including:
(i) supported living services as defined under the developmental disability waiver plan
provided in a family or corporate child foster care residence, a family adult foster care
residence, a community residential setting, or a supervised living facility;
(ii) foster care services as defined in the brain injury, community alternative care, and
community access for disability inclusion waiver plans provided in a family or corporate
child foster care residence, a family adult foster care residence, or a community residential
setting; and
(iii) residential services provided to more than four persons with developmental
disabilities in a supervised living facility, including ICFs/DD;
(4) day services, including:
(i) structured day services as defined under the brain injury waiver plan;
(ii) day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disability waiver plan; and
(iii) prevocational services as defined under the brain injury and community access for
disability inclusion waiver plans; and
(5) deleted text begin supported employment as defined under the brain injury, developmental disability,
and community access for disability inclusion waiver plansdeleted text end new text begin employment exploration services
as defined under the brain injury, community alternative care, community access for disability
inclusion, and developmental disability waiver plans;
new text end
new text begin
(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disability
waiver plans; and
new text end
new text begin (7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disability waiver plansnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 3.
Minnesota Statutes 2016, section 252.41, subdivision 3, is amended to read:
Subd. 3.
Day training and habilitation services for adults with developmental
disabilities.
new text begin (a) new text end "Day training and habilitation services for adults with developmental
disabilities" means services that:
(1) include supervision, training, assistance, deleted text begin and supported employment,deleted text end new text begin center-basednew text end
work-related activities, or other community-integrated activities designed and implemented
in accordance with the individual service and individual habilitation plans required under
Minnesota Rules, parts 9525.0004 to 9525.0036, to help an adult reach and maintain the
highest possible level of independence, productivity, and integration into the community;
and
(2) are provided by a vendor licensed under sections 245A.01 to 245A.16 and 252.28,
subdivision 2, to provide day training and habilitation services.
new text begin (b) new text end Day training and habilitation services reimbursable under this section do not include
special education and related services as defined in the Education of the Individuals with
Disabilities Act, United States Code, title 20, chapter 33, section 1401, clauses (6) and (17),
or vocational services funded under section 110 of the Rehabilitation Act of 1973, United
States Code, title 29, section 720, as amended.
new text begin
(c) Day training and habilitation services do not include employment exploration,
employment development, or employment supports services as defined in the home and
community-based services waivers for people with disabilities authorized under sections
256B.092 and 256B.49.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 4.
Minnesota Statutes 2016, section 256B.0625, subdivision 6a, is amended to read:
Subd. 6a.
Home health services.
Home health services are those services specified in
deleted text begin Minnesota Rules, part 9505.0295 anddeleted text end sections 256B.0651 and 256B.0653new text begin and Minnesota
Rules, part 9505.0295new text end . Medical assistance covers home health services at a recipient's home
residencenew text begin or in the community where normal life activities take the recipientnew text end . Medical
assistance does not cover home health services for residents of a hospital, nursing facility,
or intermediate care facility, unless the commissioner of human services has authorized
skilled nurse visits for less than 90 days for a resident at an intermediate care facility for
persons with developmental disabilities, to prevent an admission to a hospital or nursing
facility or unless a resident who is otherwise eligible is on leave from the facility and the
facility either pays for the home health services or forgoes the facility per diem for the leave
days that home health services are used. Home health services must be provided by a
Medicare certified home health agency. All nursing and home health aide services must be
provided according to sections 256B.0651 to 256B.0653.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2016, section 256B.0625, subdivision 7, is amended to read:
Subd. 7.
Home care nursing.
Medical assistance covers home care nursing services in
a recipient's home. Recipients who are authorized to receive home care nursing services in
their home may use approved hours outside of the home during hours when normal life
activities take them outside of their home. To use home care nursing services at school, the
recipient or responsible party must provide written authorization in the care plan identifying
the chosen provider and the daily amount of services to be used at school. Medical assistance
does not cover home care nursing services for residents of a hospital, nursing facility,
intermediate care facility, or a health care facility licensed by the commissioner of health,
deleted text begin except as authorized in section 256B.64 for ventilator-dependent recipients in hospitals ordeleted text end
unless a resident who is otherwise eligible is on leave from the facility and the facility either
pays for the home care nursing services or forgoes the facility per diem for the leave days
that home care nursing services are used. Total hours of service and payment allowed for
services outside the home cannot exceed that which is otherwise allowed in an in-home
setting according to sections 256B.0651 and 256B.0654 . All home care nursing services
must be provided according to the limits established under sections 256B.0651, 256B.0653,
and 256B.0654. Home care nursing services may not be reimbursed if the nurse is the family
foster care provider of a recipient who is under age 18, unless allowed under section
256B.0654, subdivision 4.
Sec. 6.
Minnesota Statutes 2016, section 256B.0651, subdivision 17, is amended to read:
Subd. 17.
Recipient protection.
(a) Providers of home care services must provide each
recipient with a copy of the home care bill of rights under section 144A.44 at least 30 days
prior to terminating services to a recipient, if the termination results from provider sanctions
deleted text begin under section 256B.064deleted text end new text begin imposed by the commissionernew text end , such as a payment withhold, a
suspension of participation, or a new text begin notice of new text end termination of participation. If a home care provider
determines it is unable to continue providing services to a recipient, the provider must notify
the recipient, the recipient's responsible party, and the commissioner 30 days prior to
terminating services to the recipient because of an action deleted text begin under section 256B.064deleted text end new text begin taken by
the commissionernew text end , and must assist the commissioner and lead agency in supporting the
recipient in transitioning to another home care provider of the recipient's choice.
(b) In the event of a payment withhold from a home care provider, a suspension of
participation, or a new text begin notice of new text end termination of participation of a home care provider deleted text begin under
section 256B.064deleted text end new text begin imposed by the commissionernew text end , the commissioner may inform the Office
of Ombudsman for Long-Term Care and the lead agencies for all recipients with active
service agreements with the provider. At the commissioner's request, the lead agencies must
contact recipients to ensure that the recipients are continuing to receive needed care, and
that the recipients have been given free choice of provider if they transfer to another home
care provider. In addition, the commissioner or the commissioner's delegate may directly
notify recipients who receive care from the provider that payments have been withheld or
that the deleted text begin provider'sdeleted text end new text begin provider has been notified of a suspension or termination ofnew text end participation
in medical assistance deleted text begin has been suspended or terminateddeleted text end , if the commissioner determines
that notification is necessary to protect the welfare of the recipients. For purposes of this
subdivision, "lead agencies" means counties, tribes, and managed care organizations.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2016, section 256B.0652, subdivision 4, is amended to read:
Subd. 4.
Home health services.
Home health services including skilled nurse visits
and home health aide visits must be authorized by the commissioner or the commissioner's
designee. Authorization must be based on medical necessity and cost-effectiveness when
compared with other care options. The commissioner must receive the request for
authorization of skilled nurse visits and home health aide visitsnew text begin , including qualifying
documentation of the face-to-face encounter as specified in section 256B.0653, subdivision
7,new text end within 20 working days of the start of service. When home health services are used in
combination with personal care and home care nursing, the cost of all home care services
shall be considered for cost-effectiveness.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2016, section 256B.0653, is amended to read:
256B.0653 HOME HEALTH deleted text begin AGENCYdeleted text end SERVICES.
Subdivision 1.
Scope.
This section applies to home health deleted text begin agencydeleted text end services including
home health aide, skilled nursing visits, physical therapy, occupational therapy, respiratory
therapy, and speech-language pathology therapy.
Subd. 2.
Definitions.
For the purposes of this section, the following terms have the
meanings given.
(a) "Assessment" means an evaluation of the recipient's medical need for home health
deleted text begin agencydeleted text end services by a registered nurse or appropriate therapist that is conducted within 30
days of a request.
(b) "Home care therapies" means occupational, physical, and respiratory therapy and
speech-language pathology services provided in the home by a Medicare certified home
health agency.
(c) "Home health deleted text begin agencydeleted text end services" means services delivered deleted text begin in the recipient's home
residence, except as specified in section 256B.0625, by a home health agencydeleted text end new text begin by a home
health agencynew text end to a recipient with medical needs due to illness, disability, or physical
conditionsnew text begin in the settings permitted by section 256B.0625new text end .
(d) "Home health aide" means an employee of a home health agency who completes
medically oriented tasks written in the plan of care for a recipient.
(e) "Home health agency" means a home care provider agency that is Medicare-certified.
(f) "Occupational therapy services" mean the services defined in Minnesota Rules, part
9505.0390.
(g) "Physical therapy services" mean the services defined in Minnesota Rules, part
9505.0390.
(h) "Respiratory therapy services" mean the services defined in chapter 147C.
(i) "Speech-language pathology services" mean the services defined in Minnesota Rules,
part 9505.0390.
(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
required due to a recipient's medical condition that can only be safely provided by a
professional nurse to restore and maintain optimal health.
(k) "Store-and-forward technology" means telehomecare services that do not occur in
real time via synchronous transmissions such as diabetic and vital sign monitoring.
(l) "Telehomecare" means the use of telecommunications technology via live, two-way
interactive audiovisual technology which may be augmented by store-and-forward
technology.
(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to deliver
a skilled nurse visit to a recipient located at a site other than the site where the nurse is
located and is used in combination with face-to-face skilled nurse visits to adequately meet
the recipient's needs.
Subd. 3.
Home health aide visits.
(a) Home health aide visits must be provided by a
certified home health aide using a written plan of care that is updated in compliance with
Medicare regulations. A home health aide shall provide hands-on personal care, perform
simple procedures as an extension of therapy or nursing services, and assist in instrumental
activities of daily living as defined in section 256B.0659, including assuring that the person
gets to medical appointments if identified in the written plan of care. Home health aide
visits must be provided in the recipient's homenew text begin or in the community where normal life
activities take the recipientnew text end .
(b) All home health aide visits must have authorization under section 256B.0652. The
commissioner shall limit home health aide visits to no more than one visit per day per
recipient.
(c) Home health aides must be supervised by a registered nurse or an appropriate therapist
when providing services that are an extension of therapy.
Subd. 4.
Skilled nurse visit services.
(a) Skilled nurse visit services must be provided
by a registered nurse or a licensed practical nurse under the supervision of a registered nurse,
according to the written plan of care and accepted standards of medical and nursing practice
according to chapter 148. Skilled nurse visit services must be ordered by a physician and
documented in a plan of care that is reviewed and approved by the ordering physician at
least once every 60 days. All skilled nurse visits must be medically necessary and provided
in the recipient's home residencenew text begin or in the community where normal life activities take the
recipient,new text end except as allowed under section 256B.0625, subdivision 6a.
(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of up
to two visits per day per recipient. All visits must be based on assessed needs.
(c) Telehomecare skilled nurse visits are allowed when the recipient's health status can
be accurately measured and assessed without a need for a face-to-face, hands-on encounter.
All telehomecare skilled nurse visits must have authorization and are paid at the same
allowable rates as face-to-face skilled nurse visits.
(d) The provision of telehomecare must be made via live, two-way interactive audiovisual
technology and may be augmented by utilizing store-and-forward technologies. Individually
identifiable patient data obtained through real-time or store-and-forward technology must
be maintained as health records according to sections 144.291 to 144.298. If the video is
used for research, training, or other purposes unrelated to the care of the patient, the identity
of the patient must be concealed.
(e) Authorization for skilled nurse visits must be completed under section 256B.0652.
A total of nine face-to-face skilled nurse visits per calendar year do not require authorization.
All telehomecare skilled nurse visits require authorization.
Subd. 5.
Home care therapies.
(a) Home care therapies include the following: physical
therapy, occupational therapy, respiratory therapy, and speech and language pathology
therapy services.
(b) Home care therapies must be:
(1) provided in the recipient's residence new text begin or in the community where normal life activities
take the recipient new text end after it has been determined the recipient is unable to access outpatient
therapy;
(2) prescribed, ordered, or referred by a physician and documented in a plan of care and
reviewed, according to Minnesota Rules, part 9505.0390;
(3) assessed by an appropriate therapist; and
(4) provided by a Medicare-certified home health agency enrolled as a Medicaid provider
agency.
(c) Restorative and specialized maintenance therapies must be provided according to
Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be used
as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
(d) For both physical and occupational therapies, the therapist and the therapist's assistant
may not both bill for services provided to a recipient on the same day.
Subd. 6.
Noncovered home health deleted text begin agencydeleted text end services.
The following are not eligible for
payment under medical assistance as a home health deleted text begin agencydeleted text end service:
(1) telehomecare skilled nurses services that is communication between the home care
nurse and recipient that consists solely of a telephone conversation, facsimile, electronic
mail, or a consultation between two health care practitioners;
(2) the following skilled nurse visits:
(i) for the purpose of monitoring medication compliance with an established medication
program for a recipient;
(ii) administering or assisting with medication administration, including injections,
prefilling syringes for injections, or oral medication setup of an adult recipient, when, as
determined and documented by the registered nurse, the need can be met by an available
pharmacy or the recipient or a family member is physically and mentally able to
self-administer or prefill a medication;
(iii) services done for the sole purpose of supervision of the home health aide or personal
care assistant;
(iv) services done for the sole purpose to train other home health agency workers;
(v) services done for the sole purpose of blood samples or lab draw when the recipient
is able to access these services outside the home; and
(vi) Medicare evaluation or administrative nursing visits required by Medicare;
(3) home health aide visits when the following activities are the sole purpose for the
visit: companionship, socialization, household tasks, transportation, and education; deleted text begin and
deleted text end
(4) home care therapies provided in other settings such as a clinicdeleted text begin , day program,deleted text end or as
an inpatient or when the recipient can access therapy outside of the recipient's residencedeleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(5) home health services without documentation of a face-to-face encounter according
to subdivision 7.
new text end
new text begin Subd. 7. new text end
new text begin Face-to-face encounter. new text end
new text begin
(a) A face-to-face encounter by a provider must be
completed for all home health services, regardless of whether the service requires prior
authorization. The face-to-face encounter may occur through telemedicine according to
section 256B.0625, subdivision 3b. The encounter must be related to the primary reason
the recipient requires home health services and must occur within 90 days before service
begins or within 30 days after service begins. The face-to-face encounter may be conducted
by a practitioner licensed in Minnesota to practice a profession described in section 214.01,
subdivision 2:
new text end
new text begin
(1) a physician;
new text end
new text begin
(2) a nurse practitioner or clinical nurse specialist;
new text end
new text begin
(3) a certified nurse midwife;
new text end
new text begin
(4) a physician assistant; or
new text end
new text begin
(5) for a recipient admitted to home health service immediately after an acute or postacute
stay, the attending recipient's acute or postacute physician.
new text end
new text begin
(b) A practitioner described in paragraph (a), clauses (2) to (5), performing the
face-to-face encounter must communicate the clinical findings to the ordering physician.
The clinical findings must be documented in the recipient's medical record.
new text end
new text begin
(c) To ensure clinical correlation between the face-to-face encounter and the associated
home health services, the ordering physician must:
new text end
new text begin
(1) document that the face-to-face encounter related to the primary reason the recipient
requires home health services occurred within the required time frames;
new text end
new text begin
(2) indicate the practitioner who conducted the face-to-face encounter; and
new text end
new text begin
(3) indicate the date of the face-to-face encounter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2016, section 256B.0659, subdivision 11, is amended to read:
Subd. 11.
Personal care assistant; requirements.
(a) A personal care assistant must
meet the following requirements:
(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:
(i) supervision by a qualified professional every 60 days; and
(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;
(2) be employed by a personal care assistance provider agency;
(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
(i) not disqualified under section 245C.14; or
(ii) is disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;
(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional or physician;
(6) not be a consumer of personal care assistance services;
(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;
(9) complete training and orientation on the needs of the recipient; and
(10) be limited to providing and being paid for up to deleted text begin 275deleted text end new text begin 310new text end hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.
(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2016, section 256B.0915, subdivision 1, is amended to read:
Subdivision 1.
Authority.
new text begin (a) new text end The commissioner is authorized to apply for a home and
community-based services waiver for the elderly, authorized under section 1915(c) of the
Social Security Act, in order to obtain federal financial participation to expand the availability
of services for persons who are eligible for medical assistance. The commissioner may
apply for additional waivers or pursue other federal financial participation which is
advantageous to the state for funding home care services for the frail elderly who are eligible
for medical assistance. The provision of waivered services to elderly and disabled medical
assistance recipients must comply with the criteria for service definitions and provider
standards approved in the waiver.
new text begin
(b) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2016, section 256B.092, subdivision 4, is amended to read:
Subd. 4.
Home and community-based services for developmental disabilities.
(a)
The commissioner shall make payments to approved vendors participating in the medical
assistance program to pay costs of providing home and community-based services, including
case management service activities provided as an approved home and community-based
service, to medical assistance eligible persons with developmental disabilities who have
been screened under subdivision 7 and according to federal requirements. Federal
requirements include those services and limitations included in the federally approved
application for home and community-based services for persons with developmental
disabilities and subsequent amendments.
(b) Effective July 1, 1995, contingent upon federal approval and state appropriations
made available for this purpose, and in conjunction with Laws 1995, chapter 207, article 8,
section 40, the commissioner of human services shall allocate resources to county agencies
for home and community-based waivered services for persons with developmental disabilities
authorized but not receiving those services as of June 30, 1995, based upon the average
resource need of persons with similar functional characteristics. To ensure service continuity
for service recipients receiving home and community-based waivered services for persons
with developmental disabilities prior to July 1, 1995, the commissioner shall make available
to the county of financial responsibility home and community-based waivered services
resources based upon fiscal year 1995 authorized levels.
(c) Home and community-based resources for all recipients shall be managed by the
county of financial responsibility within an allowable reimbursement average established
for each county. Payments for home and community-based services provided to individual
recipients shall not exceed amounts authorized by the county of financial responsibility.
For specifically identified former residents of nursing facilities, the commissioner shall be
responsible for authorizing payments and payment limits under the appropriate home and
community-based service program. Payment is available under this subdivision only for
persons who, if not provided these services, would require the level of care provided in an
intermediate care facility for persons with developmental disabilities.
new text begin
(d) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers for the elderly authorized
under this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2016, section 256B.49, subdivision 11, is amended to read:
Subd. 11.
Authority.
(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the Social Security
Act to serve persons under the age of 65 who are determined to require the level of care
provided in a nursing home and persons who require the level of care provided in a hospital.
The commissioner shall apply for the home and community-based waivers in order to:
(1) promote the support of persons with disabilities in the most integrated settings;
(2) expand the availability of services for persons who are eligible for medical assistance;
(3) promote cost-effective options to institutional care; and
(4) obtain federal financial participation.
(b) The provision of waivered services to medical assistance recipients with disabilities
shall comply with the requirements outlined in the federally approved applications for home
and community-based services and subsequent amendments, including provision of services
according to a service plan designed to meet the needs of the individual. For purposes of
this section, the approved home and community-based application is considered the necessary
federal requirement.
(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.
(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Security Act, to allow medical assistance eligibility under this section for children
under age 21 without deeming of parental income or assets.
(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.
new text begin
(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2016, section 256B.4912, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Annual data submission. new text end
new text begin
(a) As determined by the commissioner, a provider
of home and community-based services for the elderly under section 256B.0915, home and
community-based services for people with developmental disabilities under section 256B.092,
and home and community-based services for people with disabilities under section 256B.49
shall submit data to the commissioner on the following:
new text end
new text begin
(1) wages of workers;
new text end
new text begin
(2) hours worked;
new text end
new text begin
(3) benefits paid and accrued;
new text end
new text begin
(4) staff retention rates;
new text end
new text begin
(5) amount of overtime paid;
new text end
new text begin
(6) amount of travel time paid;
new text end
new text begin
(7) vacancy rates; and
new text end
new text begin
(8) other related data requested by the commissioner.
new text end
new text begin
(b) The commissioner may adjust reporting requirements for a self-employed worker.
new text end
new text begin
(c) This subdivision also applies to a provider of personal care assistance services under
section 256B.0625, subdivision 19a; community first services and supports under section
256B.85; consumer support grants under section 256.476; nursing services and home health
services under section 256B.0625, subdivision 6a; home care nursing services under section
256B.0625, subdivision 7; or day training and habilitation services for residents of
intermediate care facilities for persons with developmental disabilities under section
256B.501.
new text end
new text begin
(d) A provider shall submit the data annually on a date specified by the commissioner.
The commissioner shall give a provider at least 30 calendar days to submit the data. If a
provider fails to timely submit the requested data, medical assistance reimbursement may
be delayed.
new text end
new text begin
(e) Individually identifiable data submitted to the commissioner in this section are
considered private data on an individual, as defined by section 13.02, subdivision 12.
new text end
new text begin
(f) The commissioner shall analyze data annually for workforce assessments and how
the data impact service access.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2016, section 256B.4913, subdivision 4a, is amended to read:
Subd. 4a.
Rate stabilization adjustment.
(a) For purposes of this subdivision,
"implementation period" means the period beginning January 1, 2014, and ending on the
last day of the month in which the rate management system is populated with the data
necessary to calculate rates for substantially all individuals receiving home and
community-based waiver services under sections 256B.092 and 256B.49. "Banding period"
means the time period beginning on January 1, 2014, and ending upon the expiration of the
12-month period defined in paragraph (c), clause (5).
(b) For purposes of this subdivision, the historical rate for all service recipients means
the individual reimbursement rate for a recipient in effect on December 1, 2013, except
that:
(1) for a day service recipient who was not authorized to receive these waiver services
prior to January 1, 2014; added a new service or services on or after January 1, 2014; or
changed providers on or after January 1, 2014, the historical rate must be the new text begin weighted
average new text end authorized rate for the provider new text begin number new text end in the county of service, effective December
1, 2013; or
(2) for a unit-based service with programming or a unit-based service without
programming recipient who was not authorized to receive these waiver services prior to
January 1, 2014; added a new service or services on or after January 1, 2014; or changed
providers on or after January 1, 2014, the historical rate must be the weighted average
authorized rate for each provider number in the county of service, effective December 1,
2013; or
(3) for residential service recipients who change providers on or after January 1, 2014,
the historical rate must be set by each lead agency within their county aggregate budget
using their respective methodology for residential services effective December 1, 2013, for
determining the provider rate for a similarly situated recipient being served by that provider.
(c) The commissioner shall adjust individual reimbursement rates determined under this
section so that the unit rate is no higher or lower than:
(1) 0.5 percent from the historical rate for the implementation period;
(2) 0.5 percent from the rate in effect in clause (1), for the 12-month period immediately
following the time period of clause (1);
(3) 0.5 percent from the rate in effect in clause (2), for the 12-month period immediately
following the time period of clause (2);
(4) 1.0 percent from the rate in effect in clause (3), for the 12-month period immediately
following the time period of clause (3);
(5) 1.0 percent from the rate in effect in clause (4), for the 12-month period immediately
following the time period of clause (4); and
(6) no adjustment to the rate in effect in clause (5) for the 12-month period immediately
following the time period of clause (5). During this banding rate period, the commissioner
shall not enforce any rate decrease or increase that would otherwise result from the end of
the banding period. The commissioner shall, upon enactment, seek federal approval for the
addition of this banding period.
(d) The commissioner shall review all changes to rates that were in effect on December
1, 2013, to verify that the rates in effect produce the equivalent level of spending and service
unit utilization on an annual basis as those in effect on October 31, 2013.
(e) By December 31, 2014, the commissioner shall complete the review in paragraph
(d), adjust rates to provide equivalent annual spending, and make appropriate adjustments.
(f) During the banding period, the Medicaid Management Information System (MMIS)
service agreement rate must be adjusted to account for change in an individual's need. The
commissioner shall adjust the Medicaid Management Information System (MMIS) service
agreement rate by:
(1) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the level of service in effect on December 1, 2013;
(2) calculating a service rate under section 256B.4914, subdivision 6, 7, 8, or 9, for the
individual with variables reflecting the updated level of service at the time of application;
and
(3) adding to or subtracting from the Medicaid Management Information System (MMIS)
service agreement rate, the difference between the values in clauses (1) and (2).
(g) This subdivision must not apply to rates for recipients served by providers new to a
given county after January 1, 2014. Providers of personal supports services who also acted
as fiscal support entities must be treated as new providers as of January 1, 2014.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2016, section 256B.4913, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin New services. new text end
new text begin
(a) A service added to section 256B.4914 after January 1, 2014,
is not subject to rate stabilization adjustment in this section.
new text end
new text begin
(b) Employment support services authorized after January 1, 2018, under the new
employment support services definition according to the home and community-based services
waivers for people with disabilities under sections 256B.092 and 256B.49 are not subject
to rate stabilization adjustment in this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 16.
Minnesota Statutes 2016, section 256B.4914, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
(b) "Commissioner" means the commissioner of human services.
(c) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.
(d) "Customized living tool" means a methodology for setting service rates that delineates
and documents the amount of each component service included in a recipient's customized
living service plan.
(e) "Disability waiver rates system" means a statewide system that establishes rates that
are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.
(f) "Individual staffing" means the time spent as a one-to-one interaction specific to an
individual recipient by staff to provide direct support and assistance with activities of daily
living, instrumental activities of daily living, and training to participants, and is based on
the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.
(g) "Lead agency" means a county, partnership of counties, or tribal agency charged
with administering waivered services under sections 256B.092 and 256B.49.
(h) "Median" means the amount that divides distribution into two equal groups, one-half
above the median and one-half below the median.
(i) "Payment or rate" means reimbursement to an eligible provider for services provided
to a qualified individual based on an approved service authorization.
(j) "Rates management system" means a Web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.
(k) "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.
(l) "Shared staffing" means time spent by employees, not defined under paragraph (f),
providing or available to provide more than one individual with direct support and assistance
with activities of daily living as defined under section 256B.0659, subdivision 1, paragraph
(b); instrumental activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (i); ancillary activities needed to support individual services; and training to
participants, and is based on the requirements in each individual's coordinated service and
support plan under section 245D.02, subdivision 4b; any coordinated service and support
plan addendum under section 245D.02, subdivision 4c; an assessment tool; and provider
observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.
(m) "Staffing ratio" means the number of recipients a service provider employee supports
during a unit of service based on a uniform assessment tool, provider observation, case
history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.
(n) "Unit of service" means the following:
(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;
(2) for day services under subdivision 7:
(i) for day training and habilitation services, a unit of service is either:
(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or
(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; deleted text begin and
deleted text end
(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;new text begin
and
new text end
new text begin
(D) after December 31, 2017, 15 minute units must be used for fewer than six hours of
time spent providing direct services and transportation;
new text end
(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;
(iii) for prevocational services, a unit of service is a day or an hour. A day unit of service
is six or more hours of time spent providing direct service;
(3) for unit-based services with programming under subdivision 8:
(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; and
(ii) for all other services, a unit of service is 15 minutes; and
(4) for unit-based services without programming under subdivision 9:
(i) for respite services, a unit of service is deleted text begin a day ordeleted text end 15 minutesdeleted text begin . When a day rate is
authorized, any portion of a calendar day when an individual receives services is billable
as a daydeleted text end ; and
(ii) for all other services, a unit of service is 15 minutes.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
Minnesota Statutes 2016, section 256B.4914, subdivision 3, is amended to read:
Subd. 3.
Applicable services.
Applicable services are those authorized under the state's
home and community-based services waivers under sections 256B.092 and 256B.49,
including the following, as defined in the federally approved home and community-based
services plan:
(1) 24-hour customized living;
(2) adult day care;
(3) adult day care bath;
(4) behavioral programming;
(5) companion services;
(6) customized living;
(7) day training and habilitation;
(8) housing access coordination;
(9) independent living skills;
(10) in-home family support;
(11) night supervision;
(12) personal support;
(13) prevocational services;
(14) residential care services;
(15) residential support services;
(16) respite services;
(17) structured day services;
deleted text begin
(18) supported employment services;
deleted text end
deleted text begin (19)deleted text end new text begin (18)new text end supported living services;
deleted text begin (20)deleted text end new text begin (19)new text end transportation services; deleted text begin and
deleted text end
new text begin
(20) independent living skills specialist services;
new text end
new text begin
(21) individualized home supports;
new text end
new text begin
(22) employment exploration services;
new text end
new text begin
(23) employment development services;
new text end
new text begin
(24) employment support services; and
new text end
deleted text begin (21)deleted text end new text begin (25)new text end other services as approved by the federal government in the state home and
community-based services plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 18.
Minnesota Statutes 2016, section 256B.4914, subdivision 5, is amended to read:
Subd. 5.
Base wage index and standard component values.
(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:
(1) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end
(SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); and 20 percent of the median wage for social and human
services aide (SOC code 21-1093); and
(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end (SOC code
deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 20 percent of the median wage for social and human services aide (SOC code
21-1093);
(2) for day services, 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end (SOC code
deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(3) for residential asleep-overnight staff, the wage will be $7.66 per hour, except in a
family foster care setting, the wage is $2.80 per hour;
(4) for behavior program analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);
(5) for behavior program professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(6) for behavior program specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(7) for supportive living services staff, 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin
assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric
technician (SOC code 29-2053); and 60 percent of the median wage for social and human
services aide (SOC code 21-1093);
(8) for housing access coordination staff, 50 percent of the median wage for community
and social services specialist (SOC code 21-1099); and 50 percent of the median wage for
social and human services aide (SOC code 21-1093);
(9) for in-home family support staff, 20 percent of the median wage for nursing aide
(SOC code 31-1012); 30 percent of the median wage for community social service specialist
(SOC code 21-1099); 40 percent of the median wage for social and human services aide
(SOC code 21-1093); and ten percent of the median wage for psychiatric technician (SOC
code 29-2053);
(10) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
new text begin
(11) for independent living skills specialist staff, 100 percent of mental health and
substance abuse social worker (SOC code 21-1023);
new text end
new text begin
(12) for individualized home supports, 40 percent of the median wage for social worker
(SOC code 21-1029); 30 percent of the median wage for social and human services assistant
(SOC code 21-1093); and 30 percent of the median wage for community and social service
specialist (SOC code 21-1099);
new text end
deleted text begin (11)deleted text end new text begin (13) for services authorized through December 31, 2017,new text end for supported employment
staff, 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end );
20 percent of the median wage for psychiatric technician (SOC code 29-2053); and 60
percent of the median wage for social and human services aide (SOC code 21-1093);
new text begin
(14) effective January 1, 2018, for employment support services staff, 50 percent
rehabilitation counselor (SOC code 21-1015); and 50 percent community and social services
specialist (SOC code 21-1099);
new text end
new text begin
(15) for employment exploration services staff, 20 percent rehabilitation counselor (SOC
code 21-1015); 50 percent social and human services assistant (SOC code 21-1093); and
30 percent community and social services specialist (SOC code 21-1099);
new text end
new text begin
(16) for employment development services staff, 50 percent education, guidance, school,
and vocational counselors (SOC code 21-1012); and 50 percent community and social
services specialist (SOC code 21-1099);
new text end
deleted text begin (12)deleted text end new text begin (17)new text end for adult companion staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing deleted text begin aides,
orderlies, and attendantsdeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end );
deleted text begin (13)deleted text end new text begin (18)new text end for night supervision staff, 20 percent of the median wage for home health
aide (SOC code 31-1011); 20 percent of the median wage for personal and home health
aide (SOC code 39-9021); 20 percent of the median wage for nursing deleted text begin aidedeleted text end new text begin assistantnew text end (SOC
code deleted text begin 31-1012deleted text end new text begin 31-1014new text end ); 20 percent of the median wage for psychiatric technician (SOC
code 29-2053); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093);
deleted text begin (14)deleted text end new text begin (19)new text end for respite staff, 50 percent of the median wage for personal and home care
aide (SOC code 39-9021); and 50 percent of the median wage for nursing deleted text begin aides, orderlies,
and attendantsdeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end );
deleted text begin (15)deleted text end new text begin (20)new text end for personal support staff, 50 percent of the median wage for personal and
home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing deleted text begin aides,
orderlies, and attendantsdeleted text end new text begin assistantnew text end (SOC code deleted text begin 31-1012deleted text end new text begin 31-1014new text end );
deleted text begin (16)deleted text end new text begin (21)new text end for supervisory staff, the basic wage is $17.43 per hour with exception of the
supervisor of behavior analyst and behavior specialists, which must be $30.75 per hour;
deleted text begin (17)deleted text end new text begin (22)new text end for registered nurse, the basic wage is $30.82 per hour; and
deleted text begin (18)deleted text end new text begin (23)new text end for licensed practical nurse, the basic wage is $18.64 per hour.
(b) Component values for residential support services are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) general administrative support ratio: 13.25 percent;
(5) program-related expense ratio: 1.3 percent; and
(6) absence and utilization factor ratio: 3.9 percent.
(c) Component values for family foster care are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) general administrative support ratio: 3.3 percent;
(5) program-related expense ratio: 1.3 percent; and
(6) absence factor: 1.7 percent.
(d) Component values for day services for all services are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) program plan support ratio: 5.6 percent;
(5) client programming and support ratio: ten percent;
(6) general administrative support ratio: 13.25 percent;
(7) program-related expense ratio: 1.8 percent; and
(8) absence and utilization factor ratio: 3.9 percent.
(e) Component values for unit-based services with programming are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) program plan supports ratio: deleted text begin 3.1deleted text end new text begin 15.5new text end percent;
(5) client programming and supports ratio: deleted text begin 8.6deleted text end new text begin 4.7new text end percent;
(6) general administrative support ratio: 13.25 percent;
(7) program-related expense ratio: 6.1 percent; and
(8) absence and utilization factor ratio: 3.9 percent.
(f) Component values for unit-based services without programming except respite are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) program plan support ratio: deleted text begin 3.1deleted text end new text begin 7.0new text end percent;
(5) client programming and support ratio: deleted text begin 8.6deleted text end new text begin 2.3new text end percent;
(6) general administrative support ratio: 13.25 percent;
(7) program-related expense ratio: deleted text begin 6.1deleted text end new text begin 2.9new text end percent; and
(8) absence and utilization factor ratio: 3.9 percent.
(g) Component values for unit-based services without programming for respite are:
(1) supervisory span of control ratio: 11 percent;
(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
(3) employee-related cost ratio: 23.6 percent;
(4) general administrative support ratio: 13.25 percent;
(5) program-related expense ratio: deleted text begin 6.1deleted text end new text begin 2.9new text end percent; and
(6) absence and utilization factor ratio: 3.9 percent.
(h) On July 1, 2017, the commissioner shall update the base wage index in paragraph
(a) based on the wage data by standard occupational code (SOC) from the Bureau of Labor
Statistics available on December 31, 2016. The commissioner shall publish these updated
values and load them into the rate management system. This adjustment occurs every five
years. For adjustments in 2021 and beyond, the commissioner shall use the data available
on December 31 of the calendar year five years prior.
(i) On July 1, 2017, the commissioner shall update the framework components in
paragraphs deleted text begin (b) to (g)deleted text end new text begin (d), clause (5); (e), clause (5); and (f), clause (5)new text end ; subdivision 6, clauses
(8) and (9); and subdivision 7, clauses new text begin (10), new text end (16)new text begin ,new text end and (17), for changes in the Consumer
Price Index. The commissioner will adjust these values higher or lower by the percentage
change in the Consumer Price Index-All Items, United States city average (CPI-U) from
January 1, 2014, to January 1, 2017. The commissioner shall publish these updated values
and load them into the rate management system. This adjustment occurs every five years.
For adjustments in 2021 and beyond, the commissioner shall use the data available on
January 1 of the calendar year four years prior and January 1 of the current calendar year.
new text begin
(j) The commissioner must ensure that wage values and component values in subdivisions
5 to 9 reflect the cost to provide a service. As determined by the commissioner, a provider
enrolled to provide services with rates determined under this section must submit business
cost data to the commissioner in concurrence with the five-year provider revalidation cycle.
Reporting elements include, but are not limited to:
new text end
new text begin
(1) worker wage costs;
new text end
new text begin
(2) benefits paid;
new text end
new text begin
(3) supervisor wage costs;
new text end
new text begin
(4) executive wage costs;
new text end
new text begin
(5) vacation, sick, and training time paid;
new text end
new text begin
(6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end
new text begin
(7) administrative costs paid;
new text end
new text begin
(8) program costs paid;
new text end
new text begin
(9) transportation costs paid;
new text end
new text begin
(10) vacancy rates; and
new text end
new text begin
(11) other data relating to costs required to provide services requested by the
commissioner.
new text end
new text begin
(k) A provider must submit cost component data with provider revalidation and
reenrollment required under section 256B.04, subdivision 22. If a provider fails to submit
required reporting data, the commissioner may disenroll the provider.
new text end
new text begin
(l) The commissioner shall conduct a random audit of data submitted under paragraph
(j) to ensure data accuracy.
new text end
new text begin
(m) The commissioner shall analyze cost documentation in paragraph (j) and submit
recommendations on component value and inflationary factor adjustments to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services every four years beginning January 1, 2020. The commissioner shall make
recommendations in conjunction with reports submitted to the legislature according to
subdivision 10, paragraph (e).
new text end
new text begin
(n) In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend codes
or items to update and replace missing component values.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
Minnesota Statutes 2016, section 256B.4914, subdivision 6, is amended to read:
Subd. 6.
Payments for residential support services.
(a) Payments for residential support
services, as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
must be calculated as follows:
(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5. This is defined as the direct-care rate;
(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;
(4) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages in
subdivision 5, paragraph (a), or the customized direct-care rate;
(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16);
(6) combine the results of clauses (4) and (5), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (2). This is defined as the direct staffing cost;
(7) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (3);
(8) for client programming and supports, the commissioner shall add $2,179; and
(9) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.
(b) The total rate must be calculated using the following steps:
(1) subtotal paragraph (a), clauses (7) to (9), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (7);
(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(c) The payment methodology for customized living, 24-hour customized living, and
residential care services must be the customized living tool. Revisions to the customized
living tool must be made to reflect the services and activities unique to disability-related
recipient needs.
(d) For individuals enrolled prior to January 1, 2014, the days of service authorized must
meet or exceed the days of service used to convert service agreements in effect on December
1, 2013, and must not result in a reduction in spending or service utilization due to conversion
during the implementation period under section 256B.4913, subdivision 4a. deleted text begin If during the
implementation period, an individual's historical rate, including adjustments required under
section 256B.4913, subdivision 4a, paragraph (c), is equal to or greater than the rate
determined in this subdivision, the number of days authorized for the individual is 365.
deleted text end
(e) The number of days authorized for all individuals enrolling after January 1, 2014,
in residential services must include every day that services start and end.
new text begin
(f) Beginning January 1, 2018, for foster care and supportive living services provided
in a corporate setting and with rates calculated in this section, the number of days authorized
must not exceed 350 days in an annual service span.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20.
Minnesota Statutes 2016, section 256B.4914, subdivision 8, is amended to read:
Subd. 8.
Payments for unit-based services with programming.
Payments for unit-based
services with programming, including behavior programming, housing access coordination,
in-home family support, independent living skills training, new text begin independent living skills specialist
services, individualized home supports, new text end hourly supported living services, new text begin employment
exploration services, employment development services, new text end and deleted text begin supporteddeleted text end employmentnew text begin support
servicesnew text end provided to an individual outside of any day or residential service plan must be
calculated as follows, unless the services are authorized separately under subdivision 6 or
7:
(1) determine the number of units of service to meet a recipient's needs;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (2). This is defined as the customized direct-care rate;
(4) multiply the number of direct staff hours by the appropriate staff wage in subdivision
5, paragraph (a), or the customized direct-care rate;
(5) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph (e), clause (1), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (16);
(6) combine the results of clauses (4) and (5), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (e), clause
(2). This is defined as the direct staffing rate;
(7) for program plan support, multiply the result of clause (6) by one plus the program
plan supports ratio in subdivision 5, paragraph (e), clause (4);
(8) for employee-related expenses, multiply the result of clause (7) by one plus the
employee-related cost ratio in subdivision 5, paragraph (e), clause (3);
(9) for client programming and supports, multiply the result of clause (8) by one plus
the client programming and supports ratio in subdivision 5, paragraph (e), clause (5);
(10) this is the subtotal rate;
(11) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(12) divide the result of clause (10) by one minus the result of clause (11). This is the
total payment amount;
(13) for deleted text begin supporteddeleted text end employmentnew text begin support servicesnew text end provided in a shared manner, divide
the total payment amount in clause (12) by the number of service recipients, not to exceed
deleted text begin threedeleted text end new text begin sixnew text end . For independent living skills training provided in a shared manner, divide the total
payment amount in clause (12) by the number of service recipients, not to exceed two; and
(14) adjust the result of clause (13) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 21.
Minnesota Statutes 2016, section 256B.4914, subdivision 10, is amended to read:
Subd. 10.
Updating payment values and additional information.
(a) From January
1, 2014, through December 31, 2017, the commissioner shall develop and implement uniform
procedures to refine terms and adjust values used to calculate payment rates in this section.
(b) No later than July 1, 2014, the commissioner shall, within available resources, begin
to conduct research and gather data and information from existing state systems or other
outside sources on the following items:
(1) differences in the underlying cost to provide services and care across the state; and
(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and
(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.
(c) new text begin Beginning January 1, 2014, through December 31, 2018, new text end using a statistically valid
set of rates management system data, the commissioner, in consultation with stakeholders,
shall analyze for each service the average difference in the rate on December 31, 2013, and
the framework rate at the individual, provider, lead agency, and state levels. The
commissioner shall issue semiannual reports to the stakeholders on the difference in rates
by service and by county during the banding period under section 256B.4913, subdivision
4a. The commissioner shall issue the first report by October 1, 2014new text begin , and the final report
shall be issued by December 31, 2018new text end .
(d) No later than July 1, 2014, the commissioner, in consultation with stakeholders, shall
begin the review and evaluation of the following values already in subdivisions 6 to 9, or
issues that impact all services, including, but not limited to:
(1) values for transportation rates deleted text begin for day servicesdeleted text end ;
deleted text begin
(2) values for transportation rates in residential services;
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end values for services where monitoring technology replaces staff time;
deleted text begin (4)deleted text end new text begin (3)new text end values for indirect services;
deleted text begin (5)deleted text end new text begin (4)new text end values for nursing;
deleted text begin
(6) component values for independent living skills;
deleted text end
deleted text begin
(7) component values for family foster care that reflect licensing requirements;
deleted text end
deleted text begin
(8) adjustments to other components to replace the budget neutrality factor;
deleted text end
deleted text begin
(9) remote monitoring technology for nonresidential services;
deleted text end
deleted text begin
(10) values for basic and intensive services in residential services;
deleted text end
deleted text begin (11)deleted text end new text begin (5)new text end values for the facility use rate in day services, and the weightings used in the
day service ratios and adjustments to those weightings;
deleted text begin (12)deleted text end new text begin (6)new text end values for workers' compensation as part of employee-related expenses;
deleted text begin (13)deleted text end new text begin (7)new text end values for unemployment insurance as part of employee-related expenses;
deleted text begin
(14) a component value to reflect costs for individuals with rates previously adjusted
for the inclusion of group residential housing rate 3 costs, only for any individual enrolled
as of December 31, 2013; and
deleted text end
deleted text begin (15)deleted text end new text begin (8)new text end any changes in state or federal law with deleted text begin andeleted text end new text begin a directnew text end impact on the underlying
cost of providing home and community-based servicesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(9) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section.
new text end
(e) The commissioner shall report to the chairs and the ranking minority members of
the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs (b) to (d) on
the following dates:
(1) January 15, 2015, with preliminary results and data;
(2) January 15, 2016, with a status implementation update, and additional data and
summary information;
(3) January 15, 2017, with the full report; and
(4) January 15, deleted text begin 2019deleted text end new text begin 2020new text end , with another full report, and a full report once every four
years thereafter.
deleted text begin
(f) Based on the commissioner's evaluation of the information and data collected in
paragraphs (b) to (d), the commissioner shall make recommendations to the legislature by
January 15, 2015, to address any issues identified during the first year of implementation.
After January 15, 2015, the commissioner may make recommendations to the legislature
to address potential issues.
deleted text end
deleted text begin (g)deleted text end new text begin (f)new text end The commissioner shall implement a regional adjustment factor to all rate
calculations in subdivisions 6 to 9, effective no later than January 1, 2015. new text begin Beginning July
1, 2017, the commissioner shall renew analysis and implement changes to the regional
adjustment factors when adjustments required under subdivision 5, paragraph (h), occur.
new text end Prior to implementation, the commissioner shall consult with stakeholders on the
methodology to calculate the adjustment.
deleted text begin (h)deleted text end new text begin (g)new text end The commissioner shall provide a public notice via LISTSERV in October of
each year beginning October 1, 2014, containing information detailing legislatively approved
changes in:
(1) calculation values including derived wage rates and related employee and
administrative factors;
(2) service utilization;
(3) county and tribal allocation changes; and
(4) information on adjustments made to calculation values and the timing of those
adjustments.
The information in this notice must be effective January 1 of the following year.
deleted text begin
(i) No later than July 1, 2016, the commissioner shall develop and implement, in
consultation with stakeholders, a methodology sufficient to determine the shared staffing
levels necessary to meet, at a minimum, health and welfare needs of individuals who will
be living together in shared residential settings, and the required shared staffing activities
described in subdivision 2, paragraph (l). This determination methodology must ensure
staffing levels are adaptable to meet the needs and desired outcomes for current and
prospective residents in shared residential settings.
deleted text end
deleted text begin (j)deleted text end new text begin (h)new text end When the available shared staffing hours in a residential setting are insufficient
to meet the needs of an individual who enrolled in residential services after January 1, 2014,
or insufficient to meet the needs of an individual with a service agreement adjustment
described in section 256B.4913, subdivision 4a, paragraph (f), then individual staffing hours
shall be used.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 22.
Minnesota Statutes 2016, section 256B.85, subdivision 16, is amended to read:
Subd. 16.
Support workers requirements.
(a) Support workers shall:
(1) enroll with the department as a support worker after a background study under chapter
245C has been completed and the support worker has received a notice from the
commissioner that the support worker:
(i) is not disqualified under section 245C.14; or
(ii) is disqualified, but has received a set-aside of the disqualification under section
245C.22;
(2) have the ability to effectively communicate with the participant or the participant's
representative;
(3) have the skills and ability to provide the services and supports according to the
participant's CFSS service delivery plan and respond appropriately to the participant's needs;
(4) complete the basic standardized CFSS training as determined by the commissioner
before completing enrollment. The training must be available in languages other than English
and to those who need accommodations due to disabilities. CFSS support worker training
must include successful completion of the following training components: basic first aid,
vulnerable adult, child maltreatment, OSHA universal precautions, basic roles and
responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance to
participants;
(5) complete employer-directed training and orientation on the participant's individual
needs;
(6) maintain the privacy and confidentiality of the participant; and
(7) not independently determine the medication dose or time for medications for the
participant.
(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
(1) does not meet the requirements in paragraph (a);
(2) fails to provide the authorized services required by the employer;
(3) has been intoxicated by alcohol or drugs while providing authorized services to the
participant or while in the participant's home;
(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
(5) has been excluded as a provider by the commissioner of human services, or by the
United States Department of Health and Human Services, Office of Inspector General, from
participation in Medicaid, Medicare, or any other federal health care program.
(c) A support worker may appeal in writing to the commissioner to contest the decision
to terminate the support worker's provider enrollment and provider number.
(d) A support worker must not provide or be paid for more than deleted text begin 275deleted text end new text begin 310new text end hours of CFSS
per month, regardless of the number of participants the support worker serves or the number
of agency-providers or participant employers by which the support worker is employed.
The department shall not disallow the number of hours per day a support worker works
unless it violates other law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 23.
Minnesota Statutes 2016, section 256C.21, is amended to read:
256C.21 DEAF AND HARD-OF-HEARING SERVICES ACT; CITATION.
Sections 256C.21 to deleted text begin 256C.26deleted text end new text begin 256C.30new text end may be cited as the "Deaf and Hard-of-Hearing
Services Act."
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24.
Minnesota Statutes 2016, section 256C.23, subdivision 1, is amended to read:
Subdivision 1.
Scope.
For the purposes of sections 256C.21 to deleted text begin 256C.26deleted text end new text begin 256C.30new text end , the
terms defined in this section shall have the meanings given them, unless the context clearly
indicates otherwise.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 25.
Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Culturally affirmative services. new text end
new text begin
"Culturally affirmative services" means
services that are designed and delivered within the context of the culture, language, and life
experience of a person who is deaf, a person who is deafblind, and a person who is
hard-of-hearing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 26.
Minnesota Statutes 2016, section 256C.23, subdivision 2, is amended to read:
Subd. 2.
Deaf.
"Deaf" means a hearing loss of such severity that the individual must
depend primarily on visual communication such as writing, lip reading, deleted text begin manual
communication, anddeleted text end new text begin American Sign Language or other signed languages, visual and manual
means of communication such as signing systems in English or Cued Speech, ornew text end gestures.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
Minnesota Statutes 2016, section 256C.23, is amended by adding a subdivision
to read:
new text begin Subd. 2c. new text end
new text begin Interpreting services. new text end
new text begin
"Interpreting services" means services that include:
new text end
new text begin
(1) interpreting between a spoken language such as English and a visual language such
as American Sign Language;
new text end
new text begin
(2) interpreting between a spoken language and a visual representation of a spoken
language such as Cued Speech and signing systems in English;
new text end
new text begin
(3) interpreting within one language where the interpreter uses natural gestures and
silently repeats the spoken message, replacing some words or phrases to give higher visibility
on the lips; and
new text end
new text begin
(4) interpreting using low vision or tactile methods for people who have a combined
hearing and vision loss or are deafblind.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28.
Minnesota Statutes 2016, section 256C.233, subdivision 1, is amended to read:
Subdivision 1.
Deaf and Hard-of-Hearing Services Division.
The deleted text begin commissionersdeleted text end new text begin
commissionernew text end of human servicesdeleted text begin , education, employment and economic development, and
healthdeleted text end shall create deleted text begin a distinct and separatedeleted text end new text begin annew text end organizational unit to be known as the Deaf
and Hard-of-Hearing Services Division to address the developmental, social, deleted text begin educational,
and occupationaldeleted text end new text begin mental health, communication access, and human servicenew text end needs of new text begin persons
who are new text end deaf,new text begin persons who arenew text end deafblind, andnew text begin persons who arenew text end hard-of-hearing deleted text begin personsdeleted text end
through a statewide network of deleted text begin collaborativedeleted text end services and by deleted text begin coordinating the promulgation
ofdeleted text end new text begin implementingnew text end public policies, regulations, legislation, new text begin services, new text end and programs affecting
new text begin persons who are new text end deaf, new text begin persons who are new text end deafblind, and new text begin persons who are new text end hard-of-hearing
deleted text begin personsdeleted text end . deleted text begin An interdepartmental management team shall advise the activities of the Deaf and
Hard-of-Hearing Services Division.deleted text end The commissioner of human services shall deleted text begin coordinate
the work of the interagency management team anddeleted text end receive legislative appropriations for
the division.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 29.
Minnesota Statutes 2016, section 256C.233, subdivision 2, is amended to read:
Subd. 2.
Responsibilities.
The Deaf and Hard-of-Hearing Services Division shall:
(1) establish and maintain a statewide network of deleted text begin regional service centersdeleted text end new text begin culturally
affirmative services new text end for new text begin Minnesotans who are new text end deaf, new text begin Minnesotans who are new text end deafblind, andnew text begin
Minnesotans who arenew text end hard-of-hearing deleted text begin Minnesotansdeleted text end ;
(2) assist deleted text begin the Departments of Human Services, Education, and Employment and Economic
Developmentdeleted text end new text begin other state agenciesnew text end to coordinate the promulgation and implementation of
public policies, regulations, deleted text begin legislation,deleted text end programs, and services affecting new text begin persons who are
new text end deaf, new text begin persons who are new text end deafblind, and new text begin persons who are new text end hard-of-hearing deleted text begin personsdeleted text end ; deleted text begin and
deleted text end
(3) deleted text begin provide a coordinated system of statewide interpreting or interpreter referral servicesdeleted text end new text begin
oversee and manage grant-funded services for persons who are deaf, persons who are
deafblind, and persons who are hard-of-hearing and a person's family as provided in sections
237.23, 256C.25, 256C.261, 256C.30 and as appropriated by the legislature; and
new text end
new text begin (4) meet as a team with the commissioners of education, employment and economic
development, and health or the commissioners' designees at least three times per year to
coordinate the promulgation and implementation of public policies, regulations, programs,
and services affecting persons who are deaf, persons who are deafblind, and persons who
are hard-of-hearingnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 30.
Minnesota Statutes 2016, section 256C.233, subdivision 4, is amended to read:
Subd. 4.
State commissioners.
The commissioners of all state agencies shall consult
with the Deaf and Hard-of-Hearing Services Division concerning the promulgation of public
policies, regulations, and programs necessary to address the needs of new text begin Minnesotans who are
new text end deaf, new text begin Minnesotans who are new text end deafblind, andnew text begin Minnesotans who arenew text end hard-of-hearing deleted text begin Minnesotansdeleted text end .
Each state agency shall consult with the Deaf and Hard-of-Hearing Services Division
concerning the need to forward legislative initiatives to the governor to address the concerns
of new text begin Minnesotans who are new text end deaf, new text begin Minnesotans who are new text end deafblind, and new text begin Minnesotans who are
new text end hard-of-hearing deleted text begin Minnesotansdeleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 31.
Minnesota Statutes 2016, section 256C.24, is amended to read:
256C.24 REGIONAL deleted text begin SERVICE CENTERSdeleted text end new text begin SERVICESnew text end .
Subdivision 1.
Location.
The Deaf and Hard-of-Hearing Services Division shall establish
deleted text begin up to eight regional service centersdeleted text end new text begin statewide servicesnew text end for new text begin people who are new text end deaf deleted text begin anddeleted text end new text begin , people
who are deafblind, and people who arenew text end hard-of-hearing deleted text begin personsdeleted text end . The deleted text begin centersdeleted text end new text begin servicesnew text end shall
be distributed regionally to provide access for new text begin people who are new text end deaf, new text begin people who are new text end deafblind,
and new text begin people who are new text end hard-of-hearing deleted text begin personsdeleted text end in all parts of the state.
Subd. 2.
Responsibilities.
deleted text begin Each regional service centerdeleted text end new text begin The Deaf and Hard-of-Hearing
Services Divisionnew text end shall:
(1) deleted text begin serve as a central entry point for deaf, deafblind, and hard-of-hearing persons in need
of services and make referrals to the services neededdeleted text end new text begin provide culturally affirmative direct
assistance to a person who is deaf, a person who is deafblind, and a person who is
hard-of-hearing and the person's family to improve the person's communication access and
quality of life at home and in the community. Direct assistance may be provided using
technology only in areas of the state when a person has access to sufficient quality
telecommunications or broadband services to allow effective communication. When a person
who is deaf, a person who is deafblind, or a person who is hard-of-hearing only has access
to insufficient telecommunications or broadband service, direct assistance shall be available
in person. Direct assistance may include:
new text end
new text begin
(i) teaching communication strategies and coping skills;
new text end
new text begin
(ii) offering guidance and problem solving assistance;
new text end
new text begin
(iii) making referrals related to enhancing a person's independence;
new text end
new text begin
(iv) providing information and assistance to support the person's ability to be
self-sufficient and live independently; and
new text end
new text begin (v) identifying technology solutions to improve access to communication and to
environmental informationnew text end ;
(2) employ staff trained to work with new text begin persons who are new text end deaf, new text begin persons who are new text end deafblind,
and new text begin persons who are new text end hard-of-hearing deleted text begin personsdeleted text end ;
deleted text begin
(3) provide to all deaf, deafblind, and hard-of-hearing persons access to interpreter
services which are necessary to help them obtain services;
deleted text end
deleted text begin
(4) implement a plan to provide loaned equipment and resource materials to deaf,
deafblind, and hard-of-hearing persons;
deleted text end
deleted text begin (5) cooperate withdeleted text end new text begin (3) advisenew text end responsible departments and administrative authorities deleted text begin to
providedeleted text end new text begin about providingnew text end access for new text begin persons who are new text end deaf, new text begin persons who are new text end deafblind, andnew text begin
persons who arenew text end hard-of-hearing deleted text begin personsdeleted text end to services provided by state, county, deleted text begin anddeleted text end regionalnew text begin
and localnew text end agencies;
deleted text begin
(6) collaborate with the Resource Center for the Deaf and Hard-of-Hearing Persons,
other divisions of the Department of Education, and local school districts to develop and
deliver programs and services for families with deaf, deafblind, or hard-of-hearing children
and to support school personnel serving these children;
deleted text end
deleted text begin
(7) when possible, provide training to the social service or income maintenance staff
employed by counties or by organizations with whom counties contract for services to
ensure that communication barriers which prevent deaf, deafblind, and hard-of-hearing
persons from using services are removed;
deleted text end
deleted text begin
(8) when possible, provide training to state and regional human service agencies regarding
program access for deaf, deafblind, and hard-of-hearing persons; and
deleted text end
new text begin
(4) provide training and technical assistance to county, state, regional, and local agencies,
and others on hearing loss, deaf culture, assistive technology, and other related topics to
ensure that programs and services are accessible to persons who are deaf, persons who are
deafblind, and persons who are hard-of-hearing;
new text end
new text begin
(5) provide training to persons who are deaf, persons who are deafblind, and persons
who are hard-of-hearing to develop the skills and knowledge needed to advocate for
communication access and service needs;
new text end
deleted text begin (9)deleted text end new text begin (6)new text end assess the ongoing need and supply of services for new text begin persons who are new text end deaf, new text begin persons
who are new text end deafblind, andnew text begin persons who arenew text end hard-of-hearing deleted text begin personsdeleted text end in all parts of the state and
cooperate with public and private service providers to develop these services.
new text begin
(7) provide culturally affirmative mental health services for persons who are deaf, persons
who are deafblind, and persons who are hard-of-hearing;
new text end
new text begin
(8) provide telecommunications devices to a Minnesotan with a communication disability
according to sections 237.51 to 237.56; and
new text end
new text begin
(9) assess requests from provisionally certified educational interpreters and transliterators
for onetime limited certification extensions according to section 122A.31.
new text end
Subd. 3.
Advisory committee.
The director of the Deaf and Hard-of-Hearing Services
Division shall appoint deleted text begin an advisory committeedeleted text end new text begin eight advisory committeesnew text end of up to nine
persons deleted text begin for each regional service areadeleted text end new text begin per advisory committeenew text end . new text begin Each committee shall represent
a specific region of the state. The director shall determine the boundaries of each advisory
committee region. The committees shall advise the director on the needs of persons who
are deaf, persons who are deafblind, and persons who are hard-of-hearing and service gaps
in the region of the state the committee represents. new text end Members shall include persons who are
deaf, new text begin persons who are new text end deafblind, and new text begin persons who are new text end hard-of-hearing, persons who have
communication disabilities, parents of children who are deaf andnew text begin parents of children who
arenew text end hard-of-hearing, parents of children who have communication disabilities, and
representatives of county and regional human services, including representatives of private
service providers. At least 50 percent of the members must be deaf or deafblind or
hard-of-hearing or have a communication disability. Committee members shall serve for a
three-year term deleted text begin and shall serve no more than two consecutive termsdeleted text end . Each advisory committee
shall elect a chair. The director of the Deaf and Hard-of-Hearing Services Division shall
assign staff to serve as nonvoting members of the committee. Members shall not receive a
per diem. Otherwise, the compensation, removal of members, and filling of vacancies on
the committee shall be as provided in section 15.0575.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 32.
Minnesota Statutes 2016, section 256C.25, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Establishmentdeleted text end new text begin Dutiesnew text end .
new text begin (a) new text end The Deaf and Hard-of-Hearing Services
Division shall maintain deleted text begin and coordinate statewide interpreting or interpreter referral services
fordeleted text end new text begin a statewide information source about available interpreting services for a person who is
deaf, a person who is deafblind, and a person who is hard-of-hearing. The information
source shall be available for new text end use by any public or private agency or individual in the state.
new text begin (b) new text end new text begin The division shall identify areas of the state where there are shortages of qualified
interpreting services and develop strategies for addressing the shortages. new text end The division shall
directly coordinate these services but may contract with an appropriate agency to deleted text begin provide
this servicedeleted text end new text begin implement the strategiesnew text end . deleted text begin The division may collect a $3 fee per referral for
interpreter referral services and the actual costs of interpreter services provided by department
staff. Fees and payments collected shall be deposited in the general fund. The $3 referral
fee shall not be collected from state agencies or local units of government or deaf or
hard-of-hearing consumers or interpreters.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2016, section 256C.261, is amended to read:
256C.261 SERVICES FOR new text begin A PERSON WHO IS new text end DEAFBLIND deleted text begin PERSONSdeleted text end .
(a) deleted text begin The commissioner of human services shall combine the existing biennial base level
funding for deafblind services into a single grant program. At least 35 percent of the total
funding is awarded for services and other supports to deafblind children and their families
and at least 25 percent is awarded for services and other supports to deafblind adults.deleted text end new text begin The
commissioner of human services shall use at least 35 percent of the deafblind services
biennial base level grant funding for services and other supports for a child who is deafblind
and the child's family. The commissioner shall use at least 25 percent of the deafblind
services biennial base level grant funding for services and other supports for an adult who
is deafblind.
new text end
The commissioner shall award grants for the purposes of:
(1) providing services and supports to individuals who are deafblind; and
(2) developing and providing training to counties and the network of senior citizen
service providers. The purpose of the training grants is to teach counties how to use existing
programs that capture federal financial participation to meet the needs of eligible deafblind
persons and to build capacity of senior service programs to meet the needs of seniors with
a dual sensory hearing and vision loss.
(b) The commissioner may make grants:
(1) for services and training provided by organizations; and
(2) to develop and administer consumer-directed services.
(c) Any entity that is able to satisfy the grant criteria is eligible to receive a grant under
paragraph (a).
(d) Deafblind service providers may, but are not required to, provide deleted text begin intervenordeleted text end new text begin intervenernew text end
services as part of the service package provided with grant funds under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 34.
Minnesota Statutes 2016, section 256C.30, is amended to read:
256C.30 DUTIES OF HUMAN SERVICES COMMISSIONER.
(a) As described in this section, the commissioner of human services must enter into
grant agreements with television stations to make live local news programming accessible
to new text begin persons who are new text end deaf, new text begin persons who are new text end hard-of-hearing, andnew text begin persons who arenew text end deafblind
deleted text begin personsdeleted text end as defined in section 256C.23.
(b) The grant agreements must provide for:
(1) real-time captioning services for broadcasting that is not emergency broadcasting
subject to Code of Federal Regulations, title 47, section 79.2;
(2) real-time captioning services for commercial broadcasters in areas of Minnesota
where commercial broadcasters are not subject to the live programming closed-captioning
requirements of Code of Federal Regulations, title 47, section 79.1(d); and
(3) real-time captioning for large-market noncommercial broadcasters who produce live
news programming.
(c) For the purposes of this section, "real-time captioning" means a method of captioning
in which captions are simultaneously prepared and transmitted at the time of origination by
specially trained real-time captioners.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35. new text begin FEDERAL WAIVER AMENDMENTS.
new text end
new text begin
The commissioner of human services shall submit necessary waiver amendments to the
Centers for Medicare and Medicaid Services to add employment exploration services,
employment development services, and employment support services to the home and
community-based services waivers authorized under Minnesota Statutes, sections 256B.092
and 256B.49. The commissioner shall also submit necessary waiver amendments to remove
community-based employment services from day training and habilitation and prevocational
services. The commissioner shall submit all necessary waiver amendments by October 1,
2017.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 36. new text begin TRANSPORTATION STUDY.
new text end
new text begin
The commissioner of human services, with cooperation from lead agencies and in
consultation with stakeholders, shall conduct a study to identify opportunities to increase
access to transportation services for an individual who receives home and community-based
services. The commissioner shall submit a report with recommendations to the chairs and
ranking minority members of the legislative committees with jurisdiction over human
services by January 15, 2019. The report shall:
new text end
new text begin
(1) study all aspects of the current transportation service network, including the fleet
available, the different rate-setting methods currently used, methods that an individual uses
to access transportation, and the diversity of available provider agencies;
new text end
new text begin
(2) identify current barriers for an individual accessing transportation and for a provider
providing waiver services transportation in the marketplace;
new text end
new text begin
(3) identify efficiencies and collaboration opportunities to increase available
transportation, including transportation funded by medical assistance, and available regional
transportation and transit options;
new text end
new text begin
(4) study transportation solutions in other states for delivering home and community-based
services;
new text end
new text begin
(5) study provider costs required to administer transportation services;
new text end
new text begin
(6) make recommendations for coordinating and increasing transportation accessibility
across the state; and
new text end
new text begin
(7) make recommendations for the rate setting of waivered transportation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 37. new text begin RATE INCREASE FOR SELF-DIRECTED WORKFORCE
NEGOTIATIONS.
new text end
new text begin
(a) The commissioner of human services shall:
new text end
new text begin
(1) increase reimbursement rates, grants, or allocations by 3.09 percent for services
provided on or after July 1, 2017;
new text end
new text begin
(2) increase reimbursement rates, grants, or allocations by 0.1 percent for services
provided on or after July 1, 2018; and
new text end
new text begin
(3) increase the reimbursement rates, grants, or allocations by an additional ten percent
for services provided on or after July 1, 2018, for service recipients with complex needs,
defined as recipients with eligibility for 12 or more hours of personal care assistance services
per day according to Minnesota Statutes, section 256B.0652.
new text end
new text begin
(b) The rate changes described in this section apply to direct support services provided
through a covered program, as defined by Minnesota Statutes, section 256B.0711, subdivision
1, paragraph (b).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective if the labor agreement between the state
and SEIU Healthcare Minnesota according to Laws 2013, chapter 128, article 2, is ratified
by the legislature. The commissioner of human services shall notify the revisor of statutes
when ratification occurs.
new text end
Sec. 38. new text begin FEDERAL WAIVER REQUESTS.
new text end
new text begin
The commissioner of human services shall submit necessary waiver amendments to the
Centers for Medicare and Medicaid Services to add employment exploration services,
employment development services, and employment support services to the home and
community-based services waiver authorized under Minnesota Statutes, sections 256B.092
and 256B.49. The commissioner shall also submit necessary waiver amendments to remove
community-based employment from day training and habilitation and prevocational services.
The commissioner shall submit the necessary waiver amendments by October 1, 2017.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 39. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2016, sections 252.451; 256B.4914, subdivision 16; 256C.23,
subdivision 3; and 256C.25, subdivision 2,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2016, section 252.41, subdivision 8,
new text end
new text begin
is repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2016, section 256B.64,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective the day following final enactment.
Paragraph (b) is effective when sections 2, 3, and 16 become effective. The commissioner
of human services shall notify the revisor of statutes when sections 2, 3, and 16 are effective.
Paragraph (c) is effective July 1, 2017.
new text end
ARTICLE 2
HOUSING
Section 1.
new text begin
[256B.051] HOUSING SUPPORT SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
Housing support services are established to provide housing
support services to an individual with a disability that limits the individual's ability to obtain
or maintain stable housing. The services support an individual's transition to housing in the
community and increases long-term stability in housing, to avoid future periods of being at
risk of homelessness or institutionalization.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
new text end
new text begin
(b) "At-risk of homelessness" means (1) an individual that is faced with a set of
circumstances likely to cause the individual to become homeless, or (2) an individual
previously homeless, who will be discharged from a correctional, medical, mental health,
or treatment center, who lacks sufficient resources to pay for housing and does not have a
permanent place to live.
new text end
new text begin
(c) "Commissioner" means the commissioner of human services.
new text end
new text begin
(d) "Homeless" means an individual or family lacking a fixed, adequate nighttime
residence.
new text end
new text begin
(e) "Individual with a disability" means:
new text end
new text begin
(1) an individual who is aged, blind, or disabled as determined by the criteria used by
the title 11 program of the Social Security Act, United States Code, title 42, section 416,
paragraph (i), item (1); or
new text end
new text begin
(2) an individual who meets a category of eligibility under section 256D.05, subdivision
1, paragraph (a), clauses (1), (3), (5) to (9), or (14).
new text end
new text begin
(f) "Institution" means a setting as defined in section 256B.0621, subdivision 2, clause
(3), and the Minnesota Security Hospital as defined in section 253.20.
new text end
new text begin
(g) "Segregated setting" means:
new text end
new text begin
(1) a registered housing with services establishment under chapter 144D;
new text end
new text begin
(2) a licensed board and lodge facility;
new text end
new text begin
(3) a licensed boarding care facility;
new text end
new text begin
(4) a licensed adult foster care;
new text end
new text begin
(5) intensive residential treatment (IRTs); or
new text end
new text begin
(6) a supervised living facility.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
An individual with a disability is eligible for housing support services
if the individual:
new text end
new text begin
(1) is 18 years of age or older;
new text end
new text begin
(2) is enrolled in medical assistance;
new text end
new text begin
(3) has an assessment of functional need that determines a need for services due to
limitations caused by the individual's disability;
new text end
new text begin
(4) resides in or plans to transition to a community-based setting as defined in Code of
Federal Regulations, title 42, section 441.301(c); and
new text end
new text begin
(5) has housing instability evidenced by:
new text end
new text begin
(i) being homeless or at-risk of homelessness;
new text end
new text begin
(ii) being in the process of transitioning from, or having transitioned in the past six
months from, an institution or segregated setting;
new text end
new text begin
(iii) being eligible for waiver services under section 256B.0915, 256B.092, or 256B.49;
or
new text end
new text begin
(iv) having been identified by a long-term care consultation under section 256B.0911
as at risk of institutionalization.
new text end
new text begin Subd. 4. new text end
new text begin Assessment requirements. new text end
new text begin
(a) An individual's assessment of functional need
must be conducted by one of the following methods:
new text end
new text begin
(1) a certified assessor according to the criteria established in section 256B.0911,
subdivision 3a, using a format established by the commissioner;
new text end
new text begin
(2) documented need for services as verified by a professional statement of need as
defined in section 256I.03, subdivision 12; or
new text end
new text begin
(3) according to the continuum of care coordinated assessment system established in
Code of Federal Regulations, title 24, section 578.3, using a format established by the
commissioner.
new text end
new text begin
(b) An individual must be reassessed within one year of initial assessment, and annually
thereafter.
new text end
new text begin Subd. 5. new text end
new text begin Housing support services. new text end
new text begin
(a) Housing support services include housing
transition services and housing and tenancy sustaining services.
new text end
new text begin
(b) Housing transition services are defined as:
new text end
new text begin
(1) tenant screening and housing assessment;
new text end
new text begin
(2) assistance with the housing search and application process;
new text end
new text begin
(3) identifying resources to cover one-time moving expenses;
new text end
new text begin
(4) ensuring a new living arrangement is safe and ready for move-in;
new text end
new text begin
(5) assisting in arranging for and supporting details of a move; and
new text end
new text begin
(6) developing a housing support crisis plan.
new text end
new text begin
(c) Housing and tenancy sustaining services include:
new text end
new text begin
(1) prevention and early identification of behaviors that may jeopardize continued stable
housing;
new text end
new text begin
(2) education and training on roles, rights, and responsibilities of the tenant and the
property manager;
new text end
new text begin
(3) coaching to develop and maintain key relationships with property managers and
neighbors;
new text end
new text begin
(4) advocacy and referral to community resources to prevent eviction when housing is
at risk;
new text end
new text begin
(5) assistance with housing recertification process;
new text end
new text begin
(6) coordination with the tenant to regularly review, update, and modify housing support
and crisis plan; and
new text end
new text begin
(7) continuing training on being a good tenant, lease compliance, and household
management.
new text end
new text begin
(d) A housing support service may include person-centered planning for people who are
not eligible to receive person-centered planning through any other service, if the
person-centered planning is provided by a consultation service provider that is under contract
with the department and enrolled as a Minnesota health care program.
new text end
new text begin Subd. 6. new text end
new text begin Provider qualifications and duties. new text end
new text begin
A provider eligible for reimbursement
under this section shall:
new text end
new text begin
(1) enroll as a medical assistance Minnesota health care program provider and meet all
applicable provider standards and requirements;
new text end
new text begin
(2) demonstrate compliance with federal and state laws and policies for housing support
services as determined by the commissioner;
new text end
new text begin
(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results; and
new text end
new text begin
(4) directly provide housing support services and not use a subcontractor or reporting
agent.
new text end
new text begin Subd. 7. new text end
new text begin Housing support supplemental service rates. new text end
new text begin
Supplemental service rates for
individuals in settings according to sections 144D.025, 256I.04, subdivision 3, paragraph
(a), clause (3), and 256I.05, subdivision 1g, shall be reduced by one-half over a two-year
period. This reduction only applies to supplemental service rates for individuals eligible for
housing support services under this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
(a) Subdivisions 1 to 6 are contingent upon federal approval and
not effective until nine months after federal approval is obtained. The commissioner of
human services shall notify the revisor of statutes when federal approval is obtained.
new text end
new text begin
(b) Subdivision 7 is contingent upon federal approval of subdivisions 1 to 6 and not
effective until ten months after federal approval is obtained. The commissioner of human
services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 2.
Minnesota Statutes 2016, section 256D.44, subdivision 4, is amended to read:
Subd. 4.
Temporary absence due to illness.
For the purposes of this subdivision, "home"
means a residence owned or rented by a recipient or the recipient's spouse. deleted text begin Home does not
include a group residential housing facility.deleted text end Assistance payments for recipients who are
temporarily absent from their home due to hospitalization for illness must continue at the
same level of payment during their absence if the following criteria are met:
(1) a physician certifies that the absence is not expected to continue for more than three
months;
(2) a physician certifies that the recipient will be able to return to independent living;
and
(3) the recipient has expenses associated with maintaining a residence in the community.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 3.
Minnesota Statutes 2016, section 256D.44, subdivision 5, is amended to read:
Subd. 5.
Special needs.
new text begin (a) new text end In addition to the state standards of assistance established
in subdivisions 1 to 4, payments are allowed for the following special needs of recipients
of Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
center, or a deleted text begin group residentialdeleted text end new text begin setting authorized to receivenew text end housing deleted text begin facilitydeleted text end new text begin support payments
under chapter 256Inew text end .
deleted text begin (a)deleted text end new text begin (b)new text end The county agency shall pay a monthly allowance for medically prescribed diets
if the cost of those additional dietary needs cannot be met through some other maintenance
benefit. The need for special diets or dietary items must be prescribed by a licensed physician.
Costs for special diets shall be determined as percentages of the allotment for a one-person
household under the thrifty food plan as defined by the United States Department of
Agriculture. The types of diets and the percentages of the thrifty food plan that are covered
are as follows:
(1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
(2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent of
thrifty food plan;
(3) controlled protein diet, less than 40 grams and requires special products, 125 percent
of thrifty food plan;
(4) low cholesterol diet, 25 percent of thrifty food plan;
(5) high residue diet, 20 percent of thrifty food plan;
(6) pregnancy and lactation diet, 35 percent of thrifty food plan;
(7) gluten-free diet, 25 percent of thrifty food plan;
(8) lactose-free diet, 25 percent of thrifty food plan;
(9) antidumping diet, 15 percent of thrifty food plan;
(10) hypoglycemic diet, 15 percent of thrifty food plan; or
(11) ketogenic diet, 25 percent of thrifty food plan.
deleted text begin (b)deleted text end new text begin (c)new text end Payment for nonrecurring special needs must be allowed for necessary home
repairs or necessary repairs or replacement of household furniture and appliances using the
payment standard of the AFDC program in effect on July 16, 1996, for these expenses, as
long as other funding sources are not available.
deleted text begin (c)deleted text end new text begin (d)new text end A fee for guardian or conservator service is allowed at a reasonable rate negotiated
by the county or approved by the court. This rate shall not exceed five percent of the
assistance unit's gross monthly income up to a maximum of $100 per month. If the guardian
or conservator is a member of the county agency staff, no fee is allowed.
deleted text begin (d)deleted text end new text begin (e)new text end The county agency shall continue to pay a monthly allowance of $68 for restaurant
meals for a person who was receiving a restaurant meal allowance on June 1, 1990, and
who eats two or more meals in a restaurant daily. The allowance must continue until the
person has not received Minnesota supplemental aid for one full calendar month or until
the person's living arrangement changes and the person no longer meets the criteria for the
restaurant meal allowance, whichever occurs first.
deleted text begin (e)deleted text end new text begin (f)new text end A fee of ten percent of the recipient's gross income or $25, whichever is less, is
allowed for representative payee services provided by an agency that meets the requirements
under SSI regulations to charge a fee for representative payee services. This special need
is available to all recipients of Minnesota supplemental aid regardless of their living
arrangement.
deleted text begin (f)deleted text end new text begin (g)new text end (1) Notwithstanding the language in this subdivision, an amount equal to new text begin one-half
of new text end the maximum deleted text begin allotment authorized by the federal Food Stamp Program for adeleted text end new text begin federal
Supplemental Security Income payment amount for anew text end single individual which is in effect
on the first day of July of each year will be added to the standards of assistance established
in subdivisions 1 to 4 for adults under the age of 65 who qualify as deleted text begin shelter needydeleted text end new text begin in need
of housing assistancenew text end and are:
(i) relocating from an institution, new text begin a setting authorized to receive housing support under
chapter 256I, new text end or an adult mental health residential treatment program under section
256B.0622; deleted text begin or
deleted text end
(ii) new text begin eligible for personal care assistance under section 256B.0659; or
new text end
new text begin (iii) new text end home and community-based waiver recipients living in their own home or rented
or leased apartment deleted text begin which is not owned, operated, or controlled by a provider of service
not related by blood or marriage, unless allowed under paragraph (g)deleted text end .
(2) Notwithstanding subdivision 3, paragraph (c), an individual eligible for the shelter
needy benefit under this paragraph is considered a household of one. An eligible individual
who receives this benefit prior to age 65 may continue to receive the benefit after the age
of 65.
(3) "deleted text begin Shelter needydeleted text end new text begin Housing assistancenew text end " means that the assistance unit incurs monthly
shelter costs that exceed 40 percent of the assistance unit's gross income before the application
of this special needs standard. "Gross income" for the purposes of this section is the
applicant's or recipient's income as defined in section 256D.35, subdivision 10, or the
standard specified in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient
of a federal or state housing subsidy, that limits shelter costs to a percentage of gross income,
shall not be considered deleted text begin shelter needydeleted text end new text begin in need of housing assistancenew text end for purposes of this
paragraph.
deleted text begin
(g) Notwithstanding this subdivision, to access housing and services as provided in
paragraph (f), the recipient may choose housing that may be owned, operated, or controlled
by the recipient's service provider. When housing is controlled by the service provider, the
individual may choose the individual's own service provider as provided in section 256B.49,
subdivision 23, clause (3). When the housing is controlled by the service provider, the
service provider shall implement a plan with the recipient to transition the lease to the
recipient's name. Within two years of signing the initial lease, the service provider shall
transfer the lease entered into under this subdivision to the recipient. In the event the landlord
denies this transfer, the commissioner may approve an exception within sufficient time to
ensure the continued occupancy by the recipient. This paragraph expires June 30, 2016.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (a); (b); (c); (d); (e); and (f) are effective July 1, 2017.
Paragraph (g), clause (1), is effective July 1, 2020, except paragraph g, clause (1), items (ii)
and (iii), are effective July 1, 2017.
new text end
Sec. 4.
Minnesota Statutes 2016, section 256I.03, subdivision 8, is amended to read:
Subd. 8.
Supplementary services.
"Supplementary services" means new text begin housing support
new text end services provided to deleted text begin residents of group residential housing providersdeleted text end new text begin individualsnew text end in addition
to room and board including, but not limited to, oversight and up to 24-hour supervision,
medication reminders, assistance with transportation, arranging for meetings and
appointments, and arranging for medical and social services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 5.
Minnesota Statutes 2016, section 256I.04, subdivision 1, is amended to read:
Subdivision 1.
Individual eligibility requirements.
An individual is eligible for and
entitled to a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end payment to be made on the individual's behalf
if the agency has approved the deleted text begin individual's residence in a group residentialdeleted text end new text begin setting where
the individual will receivenew text end housing deleted text begin settingdeleted text end new text begin supportnew text end and the individual meets the requirements
in paragraph (a) or (b).
(a) The individual is aged, blind, or is over 18 years of age and disabled as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2, is less than the monthly rate specified in the agency's agreement with the
provider of deleted text begin group residentialdeleted text end housingnew text begin supportnew text end in which the individual resides.
(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (5) to (9), and (14), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of deleted text begin group residentialdeleted text end housingnew text begin supportnew text end
in which the individual resides.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 6.
Minnesota Statutes 2016, section 256I.04, subdivision 2d, is amended to read:
Subd. 2d.
Conditions of payment; commissioner's right to suspend or terminate
agreement.
(a) deleted text begin Group residentialdeleted text end Housing deleted text begin or supplementary servicesdeleted text end new text begin supportnew text end must be
provided to the satisfaction of the commissioner, as determined at the sole discretion of the
commissioner's authorized representative, and in accordance with all applicable federal,
state, and local laws, ordinances, rules, and regulations, including business registration
requirements of the Office of the Secretary of State. A provider shall not receive payment
for new text begin room and board or supplementary new text end services deleted text begin or housingdeleted text end found by the commissioner to be
performed or provided in violation of federal, state, or local law, ordinance, rule, or
regulation.
(b) The commissioner has the right to suspend or terminate the agreement immediately
when the commissioner determines the health or welfare of the housing or service recipients
is endangered, or when the commissioner has reasonable cause to believe that the provider
has breached a material term of the agreement under subdivision 2b.
(c) Notwithstanding paragraph (b), if the commissioner learns of a curable material
breach of the agreement by the provider, the commissioner shall provide the provider with
a written notice of the breach and allow ten days to cure the breach. If the provider does
not cure the breach within the time allowed, the provider shall be in default of the agreement
and the commissioner may terminate the agreement immediately thereafter. If the provider
has breached a material term of the agreement and cure is not possible, the commissioner
may immediately terminate the agreement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 7.
Minnesota Statutes 2016, section 256I.04, subdivision 2g, is amended to read:
Subd. 2g.
Crisis shelters.
Secure crisis shelters for battered women and their children
designated by the Minnesota Department of Corrections are not deleted text begin group residencesdeleted text end new text begin eligible
for housing supportnew text end under this chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 8.
Minnesota Statutes 2016, section 256I.04, subdivision 3, is amended to read:
Subd. 3.
Moratorium on development of deleted text begin group residentialdeleted text end housingnew text begin supportnew text end beds.
(a) Agencies shall not enter into agreements for new deleted text begin group residentialdeleted text end housingnew text begin supportnew text end beds
with total rates in excess of the MSA equivalent rate except:
(1) for deleted text begin group residential housingdeleted text end establishments licensed under chapter 245D provided
the facility is needed to meet the census reduction targets for persons with developmental
disabilities at regional treatment centers;
(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a, paragraph (b);
(3) notwithstanding the provisions of subdivision 2a, for up to 190 supportive housing
units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a mental
illness, a history of substance abuse, or human immunodeficiency virus or acquired
immunodeficiency syndrome. For purposes of this section, "homeless adult" means a person
who is living on the street or in a shelter or discharged from a regional treatment center,
community hospital, or residential treatment program and has no appropriate housing
available and lacks the resources and support necessary to access appropriate housing. At
least 70 percent of the supportive housing units must serve homeless adults with mental
illness, substance abuse problems, or human immunodeficiency virus or acquired
immunodeficiency syndrome who are about to be or, within the previous six months, has
been discharged from a regional treatment center, or a state-contracted psychiatric bed in
a community hospital, or a residential mental health or chemical dependency treatment
program. If a person meets the requirements of subdivision 1, paragraph (a), and receives
a federal or state housing subsidy, the deleted text begin group residentialdeleted text end housingnew text begin supportnew text end rate for that person
is limited to the supplementary rate under section 256I.05, subdivision 1a, and is determined
by subtracting the amount of the person's countable income that exceeds the MSA equivalent
rate from the deleted text begin group residentialdeleted text end housingnew text begin supportnew text end supplementarynew text begin servicenew text end rate. A resident in a
demonstration project site who no longer participates in the demonstration program shall
retain eligibility for a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end payment in an amount determined
under section 256I.06, subdivision 8, using the MSA equivalent rate. Service funding under
section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching funds are
available and the services can be provided through a managed care entity. If federal matching
funds are not available, then service funding will continue under section 256I.05, subdivision
1a;
(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end contract with the county and has been licensed as
a board and lodge facility with special services since 1980;
(5) for a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end provider located in the city of St. Cloud, or
a county contiguous to the city of St. Cloud, that operates a 40-bed facility, that received
financing through the Minnesota Housing Finance Agency Ending Long-Term Homelessness
Initiative and serves chemically dependent clientele, providing 24-hour-a-day supervision;
(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end provider that currently operates a
304-bed facility in Minneapolis, and a 44-bed facility in Duluth;
(7) for a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end provider that operates two ten-bed facilities,
one located in Hennepin County and one located in Ramsey County, that provide community
support and 24-hour-a-day supervision to serve the mental health needs of individuals who
have chronically lived unsheltered; and
(8) for a deleted text begin group residentialdeleted text end facilitynew text begin authorized for recipients of housing supportnew text end in Hennepin
County with a capacity of up to 48 beds that has been licensed since 1978 as a board and
lodging facility and that until August 1, 2007, operated as a licensed chemical dependency
treatment program.
(b) An agency may enter into a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end agreement for beds
with rates in excess of the MSA equivalent rate in addition to those currently covered under
a deleted text begin group residentialdeleted text end housingnew text begin supportnew text end agreement if the additional beds are only a replacement
of beds with rates in excess of the MSA equivalent rate which have been made available
due to closure of a setting, a change of licensure or certification which removes the beds
from deleted text begin group residentialdeleted text end housingnew text begin supportnew text end payment, or as a result of the downsizing of a deleted text begin group
residential housingdeleted text end settingnew text begin authorized for recipients of housing supportnew text end . The transfer of
available beds from one agency to another can only occur by the agreement of both agencies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 9.
Minnesota Statutes 2016, section 256I.05, subdivision 1a, is amended to read:
Subd. 1a.
Supplementary service rates.
(a) Subject to the provisions of section 256I.04,
subdivision 3, the county agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board deleted text begin provided by the group residencedeleted text end if the residence
is licensed by or registered by the Department of Health, or licensed by the Department of
Human Services to provide services in addition to room and board, and if the provider of
services is not also concurrently receiving funding for services for a recipient under a home
and community-based waiver under title XIX of the Social Security Act; or funding from
the medical assistance program under section 256B.0659, for personal care services for
residents in the setting; or residing in a setting which receives funding under section 245.73.
If funding is available for other necessary services through a home and community-based
waiver, or personal care services under section 256B.0659, then the deleted text begin GRHdeleted text end new text begin housing supportnew text end
rate is limited to the rate set in subdivision 1. Unless otherwise provided in law, in no case
may the supplementary service rate exceed $426.37. The registration and licensure
requirement does not apply to establishments which are exempt from state licensure because
they are located on Indian reservations and for which the tribe has prescribed health and
safety requirements. Service payments under this section may be prohibited under rules to
prevent the supplanting of federal funds with state funds. The commissioner shall pursue
the feasibility of obtaining the approval of the Secretary of Health and Human Services to
provide home and community-based waiver services under title XIX of the Social Security
Act for residents who are not eligible for an existing home and community-based waiver
due to a primary diagnosis of mental illness or chemical dependency and shall apply for a
waiver if it is determined to be cost-effective.
(b) The commissioner is authorized to make cost-neutral transfers from the deleted text begin GRHdeleted text end new text begin housing
supportnew text end fund for beds under this section to other funding programs administered by the
department after consultation with the county or counties in which the affected beds are
located. The commissioner may also make cost-neutral transfers from the deleted text begin GRHdeleted text end new text begin housing
supportnew text end fund to county human service agencies for beds permanently removed from the
deleted text begin GRHdeleted text end new text begin housing supportnew text end census under a plan submitted by the county agency and approved
by the commissioner. The commissioner shall report the amount of any transfers under this
provision annually to the legislature.
(c) Counties must not negotiate supplementary service rates with providers of deleted text begin group
residentialdeleted text end housing new text begin support new text end that are licensed as board and lodging with special services and
that do not encourage a policy of sobriety on their premises and make referrals to available
community services for volunteer and employment opportunities for residents.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 10.
Minnesota Statutes 2016, section 256I.05, subdivision 1c, is amended to read:
Subd. 1c.
Rate increases.
An agency may not increase the rates negotiated for deleted text begin group
residentialdeleted text end housing new text begin support new text end above those in effect on June 30, 1993, except as provided in
paragraphs (a) to (f).
(a) An agency may increase the rates for deleted text begin group residential housing settingsdeleted text end new text begin room and
boardnew text end to the MSA equivalent rate for those settings whose current rate is below the MSA
equivalent rate.
(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total deleted text begin group residentialdeleted text end housingnew text begin supportnew text end rate for these residents
must not exceed the maximum rate specified in subdivisions 1 and 1a. Agencies must not
include nor increase deleted text begin group residential housingdeleted text end difficulty of care rates for adults in foster
care whose difficulty of care is eligible for funding by home and community-based waiver
programs under title XIX of the Social Security Act.
(c) The room and board rates will be increased each year when the MSA equivalent rate
is adjusted for SSI cost-of-living increases by the amount of the annual SSI increase, less
the amount of the increase in the medical assistance personal needs allowance under section
256B.35.
(d) When deleted text begin a group residentialdeleted text end housing deleted text begin rate is used to paydeleted text end new text begin support paysnew text end for an individual's
room and board, or other costs necessary to provide room and board, the rate payable to the
residence must continue for up to 18 calendar days per incident that the person is temporarily
absent from the residence, not to exceed 60 days in a calendar year, if the absence or absences
have received the prior approval of the county agency's social service staff. Prior approval
is not required for emergency absences due to crisis, illness, or injury.
(e) For facilities meeting substantial change criteria within the prior year. Substantial
change criteria exists if the deleted text begin group residential housingdeleted text end establishment experiences a 25 percent
increase or decrease in the total number of its beds, if the net cost of capital additions or
improvements is in excess of 15 percent of the current market value of the residence, or if
the residence physically moves, or changes its licensure, and incurs a resulting increase in
operation and property costs.
(f) Until June 30, 1994, an agency may increase by up to five percent the total rate paid
for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54 who
reside in residences that are licensed by the commissioner of health as a boarding care home,
but are not certified for the purposes of the medical assistance program. However, an increase
under this clause must not exceed an amount equivalent to 65 percent of the 1991 medical
assistance reimbursement rate for nursing home resident class A, in the geographic grouping
in which the facility is located, as established under Minnesota Rules, parts 9549.0051 to
9549.0058.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 11.
Minnesota Statutes 2016, section 256I.05, subdivision 1e, is amended to read:
Subd. 1e.
Supplementary rate for certain facilities.
(a) Notwithstanding the provisions
of subdivisions 1a and 1c, beginning July 1, 2005, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed deleted text begin $700 per
monthdeleted text end new text begin the maximum rate in subdivision 1anew text end , including any legislatively authorized inflationary
adjustments, for a deleted text begin group residentialdeleted text end housing new text begin support new text end provider that:
(1) is located in Hennepin County and has had a deleted text begin group residentialdeleted text end housing new text begin support
new text end contract with the county since June 1996;
(2) operates in three separate locations a 75-bed facility, a 50-bed facility, and a 26-bed
facility; and
(3) serves a chemically dependent clientele, providing 24 hours per day supervision and
limiting a resident's maximum length of stay to 13 months out of a consecutive 24-month
period.
(b) Notwithstanding subdivisions 1a and 1c, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed deleted text begin $700 per
monthdeleted text end new text begin the maximum rate in subdivision 1anew text end , including any legislatively authorized inflationary
adjustments, of a deleted text begin group residentialdeleted text end new text begin housing supportnew text end provider that:
(1) is located in St. Louis County and has had a deleted text begin group residentialdeleted text end housing new text begin support new text end contract
with the county since 2006;
(2) operates a 62-bed facility; and
(3) serves a chemically dependent adult male clientele, providing 24 hours per day
supervision and limiting a resident's maximum length of stay to 13 months out of a
consecutive 24-month period.
(c) Notwithstanding subdivisions 1a and 1c, beginning July 1, 2013, a county agency
shall negotiate a supplementary rate in addition to the rate specified in subdivision 1, not
to exceed deleted text begin $700 per monthdeleted text end new text begin the maximum rate in subdivision 1anew text end , including any legislatively
authorized inflationary adjustments, for the deleted text begin group residentialdeleted text end provider described under
paragraphs (a) and (b), not to exceed an additional 115 beds.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 12.
Minnesota Statutes 2016, section 256I.05, subdivision 1j, is amended to read:
Subd. 1j.
Supplementary rate for certain facilities; Crow Wing County.
Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 2007, a county
agency shall negotiate a supplementary rate in addition to the rate specified in subdivision
1, not to exceed deleted text begin $700 per monthdeleted text end new text begin the maximum rate in subdivision 1anew text end , including any
legislatively authorized inflationary adjustments, for a new 65-bed facility in Crow Wing
County that will serve chemically dependent persons operated by a deleted text begin group residentialdeleted text end housing
new text begin support new text end provider that currently operates a 304-bed facility in Minneapolis and a 44-bed
facility in Duluth which opened in January of 2006.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 13.
Minnesota Statutes 2016, section 256I.05, subdivision 1m, is amended to read:
Subd. 1m.
Supplemental rate for certain facilities; Hennepin and Ramsey Counties.
(a) Notwithstanding the provisions of this section, beginning July 1, 2007, a county agency
shall negotiate a supplemental service rate in addition to the rate specified in subdivision
1, not to exceed deleted text begin $700 per month or the existing monthly rate, whichever is higherdeleted text end new text begin the
maximum rate in subdivision 1anew text end , including any legislatively authorized inflationary
adjustments, for a deleted text begin group residentialdeleted text end housing new text begin support new text end provider that operates two ten-bed
facilities, one located in Hennepin County and one located in Ramsey County, which provide
community support and serve the mental health needs of individuals who have chronically
lived unsheltered, providing 24-hour-per-day supervision.
(b) An individual who has lived in one of the facilities under paragraph (a), who is being
transitioned to independent living as part of the program plan continues to be eligible for
deleted text begin group residential housingdeleted text end new text begin room and boardnew text end and the supplemental service rate negotiated with
the county under paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 14.
Minnesota Statutes 2016, section 256I.05, subdivision 8, is amended to read:
Subd. 8.
State participation.
For a deleted text begin resident of a group residencedeleted text end new text begin personnew text end who is eligible
under section 256I.04, subdivision 1, paragraph (b), state participation in the deleted text begin group residentialdeleted text end
housing new text begin support new text end payment is determined according to section 256D.03, subdivision 2. For
a deleted text begin resident of a group residencedeleted text end new text begin personnew text end who is eligible under section 256I.04, subdivision 1,
paragraph (a), state participation in the deleted text begin group residentialdeleted text end housing new text begin support new text end rate is determined
according to section 256D.36.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 15.
Minnesota Statutes 2016, section 256I.06, subdivision 2, is amended to read:
Subd. 2.
Time of payment.
A county agency may make payments deleted text begin to a group residencedeleted text end
in advance for an individual whose stay deleted text begin in the group residencedeleted text end is expected to last beyond
the calendar month for which the payment is made. deleted text begin Group residentialdeleted text end Housingnew text begin supportnew text end
payments made by a county agency on behalf of an individual who is not expected to remain
in the group residence beyond the month for which payment is made must be made
subsequent to the individual's departure from the deleted text begin groupdeleted text end residence.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 16.
Minnesota Statutes 2016, section 256I.06, subdivision 8, is amended to read:
Subd. 8.
Amount of deleted text begin group residentialdeleted text end housingnew text begin supportnew text end payment.
(a) The amount of
a deleted text begin group residential housingdeleted text end new text begin room and boardnew text end payment to be made on behalf of an eligible
individual is determined by subtracting the individual's countable income under section
256I.04, subdivision 1, for a whole calendar month from the deleted text begin group residential housing
chargedeleted text end new text begin room and board ratenew text end for that same month. The deleted text begin group residentialdeleted text end housing deleted text begin chargedeleted text end new text begin
support paymentnew text end is determined by multiplying the deleted text begin group residentialdeleted text end housingnew text begin supportnew text end rate
times the period of time the individual was a resident or temporarily absent under section
256I.05, subdivision 1c, paragraph (d).
(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 17.
new text begin
[256I.09] COMMUNITY LIVING INFRASTRUCTURE.
new text end
new text begin
Each calendar year, the commissioner shall allocate funding to agencies for: (1) outreach
to locate and engage people who are homeless or residing in institutions or facilities to
screen for basic needs and assist with referral to community living resources, (2) housing
resource specialist staff to provide technical assistance and consultation on housing and
related support service resources for persons with both disabilities and low income, or (3)
administration and monitoring activities related to housing support funds. The commissioner
shall allocate funding according to indicators of need, such as poverty rates and housing
cost burden. An agency may partner with another agency. The commissioner may adjust
allocations to partnered agencies to reflect regional coordination.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 18. new text begin REVISOR'S INSTRUCTION.
new text end
new text begin
In each section of Minnesota Statutes referred to in column A, the revisor of statutes
shall change the phrase in column B to the phrase in column C. The revisor may make
technical and other necessary changes to sentence structure to preserve the meaning of the
text. The revisor shall make other changes in chapter titles; section, subdivision, part, and
subpart headnotes; and in other terminology necessary as a result of the enactment of this
section.
new text end
|
new text begin
Column A new text end |
new text begin
Column B new text end |
new text begin
Column C new text end |
|
new text begin
144A.071, subdivision 4d new text end |
new text begin
group residential housing new text end |
new text begin
housing support under chapter 256I new text end |
|
new text begin
201.061, subdivision 3 new text end |
new text begin
group residential housing new text end |
new text begin
setting authorized to provide housing support new text end |
|
new text begin
244.052, subdivision 4c new text end |
new text begin
group residential housing facility new text end |
new text begin
licensed setting authorized to provide housing support under section 256I.04 new text end |
|
new text begin
245.466, subdivision 7 new text end |
new text begin
under group residential housing new text end |
new text begin
by housing support under chapter 256I new text end |
|
new text begin
245.466, subdivision 7 new text end |
new text begin
from group residential housing new text end |
new text begin
from housing support new text end |
|
new text begin
245.4661, subdivision 6 new text end |
new text begin
group residential housing new text end |
new text begin
housing support under chapter 256I new text end |
|
new text begin
245C.10, subdivision 11 new text end |
new text begin
group residential housing or supplementary services new text end |
new text begin
housing support new text end |
|
new text begin
256.01, subdivision 18 new text end |
new text begin
group residential housing new text end |
new text begin
housing support under chapter 256I new text end |
|
new text begin
256.017, subdivision 1 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256.98, subdivision 8 new text end |
new text begin
group residential housing new text end |
new text begin
housing support under chapter 256I new text end |
|
new text begin
256B.49, subdivision 15 new text end |
new text begin
group residential housing new text end |
new text begin
housing support under chapter 256I new text end |
|
new text begin
256B.4914, subdivision 10 new text end |
new text begin
group residential housing rate 3 costs new text end |
new text begin
housing support rate 3 costs under chapter 256I new text end |
|
new text begin
256B.501, subdivision 4b new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256B.77, subdivision 12 new text end |
new text begin
residential services covered under the group residential housing program new text end |
new text begin
housing support services under chapter 256I new text end |
|
new text begin
256D.44, subdivision 2 new text end |
new text begin
group residential housing facility new text end |
new text begin
setting authorized to provide housing support new text end |
|
new text begin
256G.01, subdivision 3 new text end |
new text begin
group residential housing new text end |
new text begin
housing support under chapter 256I new text end |
|
new text begin
256I.01 new text end |
new text begin
Group Residential Housing new text end |
new text begin
Housing Support new text end |
|
new text begin
256I.02 new text end |
new text begin
Group Residential Housing new text end |
new text begin
Housing Support new text end |
|
new text begin
256I.03, subdivision 2 new text end |
new text begin
"Group residential housing" new text end |
new text begin
"Room and board" new text end |
|
new text begin
256I.03, subdivision 2 new text end |
new text begin
Group residential housing new text end |
new text begin
The room and board new text end |
|
new text begin
256I.03, subdivision 3 new text end |
new text begin
"Group residential housing" new text end |
new text begin
"Housing support" new text end |
|
new text begin
256I.03, subdivision 6 new text end |
new text begin
group residential housing new text end |
new text begin
room and board new text end |
|
new text begin
256I.03, subdivisions 7 and 9 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256I.04, subdivisions 1a, 1b, 1c, and 2 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256I.04, subdivision 2a new text end |
new text begin
provide group residential housing new text end |
new text begin
provide housing support new text end |
|
new text begin
256I.04, subdivision 2a new text end |
new text begin
of group residential housing or supplementary services new text end |
new text begin
of housing support new text end |
|
new text begin
256I.04, subdivision 2a new text end |
new text begin
complete group residential housing new text end |
new text begin
complete housing support new text end |
|
new text begin
256I.04, subdivision 2b new text end |
new text begin
group residential housing or supplementary services new text end |
new text begin
housing support new text end |
|
new text begin
256I.04, subdivision 2b new text end |
new text begin
provision of group residential housing new text end |
new text begin
provision of housing support new text end |
|
new text begin
256I.04, subdivision 2c new text end |
new text begin
group residential housing or supplementary services new text end |
new text begin
housing support new text end |
|
new text begin
256I.04, subdivision 2e new text end |
new text begin
group residential housing or supplementary services new text end |
new text begin
housing support new text end |
|
new text begin
256I.04, subdivision 4 new text end |
new text begin
group residential housing payment for room and board new text end |
new text begin
room and board rate new text end |
|
new text begin
256I.05, subdivision 1 new text end |
new text begin
living in group residential housing new text end |
new text begin
receiving housing support new text end |
|
new text begin
256I.05, subdivisions 1h, 1k, 1l, 7b, and 7c new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256I.05, subdivision 2 new text end |
new text begin
group residential housing new text end |
new text begin
room and board new text end |
|
new text begin
256I.05, subdivision 3 new text end |
new text begin
group residential housing new text end |
new text begin
room and board new text end |
|
new text begin
256I.05, subdivision 6 new text end |
new text begin
reside in group residential housing new text end |
new text begin
receive housing support new text end |
|
new text begin
256I.06, subdivisions 1, 3, 4, and 6 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256I.06, subdivision 7 new text end |
new text begin
group residential housing new text end |
new text begin
the housing support new text end |
|
new text begin
256I.08 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256P.03, subdivision 1 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256P.05, subdivision 1 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256P.07, subdivision 1 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
256P.08, subdivision 1 new text end |
new text begin
group residential housing new text end |
new text begin
housing support new text end |
|
new text begin
290A.03, subdivision 8 new text end |
new text begin
accepts group residential housing new text end |
new text begin
accepts housing support new text end |
|
new text begin
290A.03, subdivision 8 new text end |
new text begin
the group residential housing program new text end |
new text begin
the housing support program new text end |
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
ARTICLE 3
CONTINUING CARE
Section 1.
Minnesota Statutes 2016, section 144.0724, subdivision 6, is amended to read:
Subd. 6.
Penalties for late or nonsubmission.
(a) A facility that fails to complete or
submit an assessment according to subdivisions 4 and 5 for a RUG-IV classification within
seven days of the time requirements listed in the Long-Term Care Facility Resident
Assessment Instrument User's Manual is subject to a reduced rate for that resident. The
reduced rate shall be the lowest rate for that facility. The reduced rate is effective on the
day of admission for new admission assessments, on the ARD for significant change in
status assessments, or on the day that the assessment was due for all other assessments and
continues in effect until the first day of the month following the date of submission and
acceptance of the resident's assessment.
(b) If loss of revenue due to penalties incurred by a facility for any period of 92 days
are equal to or greater than deleted text begin 1.0deleted text end new text begin 0.1new text end percent of the total operating costs on the facility's most
recent annual statistical and cost report, a facility may apply to the commissioner of human
services for a reduction in the total penalty amount. The commissioner of human services,
in consultation with the commissioner of health, may, at the sole discretion of the
commissioner of human services, limit the penalty for residents covered by medical assistance
to deleted text begin 15deleted text end new text begin tennew text end days.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2016, section 144A.071, subdivision 4d, is amended to read:
Subd. 4d.
Consolidation of nursing facilities.
(a) The commissioner of health, in
consultation with the commissioner of human services, may approve a request for
consolidation of nursing facilities which includes the closure of one or more facilities and
the upgrading of the physical plant of the remaining nursing facility or facilities, the costs
of which exceed the threshold project limit under subdivision 2, clause (a). The
commissioners shall consider the criteria in this section, section 144A.073, and section
deleted text begin 256B.437deleted text end new text begin 256R.40new text end , in approving or rejecting a consolidation proposal. In the event the
commissioners approve the request, the commissioner of human services shall calculate an
external fixed costs rate adjustment according to clauses (1) to (3):
(1) the closure of beds shall not be eligible for a planned closure rate adjustment under
section deleted text begin 256B.437, subdivision 6deleted text end new text begin 256R.40, subdivision 5new text end ;
(2) the construction project permitted in this clause shall not be eligible for a threshold
project rate adjustment under section 256B.434, subdivision 4f, or a moratorium exception
adjustment under section 144A.073; and
(3) the payment rate for external fixed costs for a remaining facility or facilities shall
be increased by an amount equal to 65 percent of the projected net cost savings to the state
calculated in paragraph (b), divided by the state's medical assistance percentage of medical
assistance dollars, and then divided by estimated medical assistance resident days, as
determined in paragraph (c), of the remaining nursing facility or facilities in the request in
this paragraph. The rate adjustment is effective on the deleted text begin later of the first day of the month
followingdeleted text end new text begin first day of the month of January or July, whichever date occurs immediately
after the new text end completion of the construction upgrades in the consolidation plan deleted text begin or the first day
of the month followingdeleted text end new text begin andnew text end the complete deleted text begin closure of a facilitydeleted text end new text begin closure of the facility or
facilitiesnew text end designated for closure in the consolidation plan. If more than one facility is receiving
upgrades in the consolidation plan, each facility's date of construction completion must be
evaluated separately.
(b) For purposes of calculating the net cost savings to the state, the commissioner shall
consider clauses (1) to (7):
(1) the annual savings from estimated medical assistance payments from the net number
of beds closed taking into consideration only beds that are in active service on the date of
the request and that have been in active service for at least three years;
(2) the estimated annual cost of increased case load of individuals receiving services
under the elderly waiver;
(3) the estimated annual cost of elderly waiver recipients receiving support under group
residential housing;
(4) the estimated annual cost of increased case load of individuals receiving services
under the alternative care program;
(5) the annual loss of license surcharge payments on closed beds;
(6) the savings from not paying planned closure rate adjustments that the facilities would
otherwise be eligible for under section deleted text begin 256B.437deleted text end new text begin 256R.40new text end ; and
(7) the savings from not paying external fixed costs payment rate adjustments from
submission of renovation costs that would otherwise be eligible as threshold projects under
section 256B.434, subdivision 4f.
(c) For purposes of the calculation in paragraph (a), clause (3), the estimated medical
assistance resident days of the remaining facility or facilities shall be computed assuming
95 percent occupancy multiplied by the historical percentage of medical assistance resident
days of the remaining facility or facilities, as reported on the facility's or facilities' most
recent nursing facility statistical and cost report filed before the plan of closure is submitted,
multiplied by 365.
(d) For purposes of net cost of savings to the state in paragraph (b), the average occupancy
percentages will be those reported on the facility's or facilities' most recent nursing facility
statistical and cost report filed before the plan of closure is submitted, and the average
payment rates shall be calculated based on the approved payment rates in effect at the time
the consolidation request is submitted.
(e) To qualify for the external fixed costs payment rate adjustment under this subdivision,
the closing facilities shall:
(1) submit an application for closure according to section deleted text begin 256B.437, subdivision 3deleted text end new text begin
256R.40, subdivision 2new text end ; and
(2) follow the resident relocation provisions of section 144A.161.
(f) The county or counties in which a facility or facilities are closed under this subdivision
shall not be eligible for designation as a hardship area under subdivision 3 for five years
from the date of the approval of the proposed consolidation. The applicant shall notify the
county of this limitation and the county shall acknowledge this in a letter of support.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for consolidations occurring after July
1, 2017.
new text end
Sec. 3.
Minnesota Statutes 2016, section 144D.03, is amended by adding a subdivision to
read:
new text begin Subd. 1b. new text end
new text begin Fee for data collection; assisted living. new text end
new text begin
At the time for the annual registration
under subdivision 1, the commissioner shall assess an annual fee on each establishment
with an assisted living designation as defined in chapter 144G to pay the commissioner of
human services for costs related to collecting data from residents on quality of life and
quality of care. The revenue from the fee shall be deposited in the general fund. The fee is
nonrefundable. The fee for each establishment shall be $28.60 multiplied by the total
maximum resident capacity.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2018.
new text end
Sec. 4.
Minnesota Statutes 2016, section 144G.02, subdivision 2, is amended to read:
Subd. 2.
Authority of commissioner.
(a) The commissioner, upon receipt of information
that may indicate the failure of a housing with services establishment, the arranged home
care provider, an assisted living client, or an assisted living client's representative to comply
with a legal requirement to which one or more of the entities may be subject, shall make
appropriate referrals to other governmental agencies and entities having jurisdiction over
the subject matter. The commissioner may also make referrals to any public or private
agency the commissioner considers available for appropriate assistance to those involved.
(b) In addition to the authority with respect to licensed home care providers under section
144A.45 and with respect to housing with services establishments under chapter 144D, the
commissioner shall have standing to bring an action for injunctive relief in the district court
in the district in which a housing with services establishment is located to compel the housing
with services establishment or the arranged home care provider to meet the requirements
of this chapter or other requirements of the state or of any county or local governmental
unit to which the establishment or arranged home care provider is otherwise subject.
Proceedings for securing an injunction may be brought by the commissioner through the
attorney general or through the appropriate county attorney. The sanctions in this section
do not restrict the availability of other sanctions.
new text begin
(c) The commissioner, in consultation with the commissioner of human services, shall
survey establishment residents to gather data on resident quality of life and quality of care.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2019.
new text end
Sec. 5.
Minnesota Statutes 2016, section 245D.03, subdivision 1, is amended to read:
Subdivision 1.
Applicability.
(a) The commissioner shall regulate the provision of home
and community-based services to persons with disabilities and persons age 65 and older
pursuant to this chapter. The licensing standards in this chapter govern the provision of
basic support services and intensive support services.
(b) Basic support services provide the level of assistance, supervision, and care that is
necessary to ensure the health and welfare of the person and do not include services that
are specifically directed toward the training, treatment, habilitation, or rehabilitation of the
person. Basic support services include:
(1) in-home and out-of-home respite care services as defined in section 245A.02,
subdivision 15, and under the brain injury, community alternative care, community access
for disability inclusion, developmental disability, and elderly waiver plans, excluding
out-of-home respite care provided to children in a family child foster care home licensed
under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care license
holder complies with the requirements under section 245D.06, subdivisions 5, 6, 7, and 8,
or successor provisions; and section 245D.061 or successor provisions, which must be
stipulated in the statement of intended use required under Minnesota Rules, part 2960.3000,
subpart 4;
(2) adult companion services as defined under the brain injury, community access for
disability inclusion, and elderly waiver plans, excluding adult companion services provided
under the Corporation for National and Community Services Senior Companion Program
established under the Domestic Volunteer Service Act of 1973, Public Law 98-288;
(3) personal support as defined under the developmental disability waiver plan;
(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental disability waiver plans;
(5) night supervision services as defined under the brain injury waiver plan; deleted text begin and
deleted text end
(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental disability, and elderly waiver plans,
excluding providers licensed by the Department of Health under chapter 144A and those
providers providing cleaning services onlydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) individual community living support under section 256B.0915, subdivision 3j.
new text end
(c) Intensive support services provide assistance, supervision, and care that is necessary
to ensure the health and welfare of the person and services specifically directed toward the
training, habilitation, or rehabilitation of the person. Intensive support services include:
(1) intervention services, including:
(i) behavioral support services as defined under the brain injury and community access
for disability inclusion waiver plans;
(ii) in-home or out-of-home crisis respite services as defined under the developmental
disability waiver plan; and
(iii) specialist services as defined under the current developmental disability waiver
plan;
(2) in-home support services, including:
(i) in-home family support and supported living services as defined under the
developmental disability waiver plan;
(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans; and
(iii) semi-independent living services;
(3) residential supports and services, including:
(i) supported living services as defined under the developmental disability waiver plan
provided in a family or corporate child foster care residence, a family adult foster care
residence, a community residential setting, or a supervised living facility;
(ii) foster care services as defined in the brain injury, community alternative care, and
community access for disability inclusion waiver plans provided in a family or corporate
child foster care residence, a family adult foster care residence, or a community residential
setting; and
(iii) residential services provided to more than four persons with developmental
disabilities in a supervised living facility, including ICFs/DD;
(4) day services, including:
(i) structured day services as defined under the brain injury waiver plan;
(ii) day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disability waiver plan; and
(iii) prevocational services as defined under the brain injury and community access for
disability inclusion waiver plans; and
(5) supported employment as defined under the brain injury, developmental disability,
and community access for disability inclusion waiver plans.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2016, section 256.975, subdivision 7, is amended to read:
Subd. 7.
Consumer information and assistance and long-term care options
counseling; Senior LinkAge Line.
(a) The Minnesota Board on Aging shall operate a
statewide service to aid older Minnesotans and their families in making informed choices
about long-term care options and health care benefits. Language services to persons with
limited English language skills may be made available. The service, known as Senior
LinkAge Line, shall serve older adults as the designated Aging and Disability Resource
Center under United States Code, title 42, section 3001, the Older Americans Act
Amendments of 2006 in partnership with the Disability Linkage Line under section 256.01,
subdivision 24, and must be available during business hours through a statewide toll-free
number and the Internet. The Minnesota Board on Aging shall consult with, and when
appropriate work through, the area agencies on aging counties, and other entities that serve
aging and disabled populations of all ages, to provide and maintain the telephone
infrastructure and related support for the Aging and Disability Resource Center partners
which agree by memorandum to access the infrastructure, including the designated providers
of the Senior LinkAge Line and the Disability Linkage Line.
(b) The service must provide long-term care options counseling by assisting older adults,
caregivers, and providers in accessing information and options counseling about choices in
long-term care services that are purchased through private providers or available through
public options. The service must:
(1) develop and provide for regular updating of a comprehensive database that includes
detailed listings in both consumer- and provider-oriented formats that can provide search
results down to the neighborhood level;
(2) make the database accessible on the Internet and through other telecommunication
and media-related tools;
(3) link callers to interactive long-term care screening tools and make these tools available
through the Internet by integrating the tools with the database;
(4) develop community education materials with a focus on planning for long-term care
and evaluating independent living, housing, and service options;
(5) conduct an outreach campaign to assist older adults and their caregivers in finding
information on the Internet and through other means of communication;
(6) implement a messaging system for overflow callers and respond to these callers by
the next business day;
(7) link callers with county human services and other providers to receive more in-depth
assistance and consultation related to long-term care options;
(8) link callers with quality profiles for nursing facilities and other home and
community-based services providers developed by the commissioners of health and human
services;
(9) develop an outreach plan to seniors and their caregivers with a particular focus on
establishing a clear presence in places that seniors recognize and:
(i) place a significant emphasis on improved outreach and service to seniors and their
caregivers by establishing annual plans by neighborhood, city, and county, as necessary, to
address the unique needs of geographic areas in the state where there are dense populations
of seniors;
(ii) establish an efficient workforce management approach and assign community living
specialist staff and volunteers to geographic areas as well as aging and disability resource
center sites so that seniors and their caregivers and professionals recognize the Senior
LinkAge Line as the place to call for aging services and information;
(iii) recognize the size and complexity of the metropolitan area service system by working
with metropolitan counties to establish a clear partnership with them, including seeking
county advice on the establishment of local aging and disabilities resource center sites; and
(iv) maintain dashboards with metrics that demonstrate how the service is expanding
and extending or enhancing its outreach efforts in dispersed or hard to reach locations in
varied population centers;
(10) incorporate information about the availability of housing options, as well as
registered housing with services and consumer rights within the MinnesotaHelp.info network
long-term care database to facilitate consumer comparison of services and costs among
housing with services establishments and with other in-home services and to support financial
self-sufficiency as long as possible. Housing with services establishments and their arranged
home care providers shall provide information that will facilitate price comparisons, including
delineation of charges for rent and for services available. The commissioners of health and
human services shall align the data elements required by section 144G.06, the Uniform
Consumer Information Guide, and this section to provide consumers standardized information
and ease of comparison of long-term care options. The commissioner of human services
shall provide the data to the Minnesota Board on Aging for inclusion in the
MinnesotaHelp.info network long-term care database;
(11) provide long-term care options counseling. Long-term care options counselors shall:
(i) for individuals not eligible for case management under a public program or public
funding source, provide interactive decision support under which consumers, family
members, or other helpers are supported in their deliberations to determine appropriate
long-term care choices in the context of the consumer's needs, preferences, values, and
individual circumstances, including implementing a community support plan;
(ii) provide Web-based educational information and collateral written materials to
familiarize consumers, family members, or other helpers with the long-term care basics,
issues to be considered, and the range of options available in the community;
(iii) provide long-term care futures planning, which means providing assistance to
individuals who anticipate having long-term care needs to develop a plan for the more
distant future; and
(iv) provide expertise in benefits and financing options for long-term care, including
Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
private pay options, and ways to access low or no-cost services or benefits through
volunteer-based or charitable programs;
(12) using risk management and support planning protocols, provide long-term care
options counselingnew text begin under clause (13)new text end to current residents of nursing homes deemed
appropriate for discharge by the commissionerdeleted text begin , former residents of nursing homes who
were discharged to community settings, and older adults who request service after
consultation with the Senior LinkAge Line under clause (13). The Senior LinkAge Line
shall also receive referrals from the residents or staff of nursing homes.deleted text end new text begin who meet a profile
that demonstrates that the consumer is either at risk of readmission to a nursing home or
hospital, or would benefit from long-term care options counseling to age in place.new text end The Senior
LinkAge Line shall identify and contact residentsnew text begin or patientsnew text end deemed appropriate deleted text begin for
dischargedeleted text end by developing targeting criterianew text begin and creating a profilenew text end in consultation with the
commissioner deleted text begin whodeleted text end new text begin . The commissionernew text end shall provide designated Senior LinkAge Line contact
centers with a list ofnew text begin current or formernew text end nursing home residentsnew text begin or people discharged from a
hospital or for whom Medicare home care has ended,new text end that meet the criteria as being
appropriate for deleted text begin discharge planningdeleted text end new text begin long-term care options counseling through a referralnew text end via
a secure Web portal. Senior LinkAge Line shall provide these residents, if they indicate a
preference to receive long-term care options counseling, with initial assessment and, if
appropriate, a referral to:
(i) long-term care consultation services under section 256B.0911;
(ii) designated care coordinators of contracted entities under section 256B.035 for persons
who are enrolled in a managed care plan; or
(iii) the long-term care consultation team for those who are eligible for relocation service
coordination due to high-risk factors or psychological or physical disability; and
(13) develop referral protocols and processes that will assist certified health care homesnew text begin ,
Medicare home care,new text end and hospitals to identify at-risk older adults and determine when to
refer these individuals to the Senior LinkAge Line for long-term care options counseling
under this section. The commissioner is directed to work with the commissioner of health
to develop protocols that would comply with the health care home designation criteria and
protocols available at the time of hospital dischargenew text begin or the end of Medicare home carenew text end . The
commissioner shall keep a record of the number of people who choose long-term care
options counseling as a result of this section.
(c) Nursing homes shall provide contact information to the Senior LinkAge Line for
residents identified in paragraph (b), clause (12), to provide long-term care options counseling
pursuant to paragraph (b), clause (11). The contact information for residents shall include
all information reasonably necessary to contact residents, including first and last names,
permanent and temporary addresses, telephone numbers, and e-mail addresses.
new text begin
(d) The Senior LinkAge Line shall determine when it is appropriate to refer a consumer
who receives long-term care options counseling under paragraph (b), clause (12) or (13),
and who uses an unpaid caregiver to the self-directed caregiver service under subdivision
12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 7.
Minnesota Statutes 2016, section 256.975, is amended by adding a subdivision to
read:
new text begin Subd. 12. new text end
new text begin Self-directed caregiver grants. new text end
new text begin
Beginning on July 1, 2019, the Minnesota
Board on Aging shall administer self-directed caregiver grants to support at risk family
caregivers of older adults or others eligible under the Older Americans Act of 1965, United
States Code, title 42, chapter 35, sections 3001 to 3058ff, to sustain family caregivers in
the caregivers' roles so older adults can remain at home longer. The board shall give priority
to consumers referred under section 256.975, subdivision 7, paragraph (d).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 8.
Minnesota Statutes 2016, section 256B.431, subdivision 10, is amended to read:
Subd. 10.
Property rate adjustments and construction projects.
A nursing facility
completing a construction project that is eligible for a rate adjustment under section
256B.434, subdivision 4f, and that was not approved through the moratorium exception
process in section 144A.073 must request from the commissioner a property-related payment
rate adjustment. deleted text begin If the request is made within 60 days after the construction project's
completion date,deleted text end The effective date of the rate adjustment is the first of the month new text begin of January
or July, whichever occurs immediately new text end following the new text begin construction project's new text end completion datenew text begin
and submission of the provider's rate adjustment requestnew text end . deleted text begin If the request is made more than
60 days after the completion date, the rate adjustment is effective on the first of the month
following the request.deleted text end The commissioner shall provide a rate notice reflecting the allowable
costs within 60 days after receiving all the necessary information to compute the rate
adjustment. No sooner than the effective date of the rate adjustment for the construction
project, a nursing facility may adjust its rates by the amount anticipated to be allowed. Any
amounts collected from private pay residents in excess of the allowable rate must be repaid
to private pay residents with interest at the rate used by the commissioner of revenue for
the late payment of taxes and in effect on the date the rate increase is effective. Construction
projects with completion dates within one year of the completion date associated with the
property rate adjustment request and phased projects with project completion dates within
three years of the last phase of the phased project must be aggregated for purposes of the
minimum thresholds in subdivisions 16 and 17, and the maximum threshold in section
144A.071, subdivision 2. "Construction project" and "project construction costs" have the
meanings given them in Minnesota Statutes, section 144A.071, subdivision 1a.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for projects completed after January 1,
2018.
new text end
Sec. 9.
Minnesota Statutes 2016, section 256B.431, subdivision 16, is amended to read:
Subd. 16.
Major additions and replacements; equity incentive.
For rate years beginning
after June 30, 1993, if a nursing facility acquires capital assets in connection with a project
approved under the moratorium exception process in section 144A.073 or in connection
with an addition to or replacement of buildings, attached fixtures, or land improvements
for which the total historical cost of those capital asset additions exceeds the lesser of
$150,000 or ten percent of the most recent appraised value, the nursing facility shall be
eligible for an equity incentive payment rate as in paragraphs (a) to (d). This computation
is separate from the determination of the nursing facility's rental rate. An equity incentive
payment rate as computed under this subdivision is limited to one in a 12-month period.
(a) An eligible nursing facility shall receive an equity incentive payment rate equal to
the allowable historical cost of the capital asset acquired, minus the allowable debt directly
identified to that capital asset, multiplied by the equity incentive factor as described in
paragraphs (b) and (c), and divided by the nursing facility's occupancy factor under
subdivision 3f, paragraph (c). This amount shall be added to the nursing facility's total
payment rate and shall be effective the same day as the incremental increase in paragraph
(d) or subdivision 17. The allowable historical cost of the capital assets and the allowable
debt shall be determined as provided in Minnesota Rules, parts 9549.0010 to 9549.0080,
and this section.
(b) The equity incentive factor shall be determined under clauses (1) to (4):
(1) divide the initial allowable debt in paragraph (a) by the initial historical cost of the
capital asset additions referred to in paragraph (a), then cube the quotient,
(2) subtract the amount calculated in clause (1) from the number one,
(3) determine the difference between the rental factor and the lesser of two percentage
points above the posted yield for standard conventional fixed rate mortgages of the Federal
Home Loan Mortgage Corporation as published in the Wall Street Journal and in effect on
the first day of the month the debt or cost is incurred, or 16 percent,
(4) multiply the amount calculated in clause (2) by the amount calculated in clause (3).
(c) The equity incentive payment rate shall be limited to the term of the allowable debt
in paragraph (a), not greater than 20 years nor less than ten years. If no debt is incurred in
acquiring the capital asset, the equity incentive payment rate shall be paid for ten years. The
sale of a nursing facility under subdivision 14 shall terminate application of the equity
incentive payment rate effective on the date provided in subdivision 14, paragraph (f), for
the sale.
(d) A nursing facility with an addition to or a renovation of its buildings, attached fixtures,
or land improvements meeting the criteria in this subdivision and not receiving the
property-related payment rate adjustment in subdivision 17, shall receive the incremental
increase in the nursing facility's rental rate as determined under Minnesota Rules, parts
9549.0010 to 9549.0080, and this section. The incremental increase shall be added to the
nursing facility's property-related payment rate. The effective date of this incremental
increase shall be the first day of the month new text begin of January or July, whichever occurs immediately
new text end following the deleted text begin month indeleted text end new text begin date onnew text end which the addition or replacement is completed.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for additions or replacements completed
after January 1, 2018.
new text end
Sec. 10.
Minnesota Statutes 2016, section 256B.431, subdivision 30, is amended to read:
Subd. 30.
Bed layaway and delicensure.
(a) For rate years beginning on or after July
1, 2000, a nursing facility reimbursed under this section which has placed beds on layaway
shall, for purposes of application of the downsizing incentive in subdivision 3a, paragraph
(c), and calculation of the rental per diem, have those beds given the same effect as if the
beds had been delicensed so long as the beds remain on layaway. At the time of a layaway,
a facility may change its single bed election for use in calculating capacity days under
Minnesota Rules, part 9549.0060, subpart 11. The property payment rate increase shall be
effective the first day of the month new text begin of January or July, whichever occurs immediately
new text end following the deleted text begin monthdeleted text end new text begin datenew text end in which the layaway of the beds becomes effective under section
144A.071, subdivision 4b.
(b) For rate years beginning on or after July 1, 2000, notwithstanding any provision to
the contrary under section 256B.434, a nursing facility reimbursed under that section which
has placed beds on layaway shall, for so long as the beds remain on layaway, be allowed
to:
(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;
(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and
(3) establish capacity days based on the number of beds immediately prior to the layaway
and the number of beds after the layaway.
The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the layaway of beds and clauses (1), (2), and
(3). If a facility reimbursed under section 256B.434 completes a moratorium exception
project after its base year, the base year property rate shall be the moratorium project property
rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
paragraph (c). The property payment rate increase shall be effective the first day of the
month new text begin of January or July, whichever occurs immediately new text end following the deleted text begin monthdeleted text end new text begin datenew text end in which
the layaway of the beds becomes effective.
(c) If a nursing facility removes a bed from layaway status in accordance with section
144A.071, subdivision 4b, the commissioner shall establish capacity days based on the
number of licensed and certified beds in the facility not on layaway and shall reduce the
nursing facility's property payment rate in accordance with paragraph (b).
(d) For the rate years beginning on or after July 1, 2000, notwithstanding any provision
to the contrary under section 256B.434, a nursing facility reimbursed under that section,
which has delicensed beds after July 1, 2000, by giving notice of the delicensure to the
commissioner of health according to the notice requirements in section 144A.071, subdivision
4b, shall be allowed to:
(1) aggregate the applicable investment per bed limits based on the number of beds
licensed immediately prior to entering the alternative payment system;
(2) retain or change the facility's single bed election for use in calculating capacity days
under Minnesota Rules, part 9549.0060, subpart 11; and
(3) establish capacity days based on the number of beds immediately prior to the
delicensure and the number of beds after the delicensure.
The commissioner shall increase the facility's property payment rate by the incremental
increase in the rental per diem resulting from the recalculation of the facility's rental per
diem applying only the changes resulting from the delicensure of beds and clauses (1), (2),
and (3). If a facility reimbursed under section 256B.434 completes a moratorium exception
project after its base year, the base year property rate shall be the moratorium project property
rate. The base year rate shall be inflated by the factors in section 256B.434, subdivision 4,
paragraph (c). The property payment rate increase shall be effective the first day of the
month new text begin of January or July, whichever occurs immediately new text end following the deleted text begin monthdeleted text end new text begin datenew text end in which
the delicensure of the beds becomes effective.
(e) For nursing facilities reimbursed under this section or section 256B.434, any beds
placed on layaway shall not be included in calculating facility occupancy as it pertains to
leave days defined in Minnesota Rules, part 9505.0415.
(f) For nursing facilities reimbursed under this section or section 256B.434, the rental
rate calculated after placing beds on layaway may not be less than the rental rate prior to
placing beds on layaway.
(g) A nursing facility receiving a rate adjustment as a result of this section shall comply
with section deleted text begin 256B.47, subdivision 2deleted text end new text begin 256R.06, subdivision 5new text end .
(h) A facility that does not utilize the space made available as a result of bed layaway
or delicensure under this subdivision to reduce the number of beds per room or provide
more common space for nursing facility uses or perform other activities related to the
operation of the nursing facility shall have its property rate increase calculated under this
subdivision reduced by the ratio of the square footage made available that is not used for
these purposes to the total square footage made available as a result of bed layaway or
delicensure.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for layaways occurring after July 1, 2017.
new text end
Sec. 11.
Minnesota Statutes 2016, section 256B.434, subdivision 4, is amended to read:
Subd. 4.
Alternate rates for nursing facilities.
new text begin Effective for the rate years beginning
on and after January 1, 2018,new text end a nursing facility's deleted text begin case mixdeleted text end new text begin propertynew text end payment deleted text begin ratesdeleted text end new text begin rate new text end for
the second and subsequent years of a facility's contract under this section are the previous
rate year's deleted text begin contractdeleted text end new text begin property new text end payment deleted text begin ratesdeleted text end new text begin rate new text end plus an inflation adjustment deleted text begin and, for facilities
reimbursed under this section or section 256B.431, an adjustment to include the cost of any
increase in Health Department licensing fees for the facility taking effect on or after July
1, 2001deleted text end . The index for the inflation adjustment must be based on the change in the Consumer
Price Index-All Items (United States City average) (CPI-U) forecasted by the deleted text begin commissioner
of management and budget's national economic consultantdeleted text end new text begin Reports and Forecasts Division
of the Department of Human Servicesnew text end , as forecasted in the fourth quarter of the calendar
year preceding the rate year. The inflation adjustment must be based on the 12-month period
from the midpoint of the previous rate year to the midpoint of the rate year for which the
rate is being determined. deleted text begin For the rate years beginning on July 1, 1999, July 1, 2000, July 1,
2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006, July 1, 2007, July
1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall apply only to the
property-related payment rate. For the rate years beginning on October 1, 2011, October 1,
2012, October 1, 2013, October 1, 2014, October 1, 2015, January 1, 2016, and January 1,
2017, the rate adjustment under this paragraph shall be suspended. Beginning in 2005,
adjustment to the property payment rate under this section and section 256B.431 shall be
effective on October 1. In determining the amount of the property-related payment rate
adjustment under this paragraph, the commissioner shall determine the proportion of the
facility's rates that are property-related based on the facility's most recent cost report.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2016, section 256B.434, subdivision 4f, is amended to read:
Subd. 4f.
Construction project rate adjustments effective October 1, 2006.
(a)
Effective October 1, 2006, facilities reimbursed under this section may receive a property
rate adjustment for construction projects exceeding the threshold in section 256B.431,
subdivision 16, and below the threshold in section 144A.071, subdivision 2, clause (a). For
these projects, capital assets purchased shall be counted as construction project costs for a
rate adjustment request made by a facility if they are: (1) purchased within 24 months of
the completion of the construction project; (2) purchased after the completion date of any
prior construction project; and (3) are not purchased prior to July 14, 2005. Except as
otherwise provided in this subdivision, the definitions, rate calculation methods, and
principles in sections 144A.071 and 256B.431 and Minnesota Rules, parts 9549.0010 to
9549.0080, shall be used to calculate rate adjustments for allowable construction projects
under this subdivision and section 144A.073. Facilities completing construction projects
between October 1, 2005, and October 1, 2006, are eligible to have a property rate adjustment
effective October 1, 2006. Facilities completing projects after October 1, 2006, are eligible
for a property rate adjustment effective on the first day of the month following the completion
date.new text begin Facilities completing projects after January 1, 2018, are eligible for a property rate
adjustment effective on the first day of the month of January or July, whichever occurs
immediately following the completion date.
new text end
(b) Notwithstanding subdivision 18, as of July 14, 2005, facilities with rates set under
section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, that commenced a
construction project on or after October 1, 2004, and do not have a contract under subdivision
3 by September 30, 2006, are eligible to request a rate adjustment under section 256B.431,
subdivision 10, through September 30, 2006. If the request results in the commissioner
determining a rate adjustment is allowable, the rate adjustment is effective on the first of
the month following project completion. These facilities shall be allowed to accumulate
construction project costs for the period October 1, 2004, to September 30, 2006.
(c) Facilities shall be allowed construction project rate adjustments no sooner than 12
months after completing a previous construction project. Facilities must request the rate
adjustment according to section 256B.431, subdivision 10.
(d) Capacity days shall be computed according to Minnesota Rules, part 9549.0060,
subpart 11. For rate calculations under this section, the number of licensed beds in the
nursing facility shall be the number existing after the construction project is completed and
the number of days in the nursing facility's reporting period shall be 365.
(e) The value of assets to be recognized for a total replacement project as defined in
section 256B.431, subdivision 17d, shall be computed as described in clause (1). The value
of assets to be recognized for all other projects shall be computed as described in clause
(2).
(1) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
number of beds allowed under subdivision 3a, paragraph (c), shall be used to compute the
maximum amount of assets allowable in a facility's property rate calculation. If a facility's
current request for a rate adjustment results from the completion of a construction project
that was previously approved under section 144A.073, the assets to be used in the rate
calculation cannot exceed the lesser of the amount determined under sections 144A.071,
subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction
project. A current request that is not the result of a project under section 144A.073 cannot
exceed the limit under section 144A.071, subdivision 2, paragraph (a). Applicable credits
must be deducted from the cost of the construction project.
(2)(i) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
number of beds allowed under section 256B.431, subdivision 3a, paragraph (c), shall be
used to compute the maximum amount of assets allowable in a facility's property rate
calculation.
(ii) The value of a facility's assets to be compared to the amount in item (i) begins with
the total appraised value from the last rate notice a facility received when its rates were set
under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080. This value
shall be indexed by the factor in section 256B.431, subdivision 3f, paragraph (a), for each
rate year the facility received an inflation factor on its property-related rate when its rates
were set under this section. The value of assets listed as previous capital additions, capital
additions, and special projects on the facility's base year rate notice and the value of assets
related to a construction project for which the facility received a rate adjustment when its
rates were determined under this section shall be added to the indexed appraised value.
(iii) The maximum amount of assets to be recognized in computing a facility's rate
adjustment after a project is completed is the lesser of the aggregate replacement-cost-new
limit computed in (i) minus the assets recognized in (ii) or the actual allowable costs of the
construction project.
(iv) If a facility's current request for a rate adjustment results from the completion of a
construction project that was previously approved under section 144A.073, the assets to be
added to the rate calculation cannot exceed the lesser of the amount determined under
sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable
costs of the construction project. A current request that is not the result of a project under
section 144A.073 cannot exceed the limit stated in section 144A.071, subdivision 2,
paragraph (a). Assets disposed of as a result of a construction project and applicable credits
must be deducted from the cost of the construction project.
(f) For construction projects approved under section 144A.073, allowable debt may
never exceed the lesser of the cost of the assets purchased, the threshold limit in section
144A.071, subdivision 2, or the replacement-cost-new limit less previously existing capital
debt.
(g) For construction projects that were not approved under section 144A.073, allowable
debt is limited to the lesser of the threshold in section 144A.071, subdivision 2, for such
construction projects or the applicable limit in paragraph (e), clause (1) or (2), less previously
existing capital debt. Amounts of debt taken out that exceed the costs of a construction
project shall not be allowed regardless of the use of the funds.
For all construction projects being recognized, interest expense and average debt shall
be computed based on the first 12 months following project completion. "Previously existing
capital debt" means capital debt recognized on the last rate determined under section
256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, and the amount of debt
recognized for a construction project for which the facility received a rate adjustment when
its rates were determined under this section.
For a total replacement project as defined in section 256B.431, subdivision 17d, the
value of previously existing capital debt shall be zero.
(h) In addition to the interest expense allowed from the application of paragraph (f), the
amounts allowed under section 256B.431, subdivision 17a, paragraph (a), clauses (2) and
(3), will be added to interest expense.
(i) The equity portion of the construction project shall be computed as the allowable
assets in paragraph (e), less the average debt in paragraph (f). The equity portion must be
multiplied by 5.66 percent and the allowable interest expense in paragraph (f) must be added.
This sum must be divided by 95 percent of capacity days to compute the construction project
rate adjustment.
(j) For projects that are not a total replacement of a nursing facility, the amount in
paragraph (i) is adjusted for nonreimbursable areas and then added to the current property
payment rate of the facility.
(k) For projects that are a total replacement of a nursing facility, the amount in paragraph
(i) becomes the new property payment rate after being adjusted for nonreimbursable areas.
Any amounts existing in a facility's rate before the effective date of the construction project
for equity incentives under section 256B.431, subdivision 16; capital repairs and replacements
under section 256B.431, subdivision 15; or refinancing incentives under section 256B.431,
subdivision 19, shall be removed from the facility's rates.
(l) No additional equipment allowance is allowed under Minnesota Rules, part 9549.0060,
subpart 10, as the result of construction projects under this section. Allowable equipment
shall be included in the construction project costs.
(m) Capital assets purchased after the completion date of a construction project shall be
counted as construction project costs for any future rate adjustment request made by a facility
under section 144A.071, subdivision 2, clause (a), if they are purchased within 24 months
of the completion of the future construction project.
(n) In subsequent rate years, the property payment rate for a facility that results from
the application of this subdivision shall be the amount inflated in subdivision 4.
(o) Construction projects are eligible for an equity incentive under section 256B.431,
subdivision 16. When computing the equity incentive for a construction project under this
subdivision, only the allowable costs and allowable debt related to the construction project
shall be used. The equity incentive shall not be a part of the property payment rate and not
inflated under subdivision 4. Effective October 1, 2006, all equity incentives for nursing
facilities reimbursed under this section shall be allowed for a duration determined under
section 256B.431, subdivision 16, paragraph (c).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 13.
Minnesota Statutes 2016, section 256B.50, subdivision 1b, is amended to read:
Subd. 1b.
Filing an appeal.
To appeal, the provider shall file with the commissioner a
written notice of appeal; the appeal must be postmarked or received by the commissioner
within 60 days of the new text begin publication new text end date deleted text begin the determination of the payment rate was mailed or
personally received by a provider, whichever is earlierdeleted text end new text begin printed on the rate noticenew text end . The notice
of appeal must specify each disputed item; the reason for the dispute; the total dollar amount
in dispute for each separate disallowance, allocation, or adjustment of each cost item or part
of a cost item; the computation that the provider believes is correct; the authority in statute
or rule upon which the provider relies for each disputed item; the name and address of the
person or firm with whom contacts may be made regarding the appeal; and other information
required by the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2016, section 256R.02, subdivision 4, is amended to read:
Subd. 4.
Administrative costs.
"Administrative costs" means the identifiable costs for
administering the overall activities of the nursing home. These costs include salaries and
wages of the administrator, assistant administrator, business office employees, security
guards, and associated fringe benefits and payroll taxes, fees, contracts, or purchases related
to business office functions, licenses, and permits except as provided in the external fixed
costs category, employee recognition, travel including meals and lodging, all training except
as specified in subdivision 17, voice and data communication or transmission, office supplies,
property and liability insurance and other forms of new text begin allowable new text end insurance not designated to
other areas, personnel recruitment, legal services, accounting services, management or
business consultants, data processing, information technology, Web site, central or home
office costs, business meetings and seminars, postage, fees for professional organizations,
subscriptions, security services, advertising, board of directors fees, working capital interest
expense, and bad debts and bad debt collection fees.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2016, section 256R.02, subdivision 18, is amended to read:
Subd. 18.
Employer health insurance costs.
"Employer health insurance costs" means
premium expenses for group coverage deleted text begin and reinsurance,deleted text end new text begin ;new text end actual expenses incurred for
self-insured plans, new text begin including reinsurance; new text end and employer contributions to employee health
reimbursement and health savings accounts. Premium and expense costs and contributions
are allowable for (1) all employees and (2) the spouse and dependents of employees who
meet the definition of full-time employees under the federal Affordable Care Act, Public
Law 111-148.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 16.
Minnesota Statutes 2016, section 256R.10, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Not specified allowed costs. new text end
new text begin
When the cost category for allowed cost items
or services is not specified in this chapter or the provider reimbursement manual, the
commissioner, in consultation with stakeholders, shall determine the cost category for the
allowed cost item or service.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
new text begin
[256R.18] REPORT BY COMMISSIONER OF HUMAN SERVICES.
new text end
new text begin
Beginning January 1, 2019, the commissioner shall provide to the house of representatives
and senate committees with jurisdiction over nursing facility payment rates a biennial report
on the effectiveness of the reimbursement system in improving quality, restraining costs,
and any other features of the system as determined by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2016, section 256R.40, subdivision 5, is amended to read:
Subd. 5.
Planned closure rate adjustment.
(a) The commissioner shall calculate the
amount of the planned closure rate adjustment available under subdivision 6 according to
clauses (1) to (4):
(1) the amount available is the net reduction of nursing facility beds multiplied by $2,080;
(2) the total number of beds in the nursing facility or facilities receiving the planned
closure rate adjustment must be identified;
(3) capacity days are determined by multiplying the number determined under clause
(2) by 365; and
(4) the planned closure rate adjustment is the amount available in clause (1), divided by
capacity days determined under clause (3).
(b) A planned closure rate adjustment under this section is effective on the first day of
the month new text begin of January or July, whichever occurs immediately new text end following completion of closure
of the facility designated for closure in the application and becomes part of the nursing
facility's external fixed payment rate.
(c) Upon the request of a closing facility, the commissioner must allow the facility a
closure rate adjustment as provided under section 144A.161, subdivision 10.
(d) A facility that has received a planned closure rate adjustment may reassign it to
another facility that is under the same ownership at any time within three years of its effective
date. The amount of the adjustment is computed according to paragraph (a).
(e) If the per bed dollar amount specified in paragraph (a), clause (1), is increased, the
commissioner shall recalculate planned closure rate adjustments for facilities that delicense
beds under this section on or after July 1, 2001, to reflect the increase in the per bed dollar
amount. The recalculated planned closure rate adjustment is effective from the date the per
bed dollar amount is increased.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for closures occurring after July 1, 2017.
new text end
Sec. 19.
Minnesota Statutes 2016, section 256R.41, is amended to read:
256R.41 SINGLE-BED ROOM INCENTIVE.
(a) Beginning July 1, 2005, the operating payment rate for nursing facilities reimbursed
under this chapter shall be increased by 20 percent multiplied by the ratio of the number of
new single-bed rooms created divided by the number of active beds on July 1, 2005, for
each bed closure that results in the creation of a single-bed room after July 1, 2005. The
commissioner may implement rate adjustments for up to 3,000 new single-bed rooms each
year. For eligible bed closures for which the commissioner receives a notice from a facility
deleted text begin during a calendar quarterdeleted text end that a bed has been delicensed and a new single-bed room has
been established, the rate adjustment in this paragraph shall be effective on new text begin either new text end the first
day of the deleted text begin seconddeleted text end month deleted text begin following that calendar quarterdeleted text end new text begin of January or July, whichever
occurs immediately following the date of the bed delicensurenew text end .
(b) A nursing facility is prohibited from discharging residents for purposes of establishing
single-bed rooms. A nursing facility must submit documentation to the commissioner in a
form prescribed by the commissioner, certifying the occupancy status of beds closed to
create single-bed rooms. In the event that the commissioner determines that a facility has
discharged a resident for purposes of establishing a single-bed room, the commissioner shall
not provide a rate adjustment under paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for closures occurring after July 1, 2017.
new text end
Sec. 20.
Minnesota Statutes 2016, section 256R.47, is amended to read:
256R.47 RATE ADJUSTMENT FOR CRITICAL ACCESS NURSING
FACILITIES.
(a) The commissioner, in consultation with the commissioner of health, may designate
certain nursing facilities as critical access nursing facilities. The designation shall be granted
on a competitive basis, within the limits of funds appropriated for this purpose.
(b) The commissioner shall request proposals from nursing facilities every two years.
Proposals must be submitted in the form and according to the timelines established by the
commissioner. In selecting applicants to designate, the commissioner, in consultation with
the commissioner of health, and with input from stakeholders, shall develop criteria designed
to preserve access to nursing facility services in isolated areas, rebalance long-term care,
and improve quality. To the extent practicable, the commissioner shall ensure an even
distribution of designations across the state.
(c) The commissioner shall allow the benefits in clauses (1) to (5) for nursing facilities
designated as critical access nursing facilities:
(1) partial rebasing, with the commissioner allowing a designated facility operating
payment rates being the sum of up to 60 percent of the operating payment rate determined
in accordance with section 256R.21, subdivision 3, and at least 40 percent, with the sum of
the two portions being equal to 100 percent, of the operating payment rate that would have
been allowed had the facility not been designated. The commissioner may adjust these
percentages by up to 20 percent and may approve a request for less than the amount allowed;
(2) enhanced payments for leave days. Notwithstanding section 256R.43, upon
designation as a critical access nursing facility, the commissioner shall limit payment for
leave days to 60 percent of that nursing facility's total payment rate for the involved resident,
and shall allow this payment only when the occupancy of the nursing facility, inclusive of
bed hold days, is equal to or greater than 90 percent;
(3) two designated critical access nursing facilities, with up to 100 beds in active service,
may jointly apply to the commissioner of health for a waiver of Minnesota Rules, part
4658.0500, subpart 2, in order to jointly employ a director of nursing. The commissioner
of health shall consider each waiver request independently based on the criteria under
Minnesota Rules, part 4658.0040;
(4) the minimum threshold under section 256B.431, subdivision 15, paragraph (e), shall
be 40 percent of the amount that would otherwise apply; and
(5) the quality-based rate limits under section 256R.23, subdivisions 5 to 7, apply to
designated critical access nursing facilities.
(d) Designation of a critical access nursing facility is for a period of two years, after
which the benefits allowed under paragraph (c) shall be removed. Designated facilities may
apply for continued designation.
(e) This section is suspended and no state or federal funding shall be appropriated or
allocated for the purposes of this section from January 1, 2016, to December 31, deleted text begin 2017deleted text end new text begin 2019new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 21.
Minnesota Statutes 2016, section 256R.49, subdivision 1, is amended to read:
Subdivision 1.
Rate adjustments for compensation-related costs.
(a) deleted text begin Operating payment
rates of all nursing facilities that are reimbursed under this chapter shall be increased effective
for rate years beginning on and after October 1, 2014, to address changes in compensation
costs for nursing facility employees paid less than $14 per hour in accordance with this
section.deleted text end new text begin Rate increases provided under this section before October 1, 2016, expire effective
January 1, 2018, and rate increases provided on or after October 1, 2016, expire effective
January 1, 2019.
new text end
(b) Nursing facilities that receive approval of the applications in subdivision 2 must
receive rate adjustments according to subdivision 4. The rate adjustments must be used to
pay compensation costs for nursing facility employees paid less than $14 per hour.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 22.
Minnesota Statutes 2016, section 626.557, subdivision 4, is amended to read:
Subd. 4.
Reporting.
(a) Except as provided in paragraph (b), a mandated reporter shall
immediately make deleted text begin an oraldeleted text end new text begin anew text end report to the common entry point. deleted text begin The common entry point
may accept electronic reports submitted through a Web-based reporting system established
by the commissioner. Use of a telecommunications device for the deaf or other similar
device shall be considered an oral report. The common entry point may not require written
reports.deleted text end To the extent possible, the report must be of sufficient content to identify the
vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment, any
evidence of previous maltreatment, the name and address of the reporter, the time, date,
and location of the incident, and any other information that the reporter believes might be
helpful in investigating the suspected maltreatment. A mandated reporter may disclose not
public data, as defined in section 13.02, and medical records under sections 144.291 to
144.298, to the extent necessary to comply with this subdivision.
(b) A boarding care home that is licensed under sections 144.50 to 144.58 and certified
under Title 19 of the Social Security Act, a nursing home that is licensed under section
144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a hospital
that is licensed under sections 144.50 to 144.58 and has swing beds certified under Code
of Federal Regulations, title 42, section 482.66, may submit a report electronically to the
common entry point instead of submitting an oral report. The report may be a duplicate of
the initial report the facility submits electronically to the commissioner of health to comply
with the reporting requirements under Code of Federal Regulations, title 42, section 483.13.
The commissioner of health may modify these reporting requirements to include items
required under paragraph (a) that are not currently included in the electronic reporting form.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 23.
Minnesota Statutes 2016, section 626.557, subdivision 9, is amended to read:
Subd. 9.
Common entry point designation.
(a) deleted text begin Each county board shall designate a
common entry point for reports of suspected maltreatment, for use until the commissioner
of human services establishes a common entry point. Two or more county boards may
jointly designate a single common entry point.deleted text end The commissioner of human services shall
deleted text begin establishdeleted text end new text begin operatenew text end a common entry point deleted text begin effective July 1, 2015deleted text end . The common entry point is
the unit responsible for receiving the report of suspected maltreatment under this section.
(b) The common entry point must be available 24 hours per day to take calls from
reporters of suspected maltreatment. The common entry point shall use a standard intake
form that includes:
(1) the time and date of the report;
(2) the namedeleted text begin , address, and telephone number of the person reporting;deleted text end new text begin and identifying
and contact information for the alleged victim and the alleged perpetrator;
new text end
new text begin
(3) the name and contact information for the reporter, the initial reporter, witnesses, and
other relevant people;
new text end
new text begin
(4) the basis of vulnerability for the alleged victim;
new text end
deleted text begin (3)deleted text end new text begin (5)new text end the time, date, and location of the incident;
deleted text begin
(4) the names of the persons involved, including but not limited to, perpetrators, alleged
victims, and witnesses;
deleted text end
deleted text begin (5)deleted text end new text begin (6)new text end whether there deleted text begin was adeleted text end new text begin is an immediate safetynew text end risk deleted text begin of imminent dangerdeleted text end to the alleged
victim;
deleted text begin (6)deleted text end new text begin (7)new text end a description of the suspected maltreatment;
deleted text begin
(7) the disability, if any, of the alleged victim;
deleted text end
deleted text begin
(8) the relationship of the alleged perpetrator to the alleged victim;
deleted text end
deleted text begin (9)deleted text end new text begin (8)new text end whether a facility was involved and, if so, which agency licenses the facility;
new text begin
(9) actions taken to protect the alleged victim;
new text end
(10) deleted text begin any action takendeleted text end new text begin required notifications and referrals madenew text end by the common entry
point;new text begin and
new text end
deleted text begin
(11) whether law enforcement has been notified;
deleted text end
deleted text begin (12)deleted text end new text begin (11)new text end whether the reporter wishes to receive notification of the deleted text begin initial and final reports;
anddeleted text end new text begin disposition.
new text end
deleted text begin
(13) if the report is from a facility with an internal reporting procedure, the name, mailing
address, and telephone number of the person who initiated the report internally.
deleted text end
(c) The common entry point is not required to complete each item on the form prior to
dispatching the report to the appropriate lead investigative agency.
(d) The common entry point shall immediately report to a law enforcement agency any
incident in which there is reason to believe a crime has been committed.
(e) If a report is initially made to a law enforcement agency or a lead investigative agency,
those agencies shall take the report on the appropriate common entry point intake forms
and immediately forward a copy to the common entry point.
(f) The common entry point staff must receive training on how to screen and dispatch
reports efficiently and in accordance with this section.
(g) The commissioner of human services shall maintain a centralized database for the
collection of common entry point data, lead investigative agency data including maltreatment
report disposition, and appeals data. The common entry point shall have access to the
centralized database and must log the reports into the database and immediately identify
and locate prior reports of abuse, neglect, or exploitation.
(h) When appropriate, the common entry point staff must refer calls that do not allege
the abuse, neglect, or exploitation of a vulnerable adult to other organizations that might
resolve the reporter's concerns.
(i) A common entry point must be operated in a manner that enables the commissioner
of human services to:
(1) track critical steps in the reporting, evaluation, referral, response, disposition, and
investigative process to ensure compliance with all requirements for all reports;
(2) maintain data to facilitate the production of aggregate statistical reports for monitoring
patterns of abuse, neglect, or exploitation;
(3) serve as a resource for the evaluation, management, and planning of preventative
and remedial services for vulnerable adults who have been subject to abuse, neglect, or
exploitation;
(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
of the common entry point; and
(5) track and manage consumer complaints related to the common entry point.
(j) deleted text begin The commissioners of human services and health shall collaborate on the creation of
a system for referring reports to the lead investigative agencies. This systemdeleted text end new text begin The common
entry pointnew text end shall enable the commissioner of human services to track critical steps in the
reporting, evaluation, referral, response, disposition, investigation, notification, determination,
and appeal processes.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24.
Minnesota Statutes 2016, section 626.557, subdivision 12b, is amended to read:
Subd. 12b.
Data management.
(a) In performing any of the duties of this section as a
lead investigative agency, the county social service agency shall maintain appropriate
records. Data collected by the county social service agency under this section are welfare
data under section 13.46. Notwithstanding section 13.46, subdivision 1, paragraph (a), data
under this paragraph that are inactive investigative data on an individual who is a vendor
of services are private data on individuals, as defined in section 13.02. The identity of the
reporter may only be disclosed as provided in paragraph (c).
Data maintained by the common entry point are confidential data on individuals or
protected nonpublic data as defined in section 13.02. Notwithstanding section 138.163, the
common entry point shall maintain data for three calendar years after date of receipt and
then destroy the data unless otherwise directed by federal requirements.
(b) The commissioners of health and human services shall prepare an investigation
memorandum for each report alleging maltreatment investigated under this section. County
social service agencies must maintain private data on individuals but are not required to
prepare an investigation memorandum. During an investigation by the commissioner of
health or the commissioner of human services, data collected under this section are
confidential data on individuals or protected nonpublic data as defined in section 13.02.
Upon completion of the investigation, the data are classified as provided in clauses (1) to
(3) and paragraph (c).
(1) The investigation memorandum must contain the following data, which are public:
(i) the name of the facility investigated;
(ii) a statement of the nature of the alleged maltreatment;
(iii) pertinent information obtained from medical or other records reviewed;
(iv) the identity of the investigator;
(v) a summary of the investigation's findings;
(vi) statement of whether the report was found to be substantiated, inconclusive, false,
or that no determination will be made;
(vii) a statement of any action taken by the facility;
(viii) a statement of any action taken by the lead investigative agency; and
(ix) when a lead investigative agency's determination has substantiated maltreatment, a
statement of whether an individual, individuals, or a facility were responsible for the
substantiated maltreatment, if known.
The investigation memorandum must be written in a manner which protects the identity
of the reporter and of the vulnerable adult and may not contain the names or, to the extent
possible, data on individuals or private data listed in clause (2).
(2) Data on individuals collected and maintained in the investigation memorandum are
private data, including:
(i) the name of the vulnerable adult;
(ii) the identity of the individual alleged to be the perpetrator;
(iii) the identity of the individual substantiated as the perpetrator; and
(iv) the identity of all individuals interviewed as part of the investigation.
(3) Other data on individuals maintained as part of an investigation under this section
are private data on individuals upon completion of the investigation.
(c) After the assessment or investigation is completed, the name of the reporter must be
confidential. The subject of the report may compel disclosure of the name of the reporter
only with the consent of the reporter or upon a written finding by a court that the report was
false and there is evidence that the report was made in bad faith. This subdivision does not
alter disclosure responsibilities or obligations under the Rules of Criminal Procedure, except
that where the identity of the reporter is relevant to a criminal prosecution, the district court
shall do an in-camera review prior to determining whether to order disclosure of the identity
of the reporter.
(d) Notwithstanding section 138.163, data maintained under this section by the
commissioners of health and human services must be maintained under the following
schedule and then destroyed unless otherwise directed by federal requirements:
(1) data from reports determined to be false, maintained for three years after the finding
was made;
(2) data from reports determined to be inconclusive, maintained for four years after the
finding was made;
(3) data from reports determined to be substantiated, maintained for seven years after
the finding was made; and
(4) data from reports which were not investigated by a lead investigative agency and for
which there is no final disposition, maintained for three years from the date of the report.
(e) The commissioners of health and human services shall annually publish on their Web
sites the number and type of reports of alleged maltreatment involving licensed facilities
reported under this section, the number of those requiring investigation under this section,
and the resolution of those investigations. On a biennial basis, the commissioners of health
and human services shall jointly report the following information to the legislature and the
governor:
(1) the number and type of reports of alleged maltreatment involving licensed facilities
reported under this section, the number of those requiring investigations under this section,
the resolution of those investigations, and which of the two lead agencies was responsible;
(2) trends about types of substantiated maltreatment found in the reporting period;
(3) if there are upward trends for types of maltreatment substantiated, recommendations
for addressing and responding to them;
(4) efforts undertaken or recommended to improve the protection of vulnerable adults;
(5) whether and where backlogs of cases result in a failure to conform with statutory
time frames and recommendations for reducing backlogs if applicable;
(6) recommended changes to statutes affecting the protection of vulnerable adults; and
(7) any other information that is relevant to the report trends and findings.
(f) Each lead investigative agency must have a record retention policy.
(g) new text begin The common entry point, a new text end lead investigative deleted text begin agenciesdeleted text end new text begin agencynew text end , new text begin a county agency or
its designee, a new text end prosecuting deleted text begin authoritiesdeleted text end new text begin authoritynew text end , deleted text begin anddeleted text end new text begin anew text end law enforcement deleted text begin agenciesdeleted text end new text begin agency, a
state licensing board, a federal agency, a state agency, and a tribenew text end may exchange not public
data, as defined in section 13.02, if the agency or authority deleted text begin requestingdeleted text end new text begin providingnew text end the data
determines that the data are pertinent and necessary to deleted text begin the requesting agency in initiating,
furthering, or completingdeleted text end new text begin provide adult protective services or to initiate, further, or completenew text end
an investigation under this section. Data collected under this section must be made available
to prosecuting authorities and law enforcement officials, local county agencies, and licensing
agencies investigating the alleged maltreatment under this section. The lead investigative
agency shall exchange not public data with the vulnerable adult maltreatment review panel
established in section 256.021 if the data are pertinent and necessary for a review requested
under that section. Notwithstanding section 138.17, upon completion of the review, not
public data received by the review panel must be destroyed.
(h) Each lead investigative agency shall keep records of the length of time it takes to
complete its investigations.
(i) A lead investigative agency may notify other affected parties and their authorized
representative if the lead investigative agency has reason to believe maltreatment has occurred
and determines the information will safeguard the well-being of the affected parties or dispel
widespread rumor or unrest in the affected facility.
(j) Under any notification provision of this section, where federal law specifically
prohibits the disclosure of patient identifying information, a lead investigative agency may
not provide any notice unless the vulnerable adult has consented to disclosure in a manner
which conforms to federal requirements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 25.
Minnesota Statutes 2016, section 626.557, subdivision 18, is amended to read:
Subd. 18.
Outreach.
The commissioner of human services shall maintain deleted text begin an aggressivedeleted text end new text begin
anew text end program to educate those required to report, as well as the general public, about the
requirements of this section using a variety of media. deleted text begin The commissioner of human services
shall print and make available the form developed under subdivision 9.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 26.
Minnesota Statutes 2016, section 626.5572, subdivision 2, is amended to read:
Subd. 2.
Abuse.
"Abuse" means:
(a) An act against a vulnerable adult that constitutes a violation of, an attempt to violate,
or aiding and abetting a violation of:
(1) assault in the first through fifth degrees as defined in sections 609.221 to 609.224;
(2) the use of drugs to injure or facilitate crime as defined in section 609.235;
(3) the solicitation, inducement, and promotion of prostitution as defined in section
609.322; and
(4) criminal sexual conduct in the first through fifth degrees as defined in sections
609.342 to 609.3451.
A violation includes any action that meets the elements of the crime, regardless of
whether there is a criminal proceeding or conviction.
(b) Conduct which is not an accident or therapeutic conduct as defined in this section,
which produces or could reasonably be expected to produce physical pain or injury or
emotional distress including, but not limited to, the following:
(1) hitting, slapping, kicking, pinching, biting, or corporal punishment of a vulnerable
adult;
(2) use of repeated or malicious oral, written, or gestured language toward a vulnerable
adult or the treatment of a vulnerable adult which would be considered by a reasonable
person to be disparaging, derogatory, humiliating, harassing, or threatening;new text begin or
new text end
(3) use of any aversive or deprivation procedure, unreasonable confinement, or
involuntary seclusion, including the forced separation of the vulnerable adult from other
persons against the will of the vulnerable adult or the legal representative of the vulnerable
adultdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) use of any aversive or deprivation procedures for persons with developmental
disabilities or related conditions not authorized under section 245.825.
deleted text end
(c) Any sexual contact or penetration as defined in section 609.341, between a facility
staff person or a person providing services in the facility and a resident, patient, or client
of that facility.
(d) The act of forcing, compelling, coercing, or enticing a vulnerable adult against the
vulnerable adult's will to perform services for the advantage of another.
(e) For purposes of this section, a vulnerable adult is not abused for the sole reason that
the vulnerable adult or a person with authority to make health care decisions for the
vulnerable adult under sections 144.651, 144A.44, chapter 145B, 145C or 252A, or section
253B.03 or 524.5-313, refuses consent or withdraws consent, consistent with that authority
and within the boundary of reasonable medical practice, to any therapeutic conduct, including
any care, service, or procedure to diagnose, maintain, or treat the physical or mental condition
of the vulnerable adult or, where permitted under law, to provide nutrition and hydration
parenterally or through intubation. This paragraph does not enlarge or diminish rights
otherwise held under law by:
(1) a vulnerable adult or a person acting on behalf of a vulnerable adult, including an
involved family member, to consent to or refuse consent for therapeutic conduct; or
(2) a caregiver to offer or provide or refuse to offer or provide therapeutic conduct.
(f) For purposes of this section, a vulnerable adult is not abused for the sole reason that
the vulnerable adult, a person with authority to make health care decisions for the vulnerable
adult, or a caregiver in good faith selects and depends upon spiritual means or prayer for
treatment or care of disease or remedial care of the vulnerable adult in lieu of medical care,
provided that this is consistent with the prior practice or belief of the vulnerable adult or
with the expressed intentions of the vulnerable adult.
(g) For purposes of this section, a vulnerable adult is not abused for the sole reason that
the vulnerable adult, who is not impaired in judgment or capacity by mental or emotional
dysfunction or undue influence, engages in consensual sexual contact with:
(1) a person, including a facility staff person, when a consensual sexual personal
relationship existed prior to the caregiving relationship; or
(2) a personal care attendant, regardless of whether the consensual sexual personal
relationship existed prior to the caregiving relationship.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
Minnesota Statutes 2016, section 626.5572, subdivision 4, is amended to read:
Subd. 4.
Caregiver.
"Caregiver" means an individual or facility who has responsibility
for the care of a vulnerable adult as a result of deleted text begin a family relationship, or who hasdeleted text end new text begin annew text end assumed
responsibility for all or a portion of the care of a vulnerable adult voluntarily, by contract,
or by agreement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 4
HEALTH CARE
Section 1.
Minnesota Statutes 2016, section 13.69, subdivision 1, is amended to read:
Subdivision 1.
Classifications.
(a) The following government data of the Department
of Public Safety are private data:
(1) medical data on driving instructors, licensed drivers, and applicants for parking
certificates and special license plates issued to physically disabled persons;
(2) other data on holders of a disability certificate under section 169.345, except that (i)
data that are not medical data may be released to law enforcement agencies, and (ii) data
necessary for enforcement of sections 169.345 and 169.346 may be released to parking
enforcement employees or parking enforcement agents of statutory or home rule charter
cities and towns;
(3) Social Security numbers in driver's license and motor vehicle registration records,
except that Social Security numbers must be provided to the Department of Revenue for
purposes of tax administration, the Department of Labor and Industry for purposes of
workers' compensation administration and enforcement,new text begin the Department of Human Services
for purposes of recovery of Minnesota health care program benefits paid,new text end and the Department
of Natural Resources for purposes of license application administration; and
(4) data on persons listed as standby or temporary custodians under section 171.07,
subdivision 11, except that the data must be released to:
(i) law enforcement agencies for the purpose of verifying that an individual is a designated
caregiver; or
(ii) law enforcement agencies who state that the license holder is unable to communicate
at that time and that the information is necessary for notifying the designated caregiver of
the need to care for a child of the license holder.
The department may release the Social Security number only as provided in clause (3)
and must not sell or otherwise provide individual Social Security numbers or lists of Social
Security numbers for any other purpose.
(b) The following government data of the Department of Public Safety are confidential
data: data concerning an individual's driving ability when that data is received from a member
of the individual's family.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 2.
Minnesota Statutes 2016, section 256.01, is amended by adding a subdivision to
read:
new text begin Subd. 18f. new text end
new text begin Asset verification system. new text end
new text begin
The commissioner shall implement the Asset
Verification System (AVS) according to Public Law 110-252, title VII, section 7001(d), to
verify assets for or renewing an individual applying for health care benefits under section
256B.055, subdivisions 7 and 7b.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 3.
Minnesota Statutes 2016, section 256.045, subdivision 3a, is amended to read:
Subd. 3a.
Prepaid health plan appeals.
(a) All prepaid health plans under contract to
the commissioner under chapter 256B must provide for a complaint system according to
section 62D.11. When a prepaid health plan denies, reduces, or terminates a health service
or denies a request to authorize a previously authorized health service, the prepaid health
plan must notify the recipient of the right to file a complaint or an appeal. The notice must
include the name and telephone number of the ombudsman and notice of the recipient's
right to request a hearing under paragraph (b). Recipients may request the assistance of the
ombudsman in the complaint system process. The prepaid health plan must issue a written
resolution of the complaint to the recipient within 30 days after the complaint is filed with
the prepaid health plan. A recipient is deleted text begin notdeleted text end required to exhaust the complaint system
procedures in order to request a hearing under paragraph (b).
(b) Recipients enrolled in a prepaid health plan under chapter 256B may contest a prepaid
health plan's denial, reduction, or termination of health services, a prepaid health plan's
denial of a request to authorize a previously authorized health service, or the prepaid health
plan's written resolution of a complaint by submitting a written request for a hearing
according to subdivision 3. A state human services judge shall conduct a hearing on the
matter and shall recommend an order to the commissioner of human services. The
commissioner need not grant a hearing if the sole issue raised by a recipient is the
commissioner's authority to require mandatory enrollment in a prepaid health plan in a
county where prepaid health plans are under contract with the commissioner. The state
human services judge may order a second medical opinion from deleted text begin the prepaid health plan or
may order a second medical opinion fromdeleted text end a nonprepaid health plan provider at the expense
of the deleted text begin prepaid health plandeleted text end new text begin Department of Human Servicesnew text end . Recipients may request the
assistance of the ombudsman in the appeal process.
(c) In the written request for a hearing to appeal from a prepaid health plan's denial,
reduction, or termination of a health service, a prepaid health plan's denial of a request to
authorize a previously authorized service, or the prepaid health plan's written resolution to
a complaint, a recipient may request an expedited hearing. If an expedited appeal is
warranted, the state human services judge shall hear the appeal and render a decision within
a time commensurate with the level of urgency involved, based on the individual
circumstances of the case.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 4.
Minnesota Statutes 2016, section 256.962, subdivision 5, is amended to read:
Subd. 5.
Incentive program.
Beginning January 1, 2008, the commissioner shall establish
an incentive program for organizations and licensed insurance producers under chapter 60K
that directly identify and assist potential enrollees in filling out and submitting an application.
For each applicant who is successfully enrolled in MinnesotaCare or medical assistance,
the commissioner, within the available appropriation, shall pay the organization or licensed
insurance producer a deleted text begin $25deleted text end new text begin $70new text end application assistance bonus. The organization or licensed
insurance producer may provide an applicant a gift certificate or other incentive upon
enrollment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 5.
Minnesota Statutes 2016, section 256.962, is amended by adding a subdivision to
read:
new text begin Subd. 9. new text end
new text begin Department of Corrections. new text end
new text begin
By January 1, 2018, the commissioner, in
consultation with the commissioner of the Department of Corrections, shall develop and
implement a process to improve access to health care coverage by offering application
assistance to people transitioning from incarceration in a facility operated by the Department
of Corrections to the community.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 6.
Minnesota Statutes 2016, section 256.9686, subdivision 8, is amended to read:
Subd. 8.
Rate year.
"Rate year" means a calendar year from January 1 to December 31.new text begin
Effective with the 2012 base year, rate year means a state fiscal year from July 1 to June
30.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2016, section 256.969, subdivision 1, is amended to read:
Subdivision 1.
Hospital cost index.
(a) The hospital cost index shall be the change in
the Centers for Medicare and Medicaid Services Inpatient Hospital Market Basket. The
commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
the midpoint of the current rate year.
(b) new text begin Except as authorized under this section, new text end for fiscal years beginning on or after July
1, 1993, the commissioner of human services shall not provide automatic annual inflation
adjustments for hospital payment rates under medical assistance.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 8.
Minnesota Statutes 2016, section 256.969, subdivision 2b, is amended to read:
Subd. 2b.
Hospital payment rates.
(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:
(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;
(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;
(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and
(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.
(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year for the rates effective November 1, 2014, shall
be calendar year 2012. The rebasing under this paragraph shall be budget neutral, ensuring
that the total aggregate payments under the rebased system are equal to the total aggregate
payments that were made for the same number and types of services in the base year. Separate
budget neutrality calculations shall be determined for payments made to critical access
hospitals and payments made to hospitals paid under the DRG system. Only the rate increases
or decreases under subdivision 3a or 3c that applied to the hospitals being rebased during
the entire base period shall be incorporated into the budget neutrality calculation.
(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).
(e) For discharges occurring on or after November 1, 2014, through the nextnew text begin twonew text end rebasing
deleted text begin that occursdeleted text end new text begin periodsnew text end the commissioner may make additional adjustments to the rebased rates,
and when evaluating whether additional adjustments should be made, the commissioner
shall consider the impact of the rates on the following:
(1) pediatric services;
(2) behavioral health services;
(3) trauma services as defined by the National Uniform Billing Committee;
(4) transplant services;
(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;
(6) outlier admissions;
(7) low-volume providers; and
(8) services provided by small rural hospitals that are not critical access hospitals.
(f) Hospital payment rates established under paragraph (c) must incorporate the following:
(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;
(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;
(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and
(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years.new text begin In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.
new text end
(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.
(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year and the next base year. new text begin Changes in costs
between base years shall be measured using the lower of the hospital cost index defined in
subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. new text end The commissioner shall establish the base year for each rebasing period considering
the most recent year for which filed Medicare cost reports are available. The estimated
change in the average payment per hospital discharge resulting from a scheduled rebasing
must be calculated and made available to the legislature by January 15 of each year in which
rebasing is scheduled to occur, and must include by hospital the differential in payment
rates compared to the individual hospital's costs.
(i) Effective for discharges occurring on or after July 1, 2015,new text begin inpatientnew text end payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:
(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;
(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and
(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.
(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:
(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;
(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and
(6) geographic location.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 9.
Minnesota Statutes 2016, section 256.969, subdivision 3a, is amended to read:
Subd. 3a.
Payments.
(a) Acute care hospital billings under the medical assistance program
must not be submitted until the recipient is discharged. However, the commissioner shall
establish monthly interim payments for inpatient hospitals that have individual patient
lengths of stay over 30 days regardless of diagnostic category. Except as provided in section
256.9693, medical assistance reimbursement for treatment of mental illness shall be
reimbursed based on diagnostic classifications. Individual hospital payments established
under this section and sections 256.9685, 256.9686, and 256.9695, in addition to third-party
and recipient liability, for discharges occurring during the rate year shall not exceed, in
aggregate, the charges for the medical assistance covered inpatient services paid for the
same period of time to the hospital. Services that have rates established under subdivision
deleted text begin 11 ordeleted text end 12, must be limited separately from other services. After consulting with the affected
hospitals, the commissioner may consider related hospitals one entity and may merge the
payment rates while maintaining separate provider numbers. The operating and property
base rates per admission or per day shall be derived from the best Medicare and claims data
available when rates are established. The commissioner shall determine the best Medicare
and claims data, taking into consideration variables of recency of the data, audit disposition,
settlement status, and the ability to set rates in a timely manner. The commissioner shall
notify hospitals of payment rates 30 days prior to implementation. The rate setting data
must reflect the admissions data used to establish relative values. The commissioner may
adjust base year cost, relative value, and case mix index data to exclude the costs of services
that have been discontinued by deleted text begin thedeleted text end October 1 of the year preceding the rate year or that are
paid separately from inpatient services. Inpatient stays that encompass portions of two or
more rate years shall have payments established based on payment rates in effect at the time
of admission unless the date of admission preceded the rate year in effect by six months or
more. In this case, operating payment rates for services rendered during the rate year in
effect and established based on the date of admission shall be adjusted to the rate year in
effect by the hospital cost index.
(b) For fee-for-service admissions occurring on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for inpatient services is reduced
by .5 percent from the current statutory rates.
(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
admissions occurring on or after July 1, 2003, made to hospitals for inpatient services before
third-party liability and spenddown, is reduced five percent from the current statutory rates.
Mental health services within diagnosis related groups 424 to 432 or corresponding
APR-DRGs, and facilities defined under subdivision 16 are excluded from this paragraph.
(d) In addition to the reduction in paragraphs (b) and (c), the total payment for
fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 6.0 percent from
the current statutory rates. Mental health services within diagnosis related groups 424 to
432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded
from this paragraph. Payments made to managed care plans shall be reduced for services
provided on or after January 1, 2006, to reflect this reduction.
(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced
3.46 percent from the current statutory rates. Mental health services with diagnosis related
groups 424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision
16 are excluded from this paragraph. Payments made to managed care plans shall be reduced
for services provided on or after January 1, 2009, through June 30, 2009, to reflect this
reduction.
(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
to hospitals for inpatient services before third-party liability and spenddown, is reduced 1.9
percent from the current statutory rates. Mental health services with diagnosis related groups
424 to 432 or corresponding APR-DRGs, and facilities defined under subdivision 16 are
excluded from this paragraph. Payments made to managed care plans shall be reduced for
services provided on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for inpatient
services before third-party liability and spenddown, is reduced 1.79 percent from the current
statutory rates. Mental health services with diagnosis related groups 424 to 432 or
corresponding APR-DRGs, and facilities defined under subdivision 16 are excluded from
this paragraph. Payments made to managed care plans shall be reduced for services provided
on or after July 1, 2011, to reflect this reduction.
(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total payment
for fee-for-service admissions occurring on or after July 1, 2009, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced one percent from
the current statutory rates. Facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after October 1, 2009, to reflect this reduction.
(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total payment
for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
inpatient services before third-party liability and spenddown, is reduced 1.96 percent from
the current statutory rates. Facilities defined under subdivision 16 are excluded from this
paragraph. Payments made to managed care plans shall be reduced for services provided
on or after January 1, 2011, to reflect this reduction.
(j) Effective for discharges on and after November 1, 2014, from hospitals paid under
subdivision 2b, paragraph (a), clauses (1) and (4), the rate adjustments in this subdivision
must be incorporated into the rebased rates established under subdivision 2b, paragraph (c),
and must not be applied to each claim.
(k) Effective for discharges on and after July 1, 2015, from hospitals paid under
subdivision 2b, paragraph (a), clauses (2) and (3), the rate adjustments in this subdivision
must be incorporated into the rates and must not be applied to each claim.
new text begin
(l) Effective for discharges on and after July 1, 2017, from hospitals paid under
subdivision 2b, paragraph (a), clause (2), the rate adjustments in this subdivision must be
incorporated into the rates and must not be applied to each claim.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 10.
Minnesota Statutes 2016, section 256.969, subdivision 3c, is amended to read:
Subd. 3c.
deleted text begin Rateabledeleted text end new text begin Ratablenew text end reduction and readmissions reduction.
(a) The total
payment for fee for service admissions occurring on or after September 1, 2011, to October
31, 2014, made to hospitals for inpatient services before third-party liability and spenddown,
is reduced ten percent from the current statutory rates. Facilities defined under subdivision
16, long-term hospitals as determined under the Medicare program, children's hospitals
whose inpatients are predominantly under 18 years of age, and payments under managed
care are excluded from this paragraph.
(b) Effective for admissions occurring during calendar year 2010 and each year after,
the commissioner shall calculate a readmission rate for admissions to all hospitals occurring
within 30 days of a previous discharge using data from the Reducing Avoidable Readmissions
Effectively (RARE) campaign. The commissioner may adjust the readmission rate taking
into account factors such as the medical relationship, complicating conditions, and sequencing
of treatment between the initial admission and subsequent readmissions.
(c) Effective for payments to all hospitals on or after July 1, 2013, through October 31,
2014, the reduction in paragraph (a) is reduced one percentage point for every percentage
point reduction in the overall readmissions rate between the two previous calendar years to
a maximum of five percent.
(d) The exclusion from the rate reduction in paragraph (a) shall apply to a hospital located
in Hennepin County with a licensed capacity of 1,700 beds as of September 1, 2011, for
admissions of children under 18 years of age occurring on or after September 1, 2011,
through August 31, 2013, but shall not apply to payments for admissions occurring on or
after September 1, 2013, through October 31, 2014.
(e) Effective for discharges on or after November 1, 2014, from hospitals paid under
subdivision 2b, paragraph (a), clauses (1) and (4), the rate adjustments in this subdivision
must be incorporated into the rebased rates established under subdivision 2b, paragraph (c),
and must not be applied to each claim.
(f) Effective for discharges on and after July 1, 2015, from hospitals paid under
subdivision 2b, paragraph (a), clauses (2) and (3), the rate adjustments in this subdivision
must be incorporated into the rates and must not be applied to each claim.
new text begin
(g) Effective for discharges on and after July 1, 2017, from hospitals paid under
subdivision 2b, paragraph (a), clause (2), the rate adjustments in this subdivision must be
incorporated into the rates and must not be applied to each claim.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 11.
Minnesota Statutes 2016, section 256.969, subdivision 4b, is amended to read:
Subd. 4b.
Medical assistance cost reports for services.
(a) A hospital that meets one
of the following criteria must annually submit to the commissioner medical assistance cost
reports within six months of the end of the hospital's fiscal year:
(1) a hospital designated as a critical access hospital that receives medical assistance
payments; deleted text begin or
deleted text end
(2) a Minnesota hospital or out-of-state hospital located within a Minnesota local trade
area that receives a disproportionate population adjustment under subdivision 9new text begin ; or
new text end
new text begin (3) a Minnesota hospital that is a licensed children's hospitalnew text end .
For purposes of this subdivision, local trade area has the meaning given in subdivision
17.
(b) The commissioner shall suspend payments to any hospital that fails to submit a report
required under this subdivision. Payments must remain suspended until the report has been
filed with and accepted by the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 12.
Minnesota Statutes 2016, section 256.969, subdivision 8, is amended to read:
Subd. 8.
Unusual length of stay experience.
(a) The commissioner shall establish day
outlier thresholds for each diagnostic category established under subdivision 2 at two standard
deviations beyond the mean length of stay. Payment for the days beyond the outlier threshold
shall be in addition to the operating and property payment rates per admission established
under subdivisions 2 and 2b. Payment for outliers shall be at 70 percent of the allowable
operating cost, after adjustment by the case mix index, hospital cost index, relative values
and the disproportionate population adjustment. The outlier threshold for neonatal and burn
diagnostic categories shall be established at one standard deviation beyond the mean length
of stay, and payment shall be at 90 percent of allowable operating cost calculated in the
same manner as other outliers. A hospital may choose an alternative to the 70 percent outlier
payment that is at a minimum of 60 percent and a maximum of 80 percent if the
commissioner is notified in writing of the request by October 1 of the year preceding the
rate year. The chosen percentage applies to all diagnostic categories except burns and
neonates. The percentage of allowable cost that is unrecognized by the outlier payment shall
be added back to the base year operating payment rate per admission.
(b) Effective fornew text begin admissions andnew text end transfers occurring on and after November 1, 2014, the
commissioner shall establish payment rates for outlier payments that are based on Medicare
methodologies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 13.
Minnesota Statutes 2016, section 256.969, subdivision 8c, is amended to read:
Subd. 8c.
Hospital residents.
new text begin (a) new text end For discharges occurring on or after November 1,
2014, payments for hospital residents shall be made as follows:
(1) payments for the first 180 days of inpatient care shall be the APR-DRG system plus
any outliers; and
(2) payment for all medically necessary patient care subsequent to the first 180 days
shall be reimbursed at a rate computed by multiplying the statewide average cost-to-charge
ratio by the usual and customary charges.
new text begin
(b) For discharges occurring on or after July 1, 2017, payment for hospital residents
shall be equal to the payments under subdivision 8, paragraph (b).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 14.
Minnesota Statutes 2016, section 256.969, subdivision 9, is amended to read:
Subd. 9.
Disproportionate numbers of low-income patients served.
(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:
(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.
(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.
(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.
(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:
(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;
(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;
(3) a hospital that has received payment from the fee-for-service program for at least 20
transplant services in the base year shall receive a factor of 0.0435;
(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;
(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than three standard
deviations above the mean shall receive a factor of 0.2300; and
(6) a hospital that has a medical assistance utilization rate in the base year that is at least
three standard deviations above the statewide mean utilization rate shall receive a factor of
0.3711.
(e) Any payments or portion of payments made to a hospital under this subdivision that
are subsequently returned to the commissioner because the payments are found to exceed
the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
number of fee-for-service discharges, to other DSH-eligible deleted text begin nonchildren'sdeleted text end new text begin non-children'snew text end
hospitals that have a medical assistance utilization rate that is at least one standard deviation
above the mean.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 15.
Minnesota Statutes 2016, section 256.969, subdivision 12, is amended to read:
Subd. 12.
Rehabilitation hospitals and distinct parts.
(a) Units of hospitals that are
recognized as rehabilitation distinct parts by the Medicare program shall have separate
provider numbers under the medical assistance program for rate establishment and billing
purposes only. These units shall also have operating payment rates and the disproportionate
population adjustment, if allowed by federal law, established separately from other inpatient
hospital services.
(b) The commissioner shall establish separate relative values under subdivision 2 for
rehabilitation hospitals and distinct parts as defined by the Medicare program. Effective for
discharges occurring on and after November 1, 2014, the commissioner, to the extent
possible, shall replicate the existing payment rate methodology under the new diagnostic
classification system. The result must be budget neutral, ensuring that the total aggregate
payments under the new system are equal to the total aggregate payments made for the same
number and types of services in the base year, calendar year 2012.
(c) For individual hospitals that did not have separate medical assistance rehabilitation
provider numbers or rehabilitation distinct parts in the base year, hospitals shall provide the
information needed to separate rehabilitation distinct part cost and claims data from other
inpatient service data.
new text begin
(d) Effective with discharges on or after July 1, 2017, payment to rehabilitation hospitals
shall be established under subdivision 2d, paragraph (a), clause (4).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 16.
new text begin
[256B.0371] ADMINISTRATION OF DENTAL SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Contract for dental administration services. new text end
new text begin
(a) The commissioner
shall contract with up to two dental administrators to administer dental services for all
recipients of medical assistance and MinnesotaCare.
new text end
new text begin
(b) The dental administrator must provide administrative services including, but not
limited to:
new text end
new text begin
(1) provider recruitment, contracting, and assistance;
new text end
new text begin
(2) recipient outreach and assistance;
new text end
new text begin
(3) utilization management and review for medical necessity of dental services;
new text end
new text begin
(4) dental claims processing, including submission of encounter claims to the department;
new text end
new text begin
(5) coordination with other services;
new text end
new text begin
(6) management of fraud and abuse;
new text end
new text begin
(7) monitoring of access to dental services;
new text end
new text begin
(8) performance measurement;
new text end
new text begin
(9) quality improvement and evaluation requirements; and
new text end
new text begin
(10) management of third party liability requirements.
new text end
new text begin
(c) A payment to a contracted dental provider shall be at the rates established under
section 256B.76.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2019.
new text end
Sec. 17.
Minnesota Statutes 2016, section 256B.04, subdivision 21, is amended to read:
Subd. 21.
Provider enrollment.
(a)new text begin The commissioner shall enroll providers and conduct
screening activities as required by Code of Federal Regulations, title 42, section 455, subpart
E, including database checks, unannounced pre- and post-enrollment site visits, fingerprinting,
and criminal background studies. A provider providing services from multiple locations
must enroll each location separately. The commissioner may deny a provider's incomplete
application for enrollment if a provider fails to respond to the commissioner's request for
additional information within 60 days of the request.
new text end
new text begin
(b) The commissioner must revalidate each provider under this subdivision at least once
every five years. The commissioner may revalidate a personal care assistance agency under
this subdivision once every three years. The commissioner shall conduct revalidation as
follows:
new text end
new text begin
(1) provide 30-day notice of revalidation due date to include instructions for revalidation
and a list of materials the provider must submit to revalidate;
new text end
new text begin
(2) notify the provider that fails to completely respond within 30 days of any deficiencies
and allow an additional 30 days to comply; and
new text end
new text begin
(3) give 60-day notice of termination and immediately suspend a provider's ability to
bill for failure to remedy any deficiencies within the 30-day time period. The provider shall
have no right to appeal suspension of ability to bill.
new text end
new text begin
(c) The commissioner shall require that an individual rendering care to a recipient for
the following covered services enroll as an individual provider and be identified on claims:
new text end
new text begin
(1) adult rehabilitative mental health services according to section 256B.0623;
new text end
new text begin
(2) autism early intensive behavioral intervention benefits according to section
256B.0949;
new text end
new text begin
(3) home and community-based waiver services, consumer directed community supports;
and
new text end
new text begin
(4) qualified professionals supervising personal care assistant services according to
section 256B.0659.
new text end
new text begin
(d) The commissioner may suspend a provider's ability to bill for a failure to comply
with any individual provider requirements or conditions of participation until the provider
comes into compliance. The commissioner's decision to suspend the provider is not subject
to an administrative appeal.
new text end
new text begin
(e) Notwithstanding any other provision to the contrary, all correspondence and
notifications, including notifications of termination and other actions, shall be delivered
electronically to a provider's MN-ITS mailbox. For a provider that does not have a MN-ITS
account and mailbox, notice shall be sent by first class mail.
new text end
new text begin (f)new text end If the commissioner or the Centers for Medicare and Medicaid Services determines
that a provider is designated "high-risk," the commissioner may withhold payment from
providers within that category upon initial enrollment for a 90-day period. The withholding
for each provider must begin on the date of the first submission of a claim.
deleted text begin (b)deleted text end new text begin (g)new text end An enrolled provider that is also licensed by the commissioner under chapter
245A, or is licensed as a home care provider by the Department of Health under chapter
144A and has a home and community-based services designation on the home care license
under section 144A.484, must designate an individual as the entity's compliance officer.
The compliance officer must:
(1) develop policies and procedures to assure adherence to medical assistance laws and
regulations and to prevent inappropriate claims submissions;
(2) train the employees of the provider entity, and any agents or subcontractors of the
provider entity including billers, on the policies and procedures under clause (1);
(3) respond to allegations of improper conduct related to the provision or billing of
medical assistance services, and implement action to remediate any resulting problems;
(4) use evaluation techniques to monitor compliance with medical assistance laws and
regulations;
(5) promptly report to the commissioner any identified violations of medical assistance
laws or regulations; and
(6) within 60 days of discovery by the provider of a medical assistance reimbursement
overpayment, report the overpayment to the commissioner and make arrangements with
the commissioner for the commissioner's recovery of the overpayment.
The commissioner may require, as a condition of enrollment in medical assistance, that a
provider within a particular industry sector or category establish a compliance program that
contains the core elements established by the Centers for Medicare and Medicaid Services.
deleted text begin (c)deleted text end new text begin (h)new text end The commissioner may revoke the enrollment of an ordering or rendering provider
for a period of not more than one year, if the provider fails to maintain and, upon request
from the commissioner, provide access to documentation relating to written orders or requests
for payment for durable medical equipment, certifications for home health services, or
referrals for other items or services written or ordered by such provider, when the
commissioner has identified a pattern of a lack of documentation. A pattern means a failure
to maintain documentation or provide access to documentation on more than one occasion.
Nothing in this paragraph limits the authority of the commissioner to sanction a provider
under the provisions of section 256B.064.
deleted text begin (d)deleted text end new text begin (i)new text end The commissioner shall terminate or deny the enrollment of any individual or
entity if the individual or entity has been terminated from participation in Medicare or under
the Medicaid program or Children's Health Insurance Program of any other state.
deleted text begin (e)deleted text end new text begin (j)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a provider designated "moderate" or "high-risk" by the Centers for Medicare and
Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
Services, its agents, or its designated contractors and the state agency, its agents, or its
designated contractors to conduct unannounced on-site inspections of any provider location.
The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
and standards used to designate Medicare providers in Code of Federal Regulations, title
42, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
The commissioner's designations are not subject to administrative appeal.
deleted text begin (f)deleted text end new text begin (k)new text end As a condition of enrollment in medical assistance, the commissioner shall require
that a high-risk provider, or a person with a direct or indirect ownership interest in the
provider of five percent or higher, consent to criminal background checks, including
fingerprinting, when required to do so under state law or by a determination by the
commissioner or the Centers for Medicare and Medicaid Services that a provider is designated
high-risk for fraud, waste, or abuse.
deleted text begin (g)deleted text end new text begin (l)new text end (1) Upon initial enrollment, reenrollment, and notification of revalidation, all
durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) medical suppliers
meeting the durable medical equipment provider and supplier definition in clause (3),
operating in Minnesota and receiving Medicaid funds must purchase a surety bond that is
annually renewed and designates the Minnesota Department of Human Services as the
obligee, and must be submitted in a form approved by the commissioner. For purposes of
this clause, the following medical suppliers are not required to obtain a surety bond: a
federally qualified health center, a home health agency, the Indian Health Service, a
pharmacy, and a rural health clinic.
(2) At the time of initial enrollment or reenrollment, durable medical equipment providers
and suppliers defined in clause (3) must purchase a surety bond of $50,000. If a revalidating
provider's Medicaid revenue in the previous calendar year is up to and including $300,000,
the provider agency must purchase a surety bond of $50,000. If a revalidating provider's
Medicaid revenue in the previous calendar year is over $300,000, the provider agency must
purchase a surety bond of $100,000. The surety bond must allow for recovery of costs and
fees in pursuing a claim on the bond.
(3) "Durable medical equipment provider or supplier" means a medical supplier that can
purchase medical equipment or supplies for sale or rental to the general public and is able
to perform or arrange for necessary repairs to and maintenance of equipment offered for
sale or rental.
deleted text begin (h)deleted text end new text begin (m)new text end The Department of Human Services may require a provider to purchase a surety
bond as a condition of initial enrollment, reenrollment, reinstatement, or continued enrollment
if: (1) the provider fails to demonstrate financial viability, (2) the department determines
there is significant evidence of or potential for fraud and abuse by the provider, or (3) the
provider or category of providers is designated high-risk pursuant to paragraph deleted text begin (a)deleted text end new text begin (e)new text end and
as per Code of Federal Regulations, title 42, section 455.450. The surety bond must be in
an amount of $100,000 or ten percent of the provider's payments from Medicaid during the
immediately preceding 12 months, whichever is greater. The surety bond must name the
Department of Human Services as an obligee and must allow for recovery of costs and fees
in pursuing a claim on the bond. This paragraph does not apply if the provider currently
maintains a surety bond under the requirements in section 256B.0659 or 256B.85.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 18.
Minnesota Statutes 2016, section 256B.04, subdivision 22, is amended to read:
Subd. 22.
Application fee.
(a) The commissioner must collect and retain federally
required nonrefundable application fees to pay for provider screening activities in accordance
with Code of Federal Regulations, title 42, section 455, subpart E. The enrollment application
must be made under the procedures specified by the commissioner, in the form specified
by the commissioner, and accompanied by an application fee described in paragraph (b),
or a request for a hardship exception as described in the specified procedures. Application
fees must be deposited in the provider screening account in the special revenue fund.
Amounts in the provider screening account are appropriated to the commissioner for costs
associated with the provider screening activities required in Code of Federal Regulations,
title 42, section 455, subpart E. The commissioner deleted text begin shall conduct screening activities as
required by Code of Federal Regulations, title 42, section 455, subpart E, and as otherwise
provided by law, to include database checks, unannounced pre- and postenrollment site
visits, fingerprinting, and criminal background studies. The commissioner must revalidate
all providers under this subdivision at least once every five yearsdeleted text end new text begin must revalidate all personal
care assistance agencies under this subdivision at least once every three yearsnew text end .
(b) The application fee under this subdivision is $532 for the calendar year 2013. For
calendar year 2014 and subsequent years, the fee:
(1) is adjusted by the percentage change to the Consumer Price Index for all urban
consumers, United States city average, for the 12-month period ending with June of the
previous year. The resulting fee must be announced in the Federal Register;
(2) is effective from January 1 to December 31 of a calendar year;
(3) is required on the submission of an initial application, an application to establish a
new practice location, an application for reenrollment when the provider is not enrolled at
the time of application of reenrollment, or at revalidation when required by federal regulation;
and
(4) must be in the amount in effect for the calendar year during which the application
for enrollment, new practice location, or reenrollment is being submitted.
(c) The application fee under this subdivision cannot be charged to:
(1) providers who are enrolled in Medicare or who provide documentation of payment
of the fee to, and enrollment with, another state, unless the commissioner is required to
rescreen the provider;
(2) providers who are enrolled but are required to submit new applications for purposes
of reenrollment;
(3) a provider who enrolls as an individual; and
(4) group practices and clinics that bill on behalf of individually enrolled providers
within the practice who have reassigned their billing privileges to the group practice or
clinic.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 19.
Minnesota Statutes 2016, section 256B.055, subdivision 2, is amended to read:
Subd. 2.
Subsidized foster children.
Medical assistance may be paid for a child eligible
for or receiving foster care maintenance payments under Title IV-E of the Social Security
Act, United States Code, title 42, sections 670 to 676new text begin , and to any child who is not title IV-E
eligible but who is determined eligible for foster care or kinship assistance under chapter
256Nnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2019, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2016, section 256B.055, subdivision 7, is amended to read:
Subd. 7.
deleted text begin Aged, blind, or disabled personsdeleted text end new text begin Age 65 or oldernew text end .
deleted text begin (a)deleted text end Medical assistance may
be paid for a person whonew text begin is age 65 or older andnew text end meets the categorical eligibility requirements
of the Supplemental Security Income program or, who would meet those requirements
except for excess income or assets, and who meets the other eligibility requirements of this
section.
deleted text begin
(b) Following a determination that the applicant is not aged or blind and does not meet
any other category of eligibility for medical assistance and has not been determined disabled
by the Social Security Administration, applicants under this subdivision shall be referred
to the commissioner's state medical review team for a determination of disability.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 21.
Minnesota Statutes 2016, section 256B.055, is amended by adding a subdivision
to read:
new text begin Subd. 7b. new text end
new text begin Persons who are blind or who have been determined disabled. new text end
new text begin
(a) Medical
assistance may be paid for a person who meets the categorical eligibility requirements of
the Supplemental Security Income program or who would meet those requirements except
for excess income or assets and who meets the other eligibility requirements of this section.
new text end
new text begin
(b) Following a determination that the applicant is not blind and does not meet any other
category of eligibility for medical assistance and has not been determined disabled by the
Social Security Administration, an applicant under this subdivision shall be referred to the
commissioner's state medical review team for a determination of disability.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 22.
Minnesota Statutes 2016, section 256B.056, subdivision 1b, is amended to read:
Subd. 1b.
deleted text begin Aged, blind, and disableddeleted text end new text begin Age 65 or oldernew text end income methodology.
The $20
general income disregard allowed under the Supplemental Security Income program is
included in the standard and shall not be allowed as a deduction from income for a person
eligible under section 256B.055, deleted text begin subdivisionsdeleted text end new text begin subdivisionnew text end 7deleted text begin , 7a, and 12deleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 23.
Minnesota Statutes 2016, section 256B.056, is amended by adding a subdivision
to read:
new text begin Subd. 1e. new text end
new text begin
Income methodology for persons who are blind or who have been
determined disabled.
new text end
new text begin
The $20 general income disregard allowed under the Supplemental
Security Income program is included in the standard and shall not be allowed as a deduction
from income for a person eligible under section 256B.055, subdivisions 7a, 7b, and 12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 24.
Minnesota Statutes 2016, section 256B.056, subdivision 3b, is amended to read:
Subd. 3b.
Treatment of trusts.
(a) A "medical assistance qualifying trust" is a revocable
or irrevocable trust, or similar legal device, established on or before August 10, 1993, by a
person or the person's spouse under the terms of which the person receives or could receive
payments from the trust principal or income and the trustee has discretion in making payments
to the person from the trust principal or income. Notwithstanding that definition, a medical
assistance qualifying trust does not include: (1) a trust set up by will; (2) a trust set up before
April 7, 1986, solely to benefit a person with a developmental disability living in an
intermediate care facility for persons with developmental disabilities; or (3) a trust set up
by a person with payments made by the Social Security Administration pursuant to the
United States Supreme Court decision in Sullivan v. Zebley, 110 S. Ct. 885 (1990). The
maximum amount of payments that a trustee of a medical assistance qualifying trust may
make to a person under the terms of the trust is considered to be available assets to the
person, without regard to whether the trustee actually makes the maximum payments to the
person and without regard to the purpose for which the medical assistance qualifying trust
was established.
(b) deleted text begin Except as provided in paragraphs (c) and (d),deleted text end Trusts established after August 10,
1993, are treated according to deleted text begin section 13611(b) of the Omnibus Budget Reconciliation Act
of 1993 (OBRA), Public Law 103-66deleted text end new text begin United States Code, title 42, section 1396p(d)new text end .
(c) For purposes of paragraph (d), a pooled trust means a trust established under United
States Code, title 42, section 1396p(d)(4)(C).
(d) A beneficiary's interest in a pooled trust is considered an available asset unless the
trust provides that upon the death of the beneficiary or termination of the trust during the
beneficiary's lifetime, whichever is sooner, the department receives any amount, up to the
amount of medical assistance benefits paid on behalf of the beneficiary, remaining in the
beneficiary's trust account after a deduction for reasonable administrative fees and expenses,
and an additional remainder amount. The retained remainder amount of the subaccount
must not exceed ten percent of the account value at the time of the beneficiary's death or
termination of the trust, and must only be used for the benefit of disabled individuals who
have a beneficiary interest in the pooled trust.
new text begin
(e) Trusts may be established on or after December 12, 2016, by a person who has been
determined to be disabled, according to United States Code, title 42, section 1396p(d)(4)(A),
as amended by section 5007 of the 21st Century Cures Act, Public Law 114-255.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 25.
Minnesota Statutes 2016, section 256B.056, subdivision 3c, is amended to read:
Subd. 3c.
Asset limitations for families and children.
(a) A household of two or more
persons must not own more than $20,000 in total net assets, and a household of one person
must not own more than $10,000 in total net assets. In addition to these maximum amounts,
an eligible individual or family may accrue interest on these amounts, but they must be
reduced to the maximum at the time of an eligibility redetermination. The value of assets
that are not considered in determining eligibility for medical assistance for families and
children is the value of those assets excluded under the AFDC state plan as of July 16, 1996,
as required by the Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (PRWORA), Public Law 104-193, with the following exceptions:
(1) household goods and personal effects are not considered;
(2) capital and operating assets of a trade or business up to $200,000 are not considereddeleted text begin ,
except that a bank account that contains personal income or assets, or is used to pay personal
expenses, is not considered a capital or operating asset of a trade or businessdeleted text end ;
(3) one motor vehicle is excluded for each person of legal driving age who is employed
or seeking employment;
(4) assets designated as burial expenses are excluded to the same extent they are excluded
by the Supplemental Security Income program;
(5) court-ordered settlements up to $10,000 are not considered;
(6) individual retirement accounts and funds are not considered;
(7) assets owned by children are not considered; and
(8) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
deleted text begin
The assets specified in clause (2) must be disclosed to the local agency at the time of
application and at the time of an eligibility redetermination, and must be verified upon
request of the local agency.
deleted text end
(b) Beginning January 1, 2014, this subdivision applies only to parents and caretaker
relatives who qualify for medical assistance under subdivision 5.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 26.
Minnesota Statutes 2016, section 256B.056, subdivision 3d, is amended to read:
Subd. 3d.
Reduction of excess assetsnew text begin for people age 65 or oldernew text end .
new text begin For people age 65 or
older, new text end assets in excess of the limits in deleted text begin subdivisionsdeleted text end new text begin subdivisionnew text end 3 deleted text begin to 3cdeleted text end may be reduced to
allowable limits as follows:
(a) Assets may be reduced in any of the three calendar months before the month of
application in which the applicant seeks coverage by paying bills for health services that
are incurred in the retroactive period for which the applicant seeks eligibility, starting with
the oldest bill. After assets are reduced to allowable limits, eligibility begins with the next
dollar of MA-covered health services incurred in the retroactive period. Applicants reducing
assets under this subdivision who also have excess income shall first spend excess assets
to pay health service bills and may meet the income spenddown on remaining bills.
(b) Assets may be reduced beginning the month of application by paying bills for health
services that are incurred during the period specified in Minnesota Rules, part 9505.0090,
subpart 2, that would otherwise be paid by medical assistance. After assets are reduced to
allowable limits, eligibility begins with the next dollar of medical assistance covered health
services incurred in the period. Applicants reducing assets under this subdivision who also
have excess income shall first spend excess assets to pay health service bills and may meet
the income spenddown on remaining bills.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
Minnesota Statutes 2016, section 256B.056, is amended by adding a subdivision
to read:
new text begin Subd. 3f. new text end
new text begin Reduction of excess assets for people under age 65. new text end
new text begin
(a) For a person younger
than 65 years of age, assets in excess of the limits in subdivision 3 or 3c may be reduced to
allowable limits according to this subdivision.
new text end
new text begin
(b) A person's assets may be reduced in any of the three calendar months before the
month of application in which the person seeks coverage by:
new text end
new text begin
(1) designating burial funds up to $1,500 for each applicant, the applicant's spouse, and
the applicant's medical assistance-eligible dependent child; and
new text end
new text begin
(2) paying bills for health services that are incurred in the retroactive period for which
the person seeks eligibility, starting with the oldest bill. After assets are reduced to allowable
limits, eligibility begins with the next dollar of medical assistance-covered health services
incurred in the retroactive period. An applicant reducing assets under this subdivision who
also has excess income shall first spend excess assets to pay health services bills and may
meet the income spenddown on remaining bills.
new text end
new text begin
(c) A person's assets may be reduced beginning the month of application by:
new text end
new text begin
(1) paying bills for health services that are incurred during the period specified in
Minnesota Rules, part 9505.0090, subpart 2, that would otherwise be paid by medical
assistance; and
new text end
new text begin
(2) using any means other than a transfer of assets for less than fair market value defined
in section 256B.0595, subdivision 1, paragraph (b).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 28.
Minnesota Statutes 2016, section 256B.057, subdivision 9, is amended to read:
Subd. 9.
Employed persons with disabilities.
(a) Medical assistance may be paid for
a person who is employed and who:
(1) but for excess earnings or assets, meets the definition of disabled under the
Supplemental Security Income program;
(2) meets the asset limits in paragraph (d); and
(3) pays a premium and other obligations under paragraph (e).
(b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
for medical assistance under this subdivision, a person must have more than $65 of earned
income. Earned income must have Medicare, Social Security, and applicable state and
federal taxes withheld. The person must document earned income tax withholding. Any
spousal income or assets shall be disregarded for purposes of eligibility and premium
determinations.
(c) After the month of enrollment, a person enrolled in medical assistance under this
subdivision who:
(1) is temporarily unable to work and without receipt of earned income due to a medical
condition, as verified by a physician; or
(2) loses employment for reasons not attributable to the enrollee, and is without receipt
of earned income may retain eligibility for up to four consecutive months after the month
of job loss. To receive a four-month extension, enrollees must verify the medical condition
or provide notification of job loss. All other eligibility requirements must be met and the
enrollee must pay all calculated premium costs for continued eligibility.
(d) For purposes of determining eligibility under this subdivision, a person's assets must
not exceed $20,000, excluding:
(1) all assets excluded under section 256B.056;
(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, Keogh
plans, and pension plans;
(3) medical expense accounts set up through the person's employer; and
(4) spousal assets, including spouse's share of jointly held assets.
(e) All enrollees must pay a premium to be eligible for medical assistance under this
subdivision, except as provided under clause (5).
(1) An enrollee must pay the greater of a $35 premium or the premium calculated based
on the person's gross earned and unearned income and the applicable family size using a
sliding fee scale established by the commissioner, which begins at one percent of income
at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income for
those with incomes at or above 300 percent of the federal poverty guidelines.
(2) Annual adjustments in the premium schedule based upon changes in the federal
poverty guidelines shall be effective for premiums due in July of each year.
(3) All enrollees who receive unearned income must pay one-half of one percent of
unearned income in addition to the premium amount, except as provided under clause (5).
(4) Increases in benefits under title II of the Social Security Act shall not be counted as
income for purposes of this subdivision until July 1 of each year.
(5) Effective July 1, 2009, American Indians are exempt from paying premiums as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
(f) A person's eligibility and premium shall be determined by the local county agency.
Premiums must be paid to the commissioner. All premiums are dedicated to the
commissioner.
(g) Any required premium shall be determined at application and redetermined at the
enrollee's six-month income review or when a change in income or household size is reported.
Enrollees must report any change in income or household size within ten days of when the
change occurs. A decreased premium resulting from a reported change in income or
household size shall be effective the first day of the next available billing month after the
change is reported. Except for changes occurring from annual cost-of-living increases, a
change resulting in an increased premium shall not affect the premium amount until the
next six-month review.
(h) Premium payment is due upon notification from the commissioner of the premium
amount required. Premiums may be paid in installments at the discretion of the commissioner.
(i) Nonpayment of the premium shall result in denial or termination of medical assistance
unless the person demonstrates good cause for nonpayment. deleted text begin Good cause exists if the
requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to D, are
metdeleted text end new text begin "Good cause" means an excuse for the enrollee's failure to pay the required premium
when due because the circumstances were beyond the enrollee's control or not reasonably
foreseeable. The commissioner shall determine whether good cause exists based on the
weight of the supporting evidence submitted by the enrollee to demonstrate good causenew text end .
Except when an installment agreement is accepted by the commissioner, all persons
disenrolled for nonpayment of a premium must pay any past due premiums as well as current
premiums due prior to being reenrolled. Nonpayment shall include payment with a returned,
refused, or dishonored instrument. The commissioner may require a guaranteed form of
payment as the only means to replace a returned, refused, or dishonored instrument.
(j) For enrollees whose income does not exceed 200 percent of the federal poverty
guidelines and who are also enrolled in Medicare, the commissioner shall reimburse the
enrollee for Medicare part B premiums under section 256B.0625, subdivision 15, paragraph
(a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 29.
Minnesota Statutes 2016, section 256B.059, subdivision 6, is amended to read:
Subd. 6.
Temporary application.
(a) During the period in which rules against spousal
impoverishment are temporarily applied according to section 2404 of the Patient Protection
Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education
Reconciliation Act of 2010, Public Law 111-152, this section applies to an institutionalized
spouse:
(1) applying for home and community-based waivers under sections 256B.092, 256B.093,
and 256B.49 on or after June 1, 2016;
(2) enrolled in home and community-based waivers under sections 256B.092, 256B.093,
and 256B.49 before June 1, 2016new text begin , based on an application submitted on or after January 1,
2014new text end ; or
(3) applying for services under section 256B.85 upon the effective date of that section.
(b) During the applicable period of paragraph (a), the definition of "institutionalized
spouse" in subdivision 1, paragraph (f), also includes an institutionalized spouse referenced
in paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 30.
Minnesota Statutes 2016, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Medical necessity criteria for inpatient hospital treatment. new text end
new text begin
(a) The medical
review agent shall determine whether:
new text end
new text begin
(1) a recipient's admission is medically necessary;
new text end
new text begin
(2) the inpatient hospital services provided to the recipient were medically necessary;
new text end
new text begin
(3) the recipient's continued stay was or will be medically necessary; and
new text end
new text begin
(4) all medically necessary inpatient hospital services were provided to the recipient.
new text end
new text begin
(b) The medical review agent shall determine the medical necessity of inpatient hospital
services and inpatient psychiatric treatment services based on a review of the recipient's
medical condition and records in conjunction with an industry-standard, evidence-based
clinical decision tool to ensure consistent and optimal application of medical appropriateness
criteria.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 31.
Minnesota Statutes 2016, section 256B.0625, subdivision 3a, is amended to read:
Subd. 3a.
deleted text begin Sex reassignmentdeleted text end new text begin Gender confirmationnew text end surgery.
deleted text begin Sex reassignmentdeleted text end new text begin Gender
confirmationnew text end surgery is deleted text begin notdeleted text end coverednew text begin when medically necessarynew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 32.
Minnesota Statutes 2016, section 256B.0625, subdivision 18h, is amended to
read:
Subd. 18h.
Managed care.
new text begin (a) new text end The following subdivisions deleted text begin do notdeleted text end apply to managed
care plans and county-based purchasing plans:
(1) subdivision 17, paragraphs deleted text begin (d) to (k)deleted text end new text begin (a), (b), (h), and (n)new text end ;
(2) subdivision deleted text begin 18edeleted text end new text begin 18new text end ; and
(3) subdivision deleted text begin 18gdeleted text end new text begin 18anew text end .
new text begin
(b) A nonemergency medical transportation provider must comply with the operating
standards for special transportation service defined in sections 174.29 to 174.30 and
Minnesota Rules, chapter 8840, and in consultation with the Minnesota Department of
Transportation. Publicly operated transit systems, volunteers, and not-for-hire vehicles are
exempt from the requirements in this paragraph.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2016, section 256B.0625, subdivision 30, is amended to read:
Subd. 30.
Other clinic services.
(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.
(b) A federally qualified health center that is beginning initial operation shall submit an
estimate of budgeted costs and visits for the initial reporting period in the form and detail
required by the commissioner. A federally qualified health center that is already in operation
shall submit an initial report using actual costs and visits for the initial reporting period.
Within 90 days of the end of its reporting period, a federally qualified health center shall
submit, in the form and detail required by the commissioner, a report of its operations,
including allowable costs actually incurred for the period and the actual number of visits
for services furnished during the period, and other information required by the commissioner.
Federally qualified health centers that file Medicare cost reports shall provide the
commissioner with a copy of the most recent Medicare cost report filed with the Medicare
program intermediary for the reporting year which support the costs claimed on their cost
report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), a federally qualified health center or rural health clinic
must apply for designation as an essential community provider within six months of final
adoption of rules by the Department of Health according to section 62Q.19, subdivision 7.
For those federally qualified health centers and rural health clinics that have applied for
essential community provider status within the six-month time prescribed, medical assistance
payments will continue to be made according to paragraphs (a) and (b) for the first three
years after application. For federally qualified health centers and rural health clinics that
either do not apply within the time specified above or who have had essential community
provider status for three years, medical assistance payments for health services provided
by these entities shall be according to the same rates and conditions applicable to the same
service provided by health care providers that are not federally qualified health centers or
rural health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally qualified
health center or a rural health clinic to make application for an essential community provider
designation in order to have cost-based payments made according to paragraphs (a) and (b)
no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, each federally qualified health center and rural health
clinic may elect to be paid either under the prospective payment system established in United
States Code, title 42, section 1396a(aa), or under an alternative payment methodology
consistent with the requirements of United States Code, title 42, section 1396a(aa), and
approved by the Centers for Medicare and Medicaid Services. The alternative payment
methodology shall be 100 percent of cost as determined according to Medicare cost
principles.
(g) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;
(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.
(h) Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by federally qualified health centers and rural health clinics shall
be paid by the commissioner. The commissioner shall determine the most feasible method
for paying claims from the following options:
(1) federally qualified health centers and rural health clinics submit claims directly to
the commissioner for payment, and the commissioner provides claims information for
recipients enrolled in a managed care or county-based purchasing plan to the plan, on a
regular basis; or
(2) federally qualified health centers and rural health clinics submit claims for recipients
enrolled in a managed care or county-based purchasing plan to the plan, and those claims
are submitted by the plan to the commissioner for payment to the clinic.
(i) For clinic services provided prior to January 1, 2015, the commissioner shall calculate
and pay monthly the proposed managed care supplemental payments to clinics, and clinics
shall conduct a timely review of the payment calculation data in order to finalize all
supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.
(j) The commissioner shall seek a federal waiver, authorized under section 1115 of the
Social Security Act, to obtain federal financial participation at the 100 percent federal
matching percentage available to facilities of the Indian Health Service or tribal organization
in accordance with section 1905(b) of the Social Security Act for expenditures made to
organizations dually certified under Title V of the Indian Health Care Improvement Act,
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
provides services to American Indian and Alaskan Native individuals eligible for services
under this subdivision.
new text begin
(k) Effective for services provided on or after January 1, 2019, all claims for payment
of clinic services provided by federally qualified health centers and rural health clinics shall
be paid by the commissioner according to the current prospective payment system described
in paragraph (f), or an alternative payment methodology with the following requirements:
new text end
new text begin
(1) each federally qualified health center and rural health clinic must receive a single
medical and a single dental organization rate;
new text end
new text begin
(2) the commissioner shall reimburse federally qualified health centers and rural health
clinics allowable costs, including direct patient care costs and patient-related support services,
based upon Medicare cost principles that apply at the time the alternative payment
methodology is calculated;
new text end
new text begin
(3) the 2019 payment rates for federally qualified health centers and rural health clinics:
new text end
new text begin
(i) must be determined using each federally qualified health center's and rural health
clinic's Medicare cost reports from 2015 and 2016. A provider must submit the required
cost reports to the commissioner within six months of the second base year calendar or
fiscal year end. Cost reports must be submitted six months before the quarter in which the
base rate will take effect;
new text end
new text begin
(ii) must be according to current Medicare cost principles applicable to federally qualified
health centers and rural health clinics at the time of the alternative payment rate calculation
without the application of productivity screens and upper payment limits or the Medicare
prospective payment system federally qualified health center aggregate mean upper payment
limit; and
new text end
new text begin
(iii) must provide for a 60-day appeals process;
new text end
new text begin
(4) the commissioner shall inflate the base year payment rate for federally qualified
health centers and rural health clinics to the effective date by using the Bureau of Economic
Analysis' personal consumption expenditures medical care inflator;
new text end
new text begin
(5) the commissioner shall establish a statewide trend inflator using 2015-2020 costs
replacing the use of the personal consumption expenditures medical care inflator with the
2023 rate calculation forward;
new text end
new text begin
(6) federally qualified health center and rural health clinic payment rates shall be rebased
by the commissioner every two years using the methodology described in paragraph (k),
clause (3), using the provider's Medicare cost reports from the previous third and fourth
years. In nonrebasing years, the commissioner shall adjust using the Medicare economic
index until 2023 when the statewide trend inflator is available;
new text end
new text begin
(7) the commissioner shall increase payments by two percent according to Laws 2003,
First Special Session chapter 14, article 13C, section 2, subdivision 6. This is an add-on to
the rate and must not be included in the base rate calculation;
new text end
new text begin
(8) for federally qualified health centers and rural health clinics seeking a change of
scope of services:
new text end
new text begin
(i) the commissioner shall require federally qualified health centers and rural health
clinics to submit requests with the commissioner if the change of scope would result in the
medical or dental payment rate currently received by the federally qualified health center
or rural health clinic increasing or decreasing by at least 2-1/2 percent;
new text end
new text begin
(ii) federally qualified health centers and rural health clinics shall submit the request to
the commissioner within seven business days of submission of the scope change to the
federal Health Resources Services Administration;
new text end
new text begin
(iii) the effective date of the payment change is the date the Health Resources Services
Administration approves the federally qualified health center's or rural health clinic's change
of scope request;
new text end
new text begin
(iv) for change of scope requests that do not require Health Resources Services
Administration approval, federally qualified health centers and rural health clinics shall
submit the request to the commissioner before implementing the change, and the effective
date of the change is the date the commissioner receives the request from the federally
qualified health center or rural health clinic; and
new text end
new text begin
(v) the commissioner shall provide a response to the federally qualified health center's
or rural health clinic's change of scope request within 45 days of submission and provide a
final decision regarding approval or disapproval within 120 days of submission. If more
information is needed to evaluate the request, this timeline may be waived at the mutual
agreement of the commissioner and the federally qualified health center or rural health
clinic; and
new text end
new text begin
(9) the commissioner shall establish a payment rate for new federally qualified health
center and rural health clinic organizations, considering the following factors:
new text end
new text begin
(i) a comparison of patient caseload of federally qualified health centers and rural health
clinics within a 60-mile radius for organizations established outside of the seven-county
metropolitan area and within a 30-mile radius for organizations within the seven-county
metropolitan area; and
new text end
new text begin
(ii) if comparison is not feasible under item (i), the commissioner may use Medicare
cost reports or audited financial statements to establish the base rate.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 34.
Minnesota Statutes 2016, section 256B.0625, subdivision 45a, is amended to
read:
Subd. 45a.
Psychiatric residential treatment facility services for persons under 21
years of age.
(a) Medical assistance covers psychiatric residential treatment facility services
for persons under 21 years of age. Individuals who reach age 21 at the time they are receiving
services are eligible to continue receiving services until they no longer require services or
until they reach age 22, whichever occurs first.
(b) For purposes of this subdivision, "psychiatric residential treatment facility" means
a facility other than a hospital that provides psychiatric services, as described in Code of
Federal Regulations, title 42, sections 441.151 to 441.182, to individuals under age 21 in
an inpatient setting.
(c) The commissioner shall develop admissions and discharge procedures and establish
rates consistent with guidelines from the federal Centers for Medicare and Medicaid Services.
(d) The commissioner shall enroll up to 150 certified psychiatric residential treatment
facility services beds at up to six sites. The commissioner shall select psychiatric residential
treatment facility services providers through a request for proposals process. Providers of
state-operated services may respond to the request for proposals.
new text begin
(e) An individual who is eligible for mental health treatment services in a psychiatric
residential treatment facility is an individual who meets all of the following criteria:
new text end
new text begin
(1) has a certificate of need prior to admission, as determined and approved by the state's
medical review agent, to determine medical necessity according to Code of Federal
Regulations, title 42, section 441.152;
new text end
new text begin
(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;
new text end
new text begin
(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or the individual is a risk to self or others;
new text end
new text begin
(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;
new text end
new text begin
(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;
new text end
new text begin
(6) has utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and
new text end
new text begin
(7) has been referred for treatment in a psychiatric residential treatment facility by a
qualified mental health professional licensed as defined in section 245.4871, subdivision
27, clauses (1) to (6).
new text end
new text begin
A mental health professional making a referral shall submit documentation to the state's
medical review agent containing all information necessary to determine eligibility for
admission, including a standard diagnostic assessment completed within 180 days of the
individual's admission. Documentation shall include evidence of family participation in the
individual's treatment planning and signed consent for services.
new text end
new text begin
(f) The commissioner shall establish a statewide per diem rate for psychiatric residential
treatment facility services for individuals 21 years of age or younger. The rate for a provider
must not exceed the rate charged by that provider for the same service to other payers.
Except as provided in paragraph (c), payment will not be made to more than one entity for
each individual for services provided under this section on a given day. Rates are set
prospectively for the annual rate period. A provider is required to submit annual cost reports
on a uniform cost reporting form. A submitted cost report is used to inform the rate-setting
process. The cost reporting shall be done according to federal requirements for Medicare
cost reports.
new text end
new text begin
(g) "Actual cost" means costs that are allowable, allocable, reasonable, and consistent
with federal reimbursement requirements in Code of Federal Regulations, title 48, chapter
1, part 31, relating to for-profit entities, and the Office of Management and Budget Circular
Number A-122, relating to nonprofit entities. The following are included in the rate:
new text end
new text begin
(1) development of the individual plan of care, review of the individual plan of care
every 30 days, and discharge planning by required members of the treatment team according
to Code of Federal Regulations, title 42, sections 441.155 to 441.156;
new text end
new text begin
(2) any services provided by a psychiatrist or physician for development of an individual
plan of care, conducting a review of the individual plan of care every 30 days, and discharge
planning by required members of the treatment team according to Code of Federal
Regulations, title 42, sections 441.155 to 441.156;
new text end
new text begin
(3) active treatment seven days per week, which includes individual, family, and group
therapy provided by licensed mental health professionals;
new text end
new text begin
(4) individual therapy, provided a minimum of twice per week;
new text end
new text begin
(5) family engagement activities, provided a minimum of once per week;
new text end
new text begin
(6) consultation with other professionals including case managers, primary care
professionals, community-based mental health providers, school staff, or other support
planners;
new text end
new text begin
(7) coordination of educational services between local and resident school districts and
the facility;
new text end
new text begin
(8) 24-hour nursing;
new text end
new text begin
(9) direct care and supervision, supportive services for daily living and safety, and
positive behavior management;
new text end
new text begin
(10) lab and pharmacy related to the diagnosed condition of youth and an individualized
plan of care;
new text end
new text begin
(11) costs necessary for licensure and accreditation, meeting all staffing standards for
participation, meeting all service standards for participation, meeting all requirements for
active treatment, maintaining medical records, conducting utilization review, meeting
inspection of care, and discharge planning; and
new text end
new text begin
(12) payment for room and board provided by facilities meeting all accreditation and
licensing requirements for participation.
new text end
new text begin
(h) Facilities may submit claims for payment outside of the per diem for professional
services arranged by and provided at the facility by an appropriately licensed professional
who is enrolled as a provider with Minnesota health care programs. Arranged services shall
be billed by the facility on a separate claim, and the facility shall be responsible for payment
to the provider. These services must be included in the individual plan of care and require
prior authorization by the state's medical review agent:
new text end
new text begin
(1) physician or psychiatric services outside of the development of the individual plan
of care, review of the individual plan of care every 30 days, and discharge planning by
required members of the treatment team;
new text end
new text begin
(2) psychological testing;
new text end
new text begin
(3) neuropsychological testing;
new text end
new text begin
(4) health and physical medical consults;
new text end
new text begin
(5) occupational therapy;
new text end
new text begin
(6) physical therapy; and
new text end
new text begin
(7) speech therapy.
new text end
new text begin
(i) Medical assistance covers therapeutic and hospital leave days, provided the recipient
was not discharged from the psychiatric residential treatment facility (PRTF) and is expected
to return to the PRTF. A reserved bed must be held for a recipient on hospital leave or
therapeutic leave.
new text end
new text begin
(j) A therapeutic leave day to home shall be for the purposes of preparing for discharge
and reintegration and shall be included in the individual plan of care. The state will reimburse
75 percent of the per diem rate for a reserve bed day while the recipient is on therapeutic
leave. A therapeutic leave visit may not exceed three days per visit without prior
authorization.
new text end
new text begin
(k) A hospital leave day shall be a day when a recipient requires admission to a hospital
for medical or acute psychiatric care and is temporarily absent from the psychiatric residential
treatment facility. The state shall reimburse 50 percent of the per diem rate for a reserve
bed day while the recipient is receiving medical or psychiatric care in a hospital.
new text end
new text begin
(l) Medicaid shall reimburse for concurrent services as approved by the commissioner
to support continuity of care and successful discharge from the facility. "Concurrent services"
means services provided by another entity or provider while the individual is admitted to a
psychiatric residential treatment facility. Payment for concurrent services may be limited
and require prior authorization by the state's medical review agent. Concurrent services may
include targeted case management, assertive community treatment, clinical care consultation,
team consultation, and treatment planning.
new text end
new text begin
(m) Payment rates under this subdivision shall not include the costs of providing:
new text end
new text begin
(1) educational services;
new text end
new text begin
(2) acute medical care or specialty services for other medical conditions;
new text end
new text begin
(3) dental services; and
new text end
new text begin
(4) pharmacy drug costs for other medical conditions;
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35.
Minnesota Statutes 2016, section 256B.0625, subdivision 57, is amended to read:
Subd. 57.
Payment for Part B Medicare crossover claims.
(a) Effective for services
provided on or after January 1, 2012, medical assistance payment for an enrollee's
cost-sharing associated with Medicare Part B is limited to an amount up to the medical
assistance total allowed, when the medical assistance rate exceeds the amount paid by
Medicare.
(b) Excluded from this limitation are payments for mental health services and payments
for dialysis services provided to end-stage renal disease patients. The exclusion for mental
health services does not apply to payments for physician services provided by psychiatrists
and advanced practice nurses with a specialty in mental health.
(c) Excluded from this limitation are payments to federally qualified health centersnew text begin ,
Indian Health Services,new text end and rural health clinics.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 36.
Minnesota Statutes 2016, section 256B.0659, subdivision 21, is amended to read:
Subd. 21.
Requirements for provider enrollment of personal care assistance provider
agencies.
(a) All personal care assistance provider agencies must provide, at the time of
enrollment, reenrollment, and revalidation as a personal care assistance provider agency in
a format determined by the commissioner, information and documentation that includes,
but is not limited to, the following:
(1) the personal care assistance provider agency's current contact information including
address, telephone number, and e-mail address;
(2) proof of surety bond coveragenew text begin for each location providing servicesnew text end . Upon new
enrollment, or if the provider's Medicaid revenue in the previous calendar year is up to and
including $300,000, the provider agency must purchase a surety bond of $50,000. If the
Medicaid revenue in the previous year is over $300,000, the provider agency must purchase
a surety bond of $100,000. The surety bond must be in a form approved by the commissioner,
must be renewed annually, and must allow for recovery of costs and fees in pursuing a claim
on the bond;
(3) proof of fidelity bond coverage in the amount of $20,000new text begin for each business location
providing servicenew text end ;
(4) proof of workers' compensation insurance coveragenew text begin identifying the business address
where PCA services are provided fromnew text end ;
(5) proof of liability insurancenew text begin coverage identifying the business address where PCA
services are provided from and naming the department as a certificate holdernew text end ;
deleted text begin
(6) a description of the personal care assistance provider agency's organization identifying
the names of all owners, managing employees, staff, board of directors, and the affiliations
of the directors, owners, or staff to other service providers;
deleted text end
deleted text begin (7)deleted text end new text begin (6)new text end a copy of the personal care assistance provider agency's written policies and
procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety including process for notification and resolution of consumer
grievances, identification and prevention of communicable diseases, and employee
misconduct;
deleted text begin (8)deleted text end new text begin (7)new text end copies of all other forms the personal care assistance provider agency uses in the
course of daily business including, but not limited to:
(i) a copy of the personal care assistance provider agency's time sheet if the time sheet
varies from the standard time sheet for personal care assistance services approved by the
commissioner, and a letter requesting approval of the personal care assistance provider
agency's nonstandard time sheet;
(ii) the personal care assistance provider agency's template for the personal care assistance
care plan; and
(iii) the personal care assistance provider agency's template for the written agreement
in subdivision 20 for recipients using the personal care assistance choice option, if applicable;
deleted text begin (9)deleted text end new text begin (8)new text end a list of all training and classes that the personal care assistance provider agency
requires of its staff providing personal care assistance services;
deleted text begin (10)deleted text end new text begin (9)new text end documentation that the personal care assistance provider agency and staff have
successfully completed all the training required by this section;
deleted text begin (11)deleted text end new text begin (10)new text end documentation of the agency's marketing practices;
deleted text begin (12)deleted text end new text begin (11)new text end disclosure of ownership, leasing, or management of all residential properties
that is used or could be used for providing home care services;
deleted text begin (13)deleted text end new text begin (12)new text end documentation that the agency will use the following percentages of revenue
generated from the medical assistance rate paid for personal care assistance services for
employee personal care assistant wages and benefits: 72.5 percent of revenue in the personal
care assistance choice option and 72.5 percent of revenue from other personal care assistance
providers. The revenue generated by the qualified professional and the reasonable costs
associated with the qualified professional shall not be used in making this calculation; and
deleted text begin (14)deleted text end new text begin (13)new text end effective May 15, 2010, documentation that the agency does not burden
recipients' free exercise of their right to choose service providers by requiring personal care
assistants to sign an agreement not to work with any particular personal care assistance
recipient or for another personal care assistance provider agency after leaving the agency
and that the agency is not taking action on any such agreements or requirements regardless
of the date signed.
(b) Personal care assistance provider agencies shall provide the information specified
in paragraph (a) to the commissioner at the time the personal care assistance provider agency
enrolls as a vendor or upon request from the commissioner. The commissioner shall collect
the information specified in paragraph (a) from all personal care assistance providers
beginning July 1, 2009.
(c) All personal care assistance provider agencies shall require all employees in
management and supervisory positions and owners of the agency who are active in the
day-to-day management and operations of the agency to complete mandatory training as
determined by the commissioner beforenew text begin submitting an application fornew text end enrollment of the
agency as a provider.new text begin All personal care assistance provider agencies shall also require
qualified professionals to complete the training required by subdivision 13 before submitting
an application for enrollment of the agency as a provider.new text end Employees in management and
supervisory positions and owners who are active in the day-to-day operations of an agency
who have completed the required training as an employee with a personal care assistance
provider agency do not need to repeat the required training if they are hired by another
agency, if they have completed the training within the past three years. By September 1,
2010, the required training must be available with meaningful access according to title VI
of the Civil Rights Act and federal regulations adopted under that law or any guidance from
the United States Health and Human Services Department. The required training must be
available online or by electronic remote connection. The required training must provide for
competency testing. Personal care assistance provider agency billing staff shall complete
training about personal care assistance program financial management. This training is
effective July 1, 2009. Any personal care assistance provider agency enrolled before that
date shall, if it has not already, complete the provider training within 18 months of July 1,
2009. Any new owners or employees in management and supervisory positions involved
in the day-to-day operations are required to complete mandatory training as a requisite of
working for the agency. Personal care assistance provider agencies certified for participation
in Medicare as home health agencies are exempt from the training required in this
subdivision. When available, Medicare-certified home health agency owners, supervisors,
or managers must successfully complete the competency test.
new text begin
(d) All surety bonds, fidelity bonds, workers compensation insurance, and liability
insurance required by this subdivision must be maintained continuously. After initial
enrollment, a provider must submit proof of bonds and required coverages at any time at
the request of the commissioner. Services provided while there are lapses in coverage are
not eligible for payment. Lapses in coverage may result in sanctions, including termination.
The commissioner shall send instructions and a due date to submit the requested information
to the personal care assistance provider agency.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 37.
Minnesota Statutes 2016, section 256B.0755, subdivision 1, is amended to read:
Subdivision 1.
Implementation.
(a) The commissioner shall develop and authorize a
demonstration project to test alternative and innovative deleted text begin health care delivery systemsdeleted text end new text begin
integrated health partnershipsnew text end , including accountable care organizations that provide services
to a specified patient population for an agreed-upon total cost of care or risk/gain sharing
payment arrangement. The commissioner shall develop a request for proposals for
participation in the demonstration project in consultation with hospitals, primary care
providers, health plans, and other key stakeholders.
(b) In developing the request for proposals, the commissioner shall:
(1) establish uniform statewide methods of forecasting utilization and cost of care for
the appropriate Minnesota public program populations, to be used by the commissioner for
the deleted text begin health care delivery systemdeleted text end new text begin integrated health partnershipnew text end projects;
(2) identify key indicators of quality, access, patient satisfaction, and other performance
indicators that will be measured, in addition to indicators for measuring cost savings;
(3) allow maximum flexibility to encourage innovation and variation so that a variety
of provider collaborations are able to become deleted text begin health care delivery systemsdeleted text end new text begin integrated health
partnershipsnew text end ;
(4) encourage and authorize different levels and types of financial risk;
(5) encourage and authorize projects representing a wide variety of geographic locations,
patient populations, provider relationships, and care coordination models;
(6) encourage projects that involve close partnerships between the deleted text begin health care delivery
systemdeleted text end new text begin integrated health partnershipnew text end and counties and nonprofit agencies that provide services
to patients enrolled with the deleted text begin health care delivery systemdeleted text end new text begin integrated health partnershipnew text end ,
including social services, public health, mental health, community-based services, and
continuing care;
(7) encourage projects established by community hospitals, clinics, and other providers
in rural communities;
(8) identify required covered services for a total cost of care model or services considered
in whole or partially in an analysis of utilization for a risk/gain sharing model;
(9) establish a mechanism to monitor enrollment;
(10) establish quality standards for the delivery system demonstrations; and
(11) encourage participation of privately insured population so as to create sufficient
alignment in demonstration systems.
(c) To be eligible to participate in the demonstration project, deleted text begin a health care delivery systemdeleted text end new text begin
an integrated health partnershipnew text end must:
(1) provide required covered services and care coordination to recipients enrolled in the
health care delivery system;
(2) establish a process to monitor enrollment and ensure the quality of care provided;
(3) in cooperation with counties and community social service agencies, coordinate the
delivery of health care services with existing social services programs;
(4) provide a system for advocacy and consumer protection; and
(5) adopt innovative and cost-effective methods of care delivery and coordination, which
may include the use of allied health professionals, telemedicine, patient educators, care
coordinators, and community health workers.
(d) deleted text begin A health care delivery systemdeleted text end new text begin An integrated health partnershipnew text end demonstration may
be formed by the following groups of providers of services and suppliers if they have
established a mechanism for shared governance:
(1) professionals in group practice arrangements;
(2) networks of individual practices of professionals;
(3) partnerships or joint venture arrangements between hospitals and health care
professionals;
(4) hospitals employing professionals; and
(5) other groups of providers of services and suppliers as the commissioner determines
appropriate.
A managed care plan or county-based purchasing plan may participate in this
demonstration in collaboration with one or more of the entities listed in clauses (1) to (5).
deleted text begin A health care delivery systemdeleted text end new text begin An integrated health partnershipnew text end may contract with a
managed care plan or a county-based purchasing plan to provide administrative services,
including the administration of a payment system using the payment methods established
by the commissioner for deleted text begin health care delivery systemsdeleted text end new text begin integrated health partnershipsnew text end .
(e) The commissioner may require deleted text begin a health care delivery systemdeleted text end new text begin an integrated health
partnershipnew text end to enter into additional third-party contractual relationships for the assessment
of risk and purchase of stop loss insurance or another form of insurance risk management
related to the delivery of care described in paragraph (c).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 38.
Minnesota Statutes 2016, section 256B.0755, subdivision 2, is amended to read:
Subd. 2.
Enrollment.
(a) Individuals eligible for medical assistance or MinnesotaCare
shall be eligible for enrollment in deleted text begin a health care delivery systemdeleted text end new text begin an integrated health
partnershipnew text end .
(b) Eligible applicants and recipients may enroll in deleted text begin a health care delivery systemdeleted text end new text begin an
integrated health partnershipnew text end if a system serves the county in which the applicant or recipient
resides. If more than one deleted text begin health care delivery systemdeleted text end new text begin integrated health partnershipnew text end serves a
county, the applicant or recipient shall be allowed to choose among the deleted text begin delivery systemsdeleted text end new text begin
integrated health partnershipsnew text end . The commissioner may assign an applicant or recipient to deleted text begin a
health care delivery systemdeleted text end new text begin an integrated health partnershipnew text end if deleted text begin a health care delivery systemdeleted text end new text begin
an integrated health partnershipnew text end is available and no choice has been made by the applicant
or recipient.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 39.
Minnesota Statutes 2016, section 256B.0755, subdivision 3, is amended to read:
Subd. 3.
Accountability.
(a) deleted text begin Health care delivery systemsdeleted text end new text begin Integrated health partnershipsnew text end
must accept responsibility for the quality of care based on standards established under
subdivision 1, paragraph (b), clause (10), and the cost of care or utilization of services
provided to its enrollees under subdivision 1, paragraph (b), clause (1).
(b) deleted text begin A health care delivery systemdeleted text end new text begin An integrated health partnershipnew text end may contract and
coordinate with providers and clinics for the delivery of services and shall contract with
community health clinics, federally qualified health centers, community mental health
centers or programs, county agencies, and rural clinics to the extent practicable.
(c) deleted text begin A health care delivery systemdeleted text end new text begin An integrated health partnershipnew text end must indicate how it
will coordinate with other services affecting its patients' health, quality of care, and cost of
care that are provided by other providers, county agencies, and other organizations in the
local service area. The deleted text begin health care delivery systemdeleted text end new text begin integrated health partnershipnew text end must indicate
how it will engage other providers, counties, and organizations, including county-based
purchasing plans, that provide services to patients of the deleted text begin health care delivery systemdeleted text end new text begin
integrated health partnershipnew text end on issues related to local population health, including applicable
local needs, priorities, and public health goals. The deleted text begin health care delivery systemdeleted text end new text begin integrated
health partnershipnew text end must describe how local providers, counties, organizations, including
county-based purchasing plans, and other relevant purchasers were consulted in developing
the application to participate in the demonstration project.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 40.
Minnesota Statutes 2016, section 256B.0755, subdivision 4, is amended to read:
Subd. 4.
Payment system.
(a) In developing a payment system for deleted text begin health care delivery
systemsdeleted text end new text begin integrated health partnershipsnew text end , the commissioner shall establish a total cost of care
benchmark or a risk/gain sharing payment model to be paid for services provided to the
recipients enrolled in deleted text begin a health care delivery systemdeleted text end new text begin an integrated health partnershipnew text end .
(b) The payment system may include incentive payments to deleted text begin health care delivery systemsdeleted text end new text begin
integrated health partnershipsnew text end that meet or exceed annual quality and performance targets
realized through the coordination of care.
(c) An amount equal to the savings realized to the general fund as a result of the
demonstration project shall be transferred each fiscal year to the health care access fund.
new text begin
(d) The payment system may include population-based payments to integrated health
partnerships that incorporate payment for care coordination. Any integrated health partnership
participant certified as a health care home under section 256B.0751 that agrees to a payment
method that includes population-based payments for care coordination is not eligible to
receive a health care home payment or care coordination fee authorized under section 62U.03
or 256B.0753, subdivision 1, or in-reach care coordination under section 256B.0625,
subdivision 56, for any medical assistance or MinnesotaCare beneficiaries enrolled or
attributed to the integrated health partnership under this demonstration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 41.
Minnesota Statutes 2016, section 256B.0755, subdivision 7, is amended to read:
Subd. 7.
Expansion.
The commissioner shall expand the demonstration project to include
additional medical assistance and MinnesotaCare enrollees, and shall seek participation of
Medicare in demonstration projects. The commissioner shall seek to include participation
of privately insured persons and Medicare recipients in the deleted text begin health care deliverydeleted text end new text begin integrated
health partnershipnew text end demonstration. As part of the demonstration expansion, the commissioner
may procure the services of the deleted text begin health care delivery systemsdeleted text end new text begin integrated health partnershipsnew text end
authorized under this section by geographic area, to supplement or replace the services
provided by managed care plans operating under section 256B.69.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 42.
Minnesota Statutes 2016, section 256B.0943, subdivision 9, is amended to read:
Subd. 9.
Service delivery criteria.
(a) In delivering services under this section, a certified
provider entity must ensure that:
(1) each individual provider's caseload size permits the provider to deliver services to
both clients with severe, complex needs and clients with less intensive needs. The provider's
caseload size should reasonably enable the provider to play an active role in service planning,
monitoring, and delivering services to meet the client's and client's family's needs, as specified
in each client's individual treatment plan;
(2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and
(3) a day treatment program is provided to a group of clients by a multidisciplinary team
under the clinical supervision of a mental health professional. The day treatment program
must be provided in and by: (i) an outpatient hospital accredited by the Joint Commission
on Accreditation of Health Organizations and licensed under sections 144.50 to 144.55; (ii)
a community mental health center under section 245.62; or (iii) an entity that is certified
under subdivision 4 to operate a program that meets the requirements of section 245.4884,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment
program must stabilize the client's mental health status while developing and improving the
client's independent living and socialization skills. The goal of the day treatment program
must be to reduce or relieve the effects of mental illness and provide training to enable the
client to live in the community. The program must be available year-round at least three to
five days per week, two or three hours per day, unless the normal five-day school week is
shortened by a holiday, weather-related cancellation, or other districtwide reduction in a
school week. A child transitioning into or out of day treatment must receive a minimum
treatment of one day a week for a two-hour time block. The two-hour time block must
include at least one hour of patient and/or family or group psychotherapy. The remainder
of the structured treatment program may include patient and/or family or group
psychotherapy, and individual or group skills training, if included in the client's individual
treatment plan. Day treatment programs are not part of inpatient or residential treatment
services. When a day treatment group that meets the minimum group size requirement
temporarily falls below the minimum group size because of a member's temporary absence,
medical assistance covers a group session conducted for the group members in attendance.
A day treatment program may provide fewer than the minimally required hours for a
particular child during a billing period in which the child is transitioning into, or out of, the
program.
(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:
(1) patient and/or family, family, and group psychotherapy must be delivered as specified
in Minnesota Rules, part 9505.0372, subpart 6. Psychotherapy to address the child's
underlying mental health disorder must be documented as part of the child's ongoing
treatment. A provider must deliver, or arrange for, medically necessary psychotherapy,
unless the child's parent or caregiver chooses not to receive it. When a provider delivering
other services to a child under this section deems it not medically necessary to provide
psychotherapy to the child for a period of 90 days or longer, the provider entity must
document the medical reasons why psychotherapy is not necessary. When a provider
determines that a child needs psychotherapy but psychotherapy cannot be delivered due to
a shortage of licensed mental health professionals in the child's community, the provider
must document the lack of access in the child's medical record;
(2) individual, family, or group skills training must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills training is subject to the
following requirements:
(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;
(ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;
(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;
(iv) skills training delivered to the child's family must teach skills needed by parents to
enhance the child's skill development, to help the child utilize daily life skills taught by a
mental health professional, clinical trainee, or mental health practitioner, and to develop or
maintain a home environment that supports the child's progressive use of skills;
(v) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:
(A) one mental health professional or one clinical trainee or mental health practitioner
under supervision of a licensed mental health professional must work with a group of three
to eight clients; or
(B) two mental health professionals, two clinical trainees or mental health practitioners
under supervision of a licensed mental health professional, or one mental health professional
or clinical trainee and one mental health practitioner must work with a group of nine to 12
clients;
(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and
(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;
(3) crisis assistance to a child and family must include development of a written plan
that anticipates the particular factors specific to the child that may precipitate a psychiatric
crisis for the child in the near future. The written plan must document actions that the family
should be prepared to take to resolve or stabilize a crisis, such as advance arrangements for
direct intervention and support services to the child and the child's family. Crisis assistance
must include preparing resources designed to address abrupt or substantial changes in the
functioning of the child or the child's family when sudden change in behavior or a loss of
usual coping mechanisms is observed, or the child begins to present a danger to self or
others;
(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3), and which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:
(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;
(ii) performing as a practice partner or role-play partner;
(iii) reinforcing the child's accomplishments;
(iv) generalizing skill-building activities in the child's multiple natural settings;
(v) assigning further practice activities; and
(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.
To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;
(5) direction of a mental health behavioral aide must include the following:
(i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child by a mental health professional or mental health practitioner for at least
a total of one hour during every 40 hours of service provided to a child; and
(ii) immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;
(6) mental health service plan development must be performed in consultation with the
child's family and, when appropriate, with other key participants in the child's life by the
child's treating mental health professional or clinical trainee or by a mental health practitioner
and approved by the treating mental health professional. Treatment plan drafting consists
of development, review, and revision by face-to-face or electronic communication. The
provider must document events, including the time spent with the family and other key
participants in the child's life to review, revise, and sign the individual treatment plannew text begin .
Notwithstanding Minnesota Rules, part 9505.0371, subpart 7, medical assistance covers
service plan development before completion of the child's individual treatment plan. Service
plan development is covered only if a treatment plan is completed for the child. If upon
review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan developmentnew text end ; and
(7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 43.
Minnesota Statutes 2016, section 256B.15, subdivision 1, is amended to read:
Subdivision 1.
Policy and applicability.
(a) It is the policy of this state that individuals
or couples, either or both of whom participate in the medical assistance program, use their
own assets to pay their share of the cost of their care during or after their enrollment in the
program according to applicable federal law and the laws of this state. The following
provisions apply:
(1) subdivisions 1c to 1k shall not apply to claims arising under this section which are
presented under section 525.313;
(2) the provisions of subdivisions 1c to 1k expanding the interests included in an estate
for purposes of recovery under this section give effect to the provisions of United States
Code, title 42, section 1396p, governing recoveries, but do not give rise to any express or
implied liens in favor of any other parties not named in these provisions;
(3) the continuation of a recipient's life estate or joint tenancy interest in real property
after the recipient's death for the purpose of recovering medical assistance under this section
modifies common law principles holding that these interests terminate on the death of the
holder;
(4) all laws, rules, and regulations governing or involved with a recovery of medical
assistance shall be liberally construed to accomplish their intended purposes;
(5) a deceased recipient's life estate and joint tenancy interests continued under this
section shall be owned by the remainderpersons or surviving joint tenants as their interests
may appear on the date of the recipient's death. They shall not be merged into the remainder
interest or the interests of the surviving joint tenants by reason of ownership. They shall be
subject to the provisions of this section. Any conveyance, transfer, sale, assignment, or
encumbrance by a remainderperson, a surviving joint tenant, or their heirs, successors, and
assigns shall be deemed to include all of their interest in the deceased recipient's life estate
or joint tenancy interest continued under this section; and
(6) the provisions of subdivisions 1c to 1k continuing a recipient's joint tenancy interests
in real property after the recipient's death do not apply to a homestead owned of record, on
the date the recipient dies, by the recipient and the recipient's spouse as joint tenants with
a right of survivorship. Homestead means the real property occupied by the surviving joint
tenant spouse as their sole residence on the date the recipient dies and classified and taxed
to the recipient and surviving joint tenant spouse as homestead property for property tax
purposes in the calendar year in which the recipient dies. For purposes of this exemption,
real property the recipient and their surviving joint tenant spouse purchase solely with the
proceeds from the sale of their prior homestead, own of record as joint tenants, and qualify
as homestead property under section 273.124 in the calendar year in which the recipient
dies and prior to the recipient's death shall be deemed to be real property classified and
taxed to the recipient and their surviving joint tenant spouse as homestead property in the
calendar year in which the recipient dies. The surviving spouse, or any person with personal
knowledge of the facts, may provide an affidavit describing the homestead property affected
by this clause and stating facts showing compliance with this clause. The affidavit shall be
prima facie evidence of the facts it states.
(b) For purposes of this section, "medical assistance" includes the medical assistance
program under this chapter, the general assistance medical care program formerly codified
under chapter 256D, and alternative care for nonmedical assistance recipients under section
256B.0913.
(c) For purposes of this section, deleted text begin beginning January 1, 2010,deleted text end "medical assistance" does
not include Medicare cost-sharing benefits in accordance with United States Code, title 42,
section 1396p.
(d) All provisions in this subdivision, and subdivisions 1d, 1f, 1g, 1h, 1i, and 1j, related
to the continuation of a recipient's life estate or joint tenancy interests in real property after
the recipient's death for the purpose of recovering medical assistance, are effective only for
life estates and joint tenancy interests established on or after August 1, 2003. For purposes
of this paragraph, medical assistance does not include alternative care.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies retroactively to estate claims pending on or after July 1, 2016, and to the estates of
people who died on or after July 1, 2016.
new text end
Sec. 44.
Minnesota Statutes 2016, section 256B.15, subdivision 1a, is amended to read:
Subd. 1a.
Estates subject to claims.
(a) If a person receives medical assistance hereunder,
on the person's death, if single, or on the death of the survivor of a married couple, either
or both of whom received medical assistance, or as otherwise provided for in this section,
the amount paid for medical assistance as limited under subdivision 2 for the person and
spouse shall be filed as a claim against the estate of the person or the estate of the surviving
spouse in the court having jurisdiction to probate the estate or to issue a decree of descent
according to sections 525.31 to 525.313.
(b) For the purposes of this section, the person's estate must consist of:
(1) the person's probate estate;
(2) all of the person's interests or proceeds of those interests in real property the person
owned as a life tenant or as a joint tenant with a right of survivorship at the time of the
person's death;
(3) all of the person's interests or proceeds of those interests in securities the person
owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time
of the person's death, to the extent the interests or proceeds of those interests become part
of the probate estate under section 524.6-307;
(4) all of the person's interests in joint accounts, multiple-party accounts, and pay-on-death
accounts, brokerage accounts, investment accounts, or the proceeds of those accounts, as
provided under sections 524.6-201 to 524.6-214 at the time of the person's death to the
extent the interests become part of the probate estate under section 524.6-207; and
(5) assets conveyed to a survivor, heir, or assign of the person through survivorship,
living trust, or other arrangements.
(c) For the purpose of this section and recovery in a surviving spouse's estate for medical
assistance paid for a predeceased spouse, the estate must consist of all of the legal title and
interests the deceased individual's predeceased spouse had in jointly owned or marital
property at the time of the spouse's death, as defined in subdivision 2b, and the proceeds of
those interests, that passed to the deceased individual or another individual, a survivor, an
heir, or an assign of the predeceased spouse through a joint tenancy, tenancy in common,
survivorship, life estate, living trust, or other arrangement. A deceased recipient who, at
death, owned the property jointly with the surviving spouse shall have an interest in the
entire property.
(d) For the purpose of recovery in a single person's estate or the estate of a survivor of
a married couple, "other arrangement" includes any other means by which title to all or any
part of the jointly owned or marital property or interest passed from the predeceased spouse
to another including, but not limited to, transfers between spouses which are permitted,
prohibited, or penalized for purposes of medical assistance.
(e) A claim shall be filed if medical assistance was rendered for either or both persons
under one of the following circumstances:
deleted text begin
(1) the person was over 55 years of age, and received services under this chapter prior
to January 1, 2014;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end the person resided in a medical institution for six months or longer, received
services under this chapter, and, at the time of institutionalization or application for medical
assistance, whichever is later, the person could not have reasonably been expected to be
discharged and returned home, as certified in writing by the person's treating physician. For
purposes of this section only, a "medical institution" means a skilled nursing facility,
intermediate care facility, intermediate care facility for persons with developmental
disabilities, nursing facility, or inpatient hospital;
deleted text begin (3)deleted text end new text begin (2)new text end the person received general assistance medical care services under the program
formerly codified under chapter 256D; deleted text begin or
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end the person was 55 years of age or older and received medical assistance services
deleted text begin on or after January 1, 2014,deleted text end that consisted of nursing facility services, home and
community-based services, or related hospital and prescription drug benefits.
(f) The claim shall be considered an expense of the last illness of the decedent for the
purpose of section 524.3-805. Notwithstanding any law or rule to the contrary, a state or
county agency with a claim under this section must be a creditor under section 524.6-307.
Any statute of limitations that purports to limit any county agency or the state agency, or
both, to recover for medical assistance granted hereunder shall not apply to any claim made
hereunder for reimbursement for any medical assistance granted hereunder. Notice of the
claim shall be given to all heirs and devisees of the decedent, and to other persons with an
ownership interest in the real property owned by the decedent at the time of the decedent's
death, whose identity can be ascertained with reasonable diligence. The notice must include
procedures and instructions for making an application for a hardship waiver under subdivision
5; time frames for submitting an application and determination; and information regarding
appeal rights and procedures. Counties are entitled to one-half of the nonfederal share of
medical assistance collections from estates that are directly attributable to county effort.
Counties are entitled to ten percent of the collections for alternative care directly attributable
to county effort.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies retroactively to estate claims pending on or after July 1, 2016, and to the estates of
people who died on or after July 1, 2016.
new text end
Sec. 45.
Minnesota Statutes 2016, section 256B.15, subdivision 2, is amended to read:
Subd. 2.
Limitations on claims.
deleted text begin
(a) For services rendered prior to January 1, 2014, the
claim shall include only the total amount of medical assistance rendered after age 55 or
during a period of institutionalization described in subdivision 1a, paragraph (e), and the
total amount of general assistance medical care rendered under the program formerly codified
under chapter 256D, and shall not include interest.
deleted text end
deleted text begin (b) For services rendered on or after January 1, 2014,deleted text end new text begin (a)new text end The claim shall include only:
(1) the amount of medical assistance rendered to recipients 55 years of age or older deleted text begin anddeleted text end
that consisted of nursing facility services, home and community-based services, and related
hospital and prescription drug services; deleted text begin and
deleted text end
(2) the total amount of medical assistance rendered during a period of institutionalization
described in subdivision 1a, paragraph (e), clause deleted text begin (2).deleted text end new text begin (1);
new text end
new text begin
(3) the total amount of general assistance medical care rendered under the program
formerly codified under chapter 256D.
new text end
The claim shall not include interest. For the purposes of this section, "home and
community-based services" has the same meaning it has when used in United States Code,
title 42, section 1396p(b)(1)(B)(i), and includes the alternative care program under section
256B.0913new text begin even for periods when alternative care services receive only state fundingnew text end .
deleted text begin (c)deleted text end new text begin (b)new text end Claims that have been allowed but not paid shall bear interest according to section
524.3-806, paragraph (d). A claim against the estate of a surviving spouse who did not
receive medical assistance, for medical assistance rendered for the predeceased spouse,
shall be payable from the full value of all of the predeceased spouse's assets and interests
which are part of the surviving spouse's estate under subdivisions 1a and 2b. Recovery of
medical assistance expenses in the nonrecipient surviving spouse's estate is limited to the
value of the assets of the estate that were marital property or jointly owned property at any
time during the marriage. The claim is not payable from the value of assets or proceeds of
assets in the estate attributable to a predeceased spouse whom the individual married after
the death of the predeceased recipient spouse for whom the claim is filed or from assets and
the proceeds of assets in the estate which the nonrecipient decedent spouse acquired with
assets which were not marital property or jointly owned property after the death of the
predeceased recipient spouse. Claims for alternative care shall be net of all premiums paid
under section 256B.0913, subdivision 12, on or after July 1, 2003, and shall be limited to
services provided on or after July 1, 2003. Claims against marital property shall be limited
to claims against recipients who died on or after July 1, 2009.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies retroactively to estate claims pending on or after July 1, 2016, and to the estates of
people who died on or after July 1, 2016.
new text end
Sec. 46.
Minnesota Statutes 2016, section 256B.199, is amended to read:
256B.199 deleted text begin PAYMENTS REPORTED BY GOVERNMENTAL ENTITIESdeleted text end new text begin FEDERAL
MATCHING FUNDSnew text end .
deleted text begin
(a) The commissioner shall apply for federal matching funds for the expenditures in
paragraphs (b) and (c).
deleted text end
deleted text begin (b)deleted text end The commissioner shall apply for federal matching funds for certified public
expenditures deleted text begin as follows:deleted text end new text begin for the
new text end
deleted text begin (1)deleted text end Hennepin County deleted text begin , Hennepin County Medical Center, Ramsey County, and Regions
Hospital shall report quarterly to the commissioner beginning June 1, 2007, payments made
during the second previous quarter that may qualify for reimbursement under federal law;deleted text end new text begin
Mental Health Center.
new text end
deleted text begin
(2) based on these reports, the commissioner shall apply for federal matching funds; and
deleted text end
deleted text begin
(3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform the
nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
hospital payment money expected to be available in the current federal fiscal year.
deleted text end
deleted text begin
(c) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
apply for additional federal matching funds available as disproportionate share hospital
payments under the American Recovery and Reinvestment Act of 2009. These funds shall
be made available as the state share of payments. The entities required to report certified
public expenditures under paragraph (b), clause (1), shall report additional certified public
expenditures as necessary under this paragraph.
deleted text end
deleted text begin
(d) For services provided on or after September 1, 2011, the commissioner shall apply
for additional federal matching funds available as disproportionate share hospital payments
under the MinnesotaCare program. A hospital may elect on an annual basis to not be a
disproportionate share hospital for purposes of this paragraph, if the hospital does not qualify
for a payment under section 256.969, subdivision 9, paragraph (a).
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 47.
Minnesota Statutes 2016, section 256B.75, is amended to read:
256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.
(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs.new text begin Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2016, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.
new text end
(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.
(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.
(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 48.
Minnesota Statutes 2016, section 256B.76, subdivision 1, is amended to read:
Subdivision 1.
Physician reimbursement.
(a) Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for physician services as follows:
(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care," "critical
care," cesarean delivery and pharmacologic management provided to psychiatric patients,
and level three codes for enhanced services for prenatal high risk, shall be paid at the lower
of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992deleted text begin . If the
rate on any procedure code within these categories is different than the rate that would have
been paid under the methodology in section 256B.74, subdivision 2, then the larger rate
shall be paiddeleted text end ;
(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect on
September 30, 1992.
(b) Effective for services rendered on or after January 1, 2000, payment rates for physician
and professional services shall be increased by three percent over the rates in effect on
December 31, 1999, except for home health agency and family planning agency services.
The increases in this paragraph shall be implemented January 1, 2000, for managed care.
(c) Effective for services rendered on or after July 1, 2009, payment rates for physician
and professional services shall be reduced by five percent, except that for the period July
1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical
assistance and general assistance medical care programs, over the rates in effect on June
30, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other
outpatient visits, preventive medicine visits and family planning visits billed by physicians,
advanced practice nurses, or physician assistants in a family planning agency or in one of
the following primary care practices: general practice, general internal medicine, general
pediatrics, general geriatrics, and family medicine. This reduction and the reductions in
paragraph (d) do not apply to federally qualified health centers, rural health centers, and
Indian health services. Effective October 1, 2009, payments made to managed care plans
and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall
reflect the payment reduction described in this paragraph.
(d) Effective for services rendered on or after July 1, 2010, payment rates for physician
and professional services shall be reduced an additional seven percent over the five percent
reduction in rates described in paragraph (c). This additional reduction does not apply to
physical therapy services, occupational therapy services, and speech pathology and related
services provided on or after July 1, 2010. This additional reduction does not apply to
physician services billed by a psychiatrist or an advanced practice nurse with a specialty in
mental health. Effective October 1, 2010, payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the payment reduction described in this paragraph.
(e) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for physician and professional services shall be reduced three percent from
the rates in effect on August 31, 2011. This reduction does not apply to physical therapy
services, occupational therapy services, and speech pathology and related services.
(f) Effective for services rendered on or after September 1, 2014, payment rates for
physician and professional services, including physical therapy, occupational therapy, speech
pathology, and mental health services shall be increased by five percent from the rates in
effect on August 31, 2014. In calculating this rate increase, the commissioner shall not
include in the base rate for August 31, 2014, the rate increase provided under section
256B.76, subdivision 7. This increase does not apply to federally qualified health centers,
rural health centers, and Indian health services. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
(g) Effective for services rendered on or after July 1, 2015, payment rates for physical
therapy, occupational therapy, and speech pathology and related services provided by a
hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause
(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments
made to managed care plans and county-based purchasing plans shall not be adjusted to
reflect payments under this paragraph.
new text begin
(h) Any ratables effective before July 1, 2015, do not apply to autism early intensive
intervention benefits described in section 256B.0949.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 49.
Minnesota Statutes 2016, section 256B.76, subdivision 2, is amended to read:
Subd. 2.
Dental reimbursement.
(a) Effective for services rendered on or after October
1, 1992, the commissioner shall make payments for dental services as follows:
(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent
above the rate in effect on June 30, 1992; and
(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile
of 1989, less the percent in aggregate necessary to equal the above increases.
(b) Beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
shall be the lower of (1) submitted charge, or (2) 80 percent of median 1997 charges.
(c) Effective for services rendered on or after January 1, 2000, payment rates for dental
services shall be increased by three percent over the rates in effect on December 31, 1999.
(d) Effective for services provided on or after January 1, 2002, payment for diagnostic
examinations and dental x-rays provided to children under age 21 shall be the lower of (1)
the submitted charge, or (2) 85 percent of median 1999 charges.
(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 2000,
for managed care.
(f) Effective for dental services rendered on or after October 1, 2010, by a state-operated
dental clinic, payment shall be paid on a reasonable cost basis that is based on the Medicare
principles of reimbursement. This payment shall be effective for services rendered on or
after January 1, 2011, to recipients enrolled in managed care plans or county-based
purchasing plans.
(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics in
paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal year, a
supplemental state payment equal to the difference between the total payments in paragraph
(f) and $1,850,000 shall be paid from the general fund to state-operated services for the
operation of the dental clinics.
deleted text begin
(h) If the cost-based payment system for state-operated dental clinics described in
paragraph (f) does not receive federal approval, then state-operated dental clinics shall be
designated as critical access dental providers under subdivision 4, paragraph (b), and shall
receive the critical access dental reimbursement rate as described under subdivision 4,
paragraph (a).
deleted text end
deleted text begin (i)deleted text end new text begin (h)new text end Effective for services rendered on or after September 1, 2011, through June 30,
2013, payment rates for dental services shall be reduced by three percent. This reduction
does not apply to state-operated dental clinics in paragraph (f).
deleted text begin (j)deleted text end new text begin (i)new text end Effective for services rendered on or after January 1, 2014, payment rates for
dental services shall be increased by five percent from the rates in effect on December 31,
2013. This increase does not apply to state-operated dental clinics in paragraph (f), federally
qualified health centers, rural health centers, and Indian health services. Effective January
1, 2014, payments made to managed care plans and county-based purchasing plans under
sections 256B.69, 256B.692, and 256L.12 shall reflect the payment increase described in
this paragraph.
deleted text begin (k)deleted text end new text begin (j)new text end Effective for services rendered on or after July 1, 2015, through December 31,
2016, the commissioner shall increase payment rates for services furnished by dental
providers located outside of the seven-county metropolitan area by the maximum percentage
possible above the rates in effect on June 30, 2015, while remaining within the limits of
funding appropriated for this purpose. This increase does not apply to state-operated dental
clinics in paragraph (f), federally qualified health centers, rural health centers, and Indian
health services. Effective January 1, 2016, through December 31, 2016, payments to managed
care plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall
reflect the payment increase described in this paragraph. The commissioner shall require
managed care and county-based purchasing plans to pass on the full amount of the increase,
in the form of higher payment rates to dental providers located outside of the seven-county
metropolitan area.
deleted text begin (l)deleted text end new text begin (k)new text end Effective for services provided on or after January 1, 2017,new text begin through December
31, 2018,new text end the commissioner shall increase payment rates by 9.65 percent for dental services
provided outside of the seven-county metropolitan area. This increase does not apply to
state-operated dental clinics in paragraph (f), federally qualified health centers, rural health
centers, or Indian health services. Effective January 1, 2017,new text begin through December 31, 2018,new text end
payments to managed care plans and county-based purchasing plans under sections 256B.69
and 256B.692 shall reflect the payment increase described in this paragraph.
new text begin
(l) Effective for services rendered on or after January 1, 2019, payment rates for dental
services shall be increased by 54 percent. This increase does not apply to state-operated
dental clinics in paragraph (f), federally qualified health centers, rural health centers, and
Indian health services when an encounter rate is paid.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 50.
Minnesota Statutes 2016, section 256B.76, subdivision 4, is amended to read:
Subd. 4.
Critical access dental providers.
(a) The commissioner shall increase
reimbursements to dentists and dental clinics deemed by the commissioner to be critical
access dental providers. For dental services rendered on or after July 1, 2016, the
commissioner shall increase reimbursement by 37.5 percent above the reimbursement rate
that would otherwise be paid to the critical access dental provider, except as specified under
paragraph (b). The commissioner shall pay the managed care plans and county-based
purchasing plans in amounts sufficient to reflect increased reimbursements to critical access
dental providers as approved by the commissioner.
(b) For dental services rendered on or after July 1, 2016, by a dental clinic or dental
group that meets the critical access dental provider designation under paragraph (d), clause
(4), and is owned and operated by a health maintenance organization licensed under chapter
62D, the commissioner shall increase reimbursement by 35 percent above the reimbursement
rate that would otherwise be paid to the critical access provider.
(c) Critical access dental payments made under paragraph (a) or (b) for dental services
provided by a critical access dental provider to an enrollee of a managed care plan or
county-based purchasing plan must not reflect any capitated payments or cost-based payments
from the managed care plan or county-based purchasing plan. The managed care plan or
county-based purchasing plan must base the additional critical access dental payment on
the amount that would have been paid for that service had the dental provider been paid
according to the managed care plan or county-based purchasing plan's fee schedule that
applies to dental providers that are not paid under a capitated payment or cost-based payment.
(d) The commissioner shall designate the following dentists and dental clinics as critical
access dental providers:
(1) nonprofit community clinics that:
(i) have nonprofit status in accordance with chapter 317A;
(ii) have tax exempt status in accordance with the Internal Revenue Code, section
501(c)(3);
(iii) are established to provide oral health services to patients who are low income,
uninsured, have special needs, and are underserved;
(iv) have professional staff familiar with the cultural background of the clinic's patients;
(v) charge for services on a sliding fee scale designed to provide assistance to low-income
patients based on current poverty income guidelines and family size;
(vi) do not restrict access or services because of a patient's financial limitations or public
assistance status; and
(vii) have free care available as needed;
(2) federally qualified health centers, rural health clinics, and public health clinics;
(3) hospital-based dental clinics owned and operated by a city, county, or former state
hospital as defined in section 62Q.19, subdivision 1, paragraph (a), clause (4);
(4) a dental clinic or dental group owned and operated by a nonprofit corporation in
accordance with chapter 317A with more than 10,000 patient encounters per year with
patients who are uninsured or covered by medical assistance or MinnesotaCare;
(5) a dental clinic owned and operated by the University of Minnesota or the Minnesota
State Colleges and Universities system; and
(6) private practicing dentists if:
(i) the dentist's office is located within the seven-county metropolitan area and more
than 50 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare; or
(ii) the dentist's office is located outside the seven-county metropolitan area and more
than 25 percent of the dentist's patient encounters per year are with patients who are uninsured
or covered by medical assistance or MinnesotaCare.
new text begin
(e) The program established under this subdivision expires January 1, 2019. No payments
under this subdivision shall be made for dates of service on and after January 1, 2019.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51.
Minnesota Statutes 2016, section 256B.76, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Payment for certain preventive medical visits. new text end
new text begin
(a) Payment for certain
preventive medical visits rendered on or after July 1, 2017, shall be increased by five percent,
unless otherwise limited by state or federal regulations. This rate increase is not applicable
to federally qualified health centers, rural health centers, Indian health services, other
cost-based rates, rates that are negotiated with the county, or rates that are established by
the federal government. This rate increase under this subdivision does not apply to managed
care.
new text end
new text begin
(b) For purposes of paragraph (a), preventive medical visits shall be limited to preventive
medicine visits when provided by a physician, advanced practice registered nurse, or
physician assistant.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 52.
Minnesota Statutes 2016, section 256B.761, is amended to read:
256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.
(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.
(c) The commissioner shall establish three levels of payment for mental health diagnostic
assessment, based on three levels of complexity. The aggregate payment under the tiered
rates must not exceed the projected aggregate payments for mental health diagnostic
assessment under the previous single rate. The new rate structure is effective January 1,
2011, or upon federal approval, whichever is later.
(d) In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.
new text begin
(e) Any ratables effective before July 1, 2015, do not apply to autism early intensive
intervention benefits described in section 256B.0949.
new text end
new text begin
(f) Effective for services provided on or after July 1, 2017, payments for outpatient
mental health services shall be increased by five percent. This rate increase is not applicable
to federally qualified health centers, rural health centers, Indian health services, other
cost-based rates, rates that are negotiated with the county, or rates that are established by
the federal government. This rate increase does not apply to managed care.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 53.
new text begin
[256B.7625] REIMBURSEMENT FOR EVIDENCE-BASED PUBLIC
HEALTH NURSE HOME VISITS.
new text end
new text begin
Prenatal and postpartum follow-up home visits provided by public health nurses or
registered nurses supervised by a public health nurse using evidence-based models shall be
paid $140 per visit. Evidence-based postpartum follow-up home visits must be administered
by home visiting programs that meet the United States Department of Health and Human
Services criteria for evidence-based models and are identified by the commissioner of health
as eligible to be implemented under the maternal, infant, and early childhood home visiting
program. Home visits shall be targeted at mothers and the mothers' children beginning with
prenatal visits through three years of age.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for services provided on or after January
1, 2018.
new text end
Sec. 54.
Minnesota Statutes 2016, section 256B.766, is amended to read:
256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.
(a) Effective for services provided on or after July 1, 2009, total payments for basic care
services, shall be reduced by three percent, except that for the period July 1, 2009, through
June 30, 2011, total payments shall be reduced by 4.5 percent for the medical assistance
and general assistance medical care programs, prior to third-party liability and spenddown
calculation. Effective July 1, 2010, the commissioner shall classify physical therapy services,
occupational therapy services, and speech-language pathology and related services as basic
care services. The reduction in this paragraph shall apply to physical therapy services,
occupational therapy services, and speech-language pathology and related services provided
on or after July 1, 2010.
(b) Payments made to managed care plans and county-based purchasing plans shall be
reduced for services provided on or after October 1, 2009, to reflect the reduction effective
July 1, 2009, and payments made to the plans shall be reduced effective October 1, 2010,
to reflect the reduction effective July 1, 2010.
(c) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for outpatient hospital facility fees shall be reduced by five percent from the
rates in effect on August 31, 2011.
(d) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for ambulatory surgery centers facility fees, medical supplies and durable
medical equipment not subject to a volume purchase contract, prosthetics and orthotics,
renal dialysis services, laboratory services, public health nursing services, physical therapy
services, occupational therapy services, speech therapy services, eyeglasses not subject to
a volume purchase contract, hearing aids not subject to a volume purchase contract, and
anesthesia services shall be reduced by three percent from the rates in effect on August 31,
2011.
(e) Effective for services provided on or after September 1, 2014, payments for
ambulatory surgery centers facility fees, hospice services, renal dialysis services, laboratory
services, public health nursing services, eyeglasses not subject to a volume purchase contract,
and hearing aids not subject to a volume purchase contract shall be increased by three percent
and payments for outpatient hospital facility fees shall be increased by three percent.
Payments made to managed care plans and county-based purchasing plans shall not be
adjusted to reflect payments under this paragraph.
(f) Payments for medical supplies and durable medical equipment not subject to a volume
purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014, through
June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies and durable
medical equipment not subject to a volume purchase contract, and prosthetics and orthotics,
provided on or after July 1, 2015, shall be increased by three percent from the rates as
determined under paragraphs (i) and (j).
(g) Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics and orthotics, and deleted text begin laboratory servicesdeleted text end to a hospital
meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause (4),
shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments made
to managed care plans and county-based purchasing plans shall not be adjusted to reflect
payments under this paragraph.
(h) This section does not apply to physician and professional services, inpatient hospital
services, family planning services, mental health services, dental services, prescription
drugs, medical transportation, federally qualified health centers, rural health centers, Indian
health services, and Medicare cost-sharing.
(i) Effective for services provided on or after July 1, 2015, the following categories of
durable medical equipment shall be individually priced items: enteral nutrition and supplies,
customized and other specialized tracheostomy tubes and supplies, electric patient lifts, and
durable medical equipment repair and service. This paragraph does not apply to medical
supplies and durable medical equipment subject to a volume purchase contract, products
subject to the preferred diabetic testing supply program, and items provided to dually eligible
recipients when Medicare is the primary payer for the item. The commissioner shall not
apply any medical assistance rate reductions to durable medical equipment as a result of
Medicare competitive bidding.
(j) Effective for services provided on or after July 1, 2015, medical assistance payment
rates for durable medical equipment, prosthetics, orthotics, or supplies shall be increased
as follows:
(1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
were subject to the Medicare competitive bid that took effect in January of 2009 shall be
increased by 9.5 percent; and
(2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
being applied after calculation of any increased payment rate under clause (1).
This paragraph does not apply to medical supplies and durable medical equipment subject
to a volume purchase contract, products subject to the preferred diabetic testing supply
program, items provided to dually eligible recipients when Medicare is the primary payer
for the item, and individually priced items identified in paragraph (i). Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect the
rate increases in this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 55.
new text begin
[256B.90] LONG-ACTING REVERSIBLE CONTRACEPTIVE ACCESS
GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
The commissioner of human services shall coordinate and
implement a long-acting reversible contraceptive access grant program to reduce rapid
repeat births and improve birth outcomes for adolescents enrolled in medical assistance.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given them.
new text end
new text begin
(b) "Commissioner" means the commissioner of human services.
new text end
new text begin
(c) "Long-acting reversible contraceptive" means a method of contraception, including
an intrauterine device or a subdermal contraceptive implant, that provides effective
contraception for an extended period of time without requiring user action.
new text end
new text begin
(d) "Manufacturer" means the manufacturer of the long-acting reversible contraceptive
defined in section 151.01, subdivision 14a.
new text end
new text begin
(e) "Provider" means a hospital or clinic provider enrolled in Minnesota health care
programs.
new text end
new text begin Subd. 3. new text end
new text begin Grants. new text end
new text begin
(a) The commissioner shall adopt and implement a preferred long-acting
reversible contraceptive list by March 1, 2018. The commissioner shall employ competitive
bidding and negotiation with manufacturers under the provisions of chapter 16C to develop
the preferred long-acting reversible contraceptive list. To be included on the list, the
manufacturer must offer a price for the long-acting reversible contraceptive that is no more
than the payment rate established in section 256B.0625, subdivision 13e, minus the federal
Medicaid drug rebate pursuant to the Social Security Act, title XIX, section 1927.
new text end
new text begin
(b) The commissioner shall award through a competitive process contracts for grants to
providers to purchase long-acting reversible contraceptives on the preferred long-acting
reversible contraceptive list at the negotiated manufacturer price. The long-acting reversible
contraceptives purchased through the grant program shall be made available to medical
assistance enrollees receiving services from the participating provider.
new text end
new text begin
(c) A provider receiving long-acting reversible contraceptive access grants must document
the use of the contraceptives and work with the commissioner to track and analyze outcomes.
new text end
new text begin
(d) The cost of long-acting reversible contraceptives purchased with grant funds shall
not be billed to medical assistance.
new text end
new text begin
(e) The commissioner shall submit a 1115(a) demonstration waiver request to the Centers
for Medicaid and Medicare Services to make available administrative funding at the 90
percent federal matching rate for the long-acting reversible contraceptive access grant
program, as authorized by United States Code, title 42, section 1903, paragraph (a), clause
(5).
new text end
new text begin
(f) The grants shall be available by July 1, 2018, or upon federal approval of the 1115(a)
demonstration project, whichever is later.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 56.
Minnesota Statutes 2016, section 256L.03, subdivision 1, is amended to read:
Subdivision 1.
Covered health services.
(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation
services, personal care assistance and case management services, and nursing home or
intermediate care facilities services.
(b) No public funds shall be used for coverage of abortion under MinnesotaCare except
where the life of the female would be endangered or substantial and irreversible impairment
of a major bodily function would result if the fetus were carried to term; or where the
pregnancy is the result of rape or incest.
(c) Covered health services shall be expanded as provided in this section.
new text begin
(d) For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 57.
Minnesota Statutes 2016, section 256L.03, subdivision 1a, is amended to read:
Subd. 1a.
Children; MinnesotaCare health care reform waiver.
Children are eligible
for coverage of all services that are eligible for reimbursement under the medical assistance
program according to chapter 256B, exceptnew text begin special education services andnew text end that abortion
services under MinnesotaCare shall be limited as provided under subdivision 1. Children
are exempt from the provisions of subdivision 5, regarding co-payments. Children who are
lawfully residing in the United States but who are not "qualified noncitizens" under title IV
of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Public
Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage of all
services provided under the medical assistance program according to chapter 256B.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 58.
Minnesota Statutes 2016, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
deleted text begin
(a) Except as otherwise provided in this subdivision, the
MinnesotaCare benefit plan shall include the following cost-sharing requirements for all
enrollees:
deleted text end
deleted text begin
(1) $3 per prescription for adult enrollees;
deleted text end
deleted text begin
(2) $25 for eyeglasses for adult enrollees;
deleted text end
deleted text begin
(3) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician assistant, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist;
deleted text end
deleted text begin
(4) $6 for nonemergency visits to a hospital-based emergency room for services provided
through December 31, 2010, and $3.50 effective January 1, 2011; and
deleted text end
deleted text begin
(5) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next-higher five
cent increment.
deleted text end
deleted text begin (b) Paragraph (a) doesdeleted text end new text begin (a) Co-payments, coinsurance, and deductibles donew text end not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section deleted text begin 447.51deleted text end new text begin 600.5new text end .
deleted text begin
(c) Paragraph (a), clause (3), does not apply to mental health services.
deleted text end
deleted text begin
(d) MinnesotaCare reimbursements to fee-for-service providers and payments to managed
care plans or county-based purchasing plans shall not be increased as a result of the reduction
of the co-payments in paragraph (a), clause (4), effective January 1, 2011.
deleted text end
deleted text begin
(e) The commissioner, through the contracting process under section 256L.12, may
allow managed care plans and county-based purchasing plans to waive the family deductible
under paragraph (a), clause (5). The value of the family deductible shall not be included in
the capitation payment to managed care plans and county-based purchasing plans. Managed
care plans and county-based purchasing plans shall certify annually to the commissioner
the dollar value of the family deductible.
deleted text end
deleted text begin (f)deleted text end new text begin (b)new text end The commissioner shall deleted text begin increasedeleted text end new text begin adjustnew text end co-paymentsnew text begin , coinsurance, and deductiblesnew text end
for covered services in a manner sufficient to deleted text begin reducedeleted text end new text begin maintainnew text end the actuarial value of the
benefit to 94 percent. The cost-sharing changes described in this paragraph do not apply to
eligible recipients or services exempt from cost-sharing under state law. The cost-sharing
changes described in this paragraph shall not be implemented prior to January 1, 2016.
deleted text begin (g)deleted text end new text begin (c)new text end The cost-sharing changes authorized under paragraph deleted text begin (f)deleted text end new text begin (b)new text end must satisfy the
requirements for cost-sharing under the Basic Health Program as set forth in Code of Federal
Regulations, title 42, sections 600.510 and 600.520.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 59.
Minnesota Statutes 2016, section 256L.04, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Federal waiver. new text end
new text begin
The commissioner of human services shall apply for a federal
waiver to allow the state to permit a person who has access to employer-sponsored health
insurance through a spouse or parent that is deemed minimum essential coverage under
Code of Federal Regulations, title 26, section 1.36B-2, and the portion of the annual premium
the person pays for employee and dependent coverage exceeds the required contribution
percentage in Code of Federal Regulations, title 26, section 1.36B-2, to enroll in the
MinnesotaCare program, if the person meets all eligibility requirements, except for section
256L.07, subdivision 2, paragraph (a).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 60.
Minnesota Statutes 2016, section 256L.05, is amended by adding a subdivision
to read:
new text begin Subd. 3d. new text end
new text begin Coverage for gap months. new text end
new text begin
(a) Notwithstanding subdivision 3, MinnesotaCare
coverage may be made available beginning the first day of the month of application for a
new applicant who meets all MinnesotaCare eligibility requirements or beginning the first
day of the month in which an applicant enrolled in medical assistance or a qualified health
plan offered through MNsure under chapter 62V is eligible for MinnesotaCare due to a
change in circumstances.
new text end
new text begin
(b) For an applicant required to pay a premium, coverage under paragraph (a) is available
if:
new text end
new text begin
(1) the first premium payment for coverage according to subdivision 3 is received within
30 days of the premium billing; and
new text end
new text begin
(2) the premiums for coverage under paragraph (a) are paid in full within 30 days of the
premium billing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2019.
new text end
Sec. 61.
Minnesota Statutes 2016, section 256L.11, subdivision 7, is amended to read:
Subd. 7.
Critical access dental providers.
new text begin (a) new text end Effective for dental services provided to
MinnesotaCare enrollees on or after July 1, 2016, the commissioner shall increase payment
rates to dentists and dental clinics deemed by the commissioner to be critical access providers
under section 256B.76, subdivision 4, by 32.5 percent above the payment rate that would
otherwise be paid to the provider, except for a dental clinic or dental group described in
section 256B.76, subdivision 4, paragraph (b), in which the commissioner shall increase
the payment rate by 30 percent above the payment rate that would otherwise be paid to the
provider. The commissioner shall pay the prepaid health plans under contract with the
commissioner amounts sufficient to reflect this rate increase. The prepaid health plan must
pass this rate increase to providers who have been identified by the commissioner as critical
access dental providers under section 256B.76, subdivision 4.
new text begin
(b) The program established under this subdivision expires January 1, 2019. No payments
under this subdivision shall be made for dates of service on and after January 1, 2019.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 62.
Minnesota Statutes 2016, section 256L.15, subdivision 2, is amended to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
(c) Paragraph (b) does not apply to:
(1) children 20 years of age or younger; and
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
|
Federal Poverty Guideline Greater than or Equal to |
Less than |
Individual Premium Amount |
| 35% |
55% |
$4 |
| 55% |
80% |
$6 |
| 80% |
90% |
$8 |
| 90% |
100% |
$10 |
| 100% |
110% |
$12 |
| 110% |
120% |
$14 |
| 120% |
130% |
$15 |
| 130% |
140% |
$16 |
| 140% |
150% |
$25 |
| 150% |
160% |
deleted text begin
$29
deleted text end
new text begin
$37 new text end |
| 160% |
170% |
deleted text begin
$33
deleted text end
new text begin
$44 new text end |
| 170% |
180% |
deleted text begin
$38
deleted text end
new text begin
$52 new text end |
| 180% |
190% |
deleted text begin
$43
deleted text end
new text begin
$61 new text end |
| 190% |
new text begin
200% new text end |
deleted text begin
$50
deleted text end
new text begin
$71 new text end |
|
new text begin
200% new text end |
new text begin
$80 new text end |
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2015.
new text end
Sec. 63.
new text begin
[256L.29] MINNESOTACARE BUY-IN OPTION.
new text end
new text begin Subdivision 1. new text end
new text begin Request for federal authority and program establishment. new text end
new text begin
(a) The
commissioner of human services shall seek all necessary federal authority to establish a
program that allows individuals who are determined eligible for enrollment in a qualified
health plan with or without advance premium tax credits and cost-sharing reductions
according to the requirements of Code of Federal Regulations, title 45, section 155.305,
paragraphs (a), (f), and (g), to purchase coverage in the MinnesotaCare program pursuant
to this section (MinnesotaCare buy-in option), instead of purchasing a qualified health plan
through MNsure, as defined in section 62V.02.
new text end
new text begin
(b) The commissioner shall also seek all necessary federal authority to:
new text end
new text begin
(1) allow individuals who qualify under paragraph (a) and who choose to purchase the
MinnesotaCare buy-in option to use advance premium tax credits and cost-sharing reductions,
if eligible, to purchase this option;
new text end
new text begin
(2) permit the MinnesotaCare buy-in option to be offered through MNsure as a coverage
option and to be compared with qualified health plans offered through MNsure;
new text end
new text begin
(3) allow the commissioner to use any surplus funds in the basic health plan trust fund
under section 16A.724, subdivision 3, for purposes of establishing a special revenue account
that will serve as a reserve to support the payment of claims and liabilities and other financial
needs for the MinnesotaCare program as described in section 256L.04, and the MinnesotaCare
buy-in option as described in this section; and
new text end
new text begin
(4) maintain program requirements and funding mechanisms to the MinnesotaCare
program that provides coverage to individuals eligible under section 256L.04.
new text end
new text begin
(c) The commissioner is exempt from the requirements in chapter 16C to contract for
actuarial services that satisfy the waiver submission requirements under this subdivision.
The commissioner may utilize existing contracts to satisfy the waiver submission
requirements of this subdivision.
new text end
new text begin Subd. 2. new text end
new text begin Program establishment and criteria. new text end
new text begin
(a) The commissioner shall establish a
program consistent with this section to offer plans developed for the MinnesotaCare buy-in
option through the MNsure Web site, as defined in section 62V.02, subdivision 13, and
contract with vendors to provide these services, consistent with sections 256L.12 and
256L.121.
new text end
new text begin
(b) The commissioner shall coordinate administration of the MinnesotaCare buy-in
option with the MinnesotaCare program, as described in section 256L.04, to maximize
efficiency and improve continuity of care for enrollees. The commissioner shall seek to
implement mechanisms to ensure the long-term financial sustainability of MinnesotaCare
and mitigate any adverse financial impacts to the state and MNsure. These mechanisms
must address issues related to minimizing adverse selection, the state financial risk and
contribution, and negative impacts to premiums in the individual and group health insurance
market both inside and outside of MNsure.
new text end
new text begin
(c) The MinnesotaCare buy-in option shall include, at a minimum, the following:
new text end
new text begin
(1) establishment of an annual per-enrollee premium rate similar to the average rate paid
by the state to contractors under sections 256L.12 and 256L.121;
new text end
new text begin
(2) establishment of a benefit set similar to the benefits covered under section 256L.03;
new text end
new text begin
(3) limiting enrollment of eligible individuals to the same annual open and special
enrollment periods established for MNsure as defined in Code of Federal Regulations, title
45, sections 155.410 and 155.420;
new text end
new text begin
(4) establishment of two plans to be offered in MNsure with actuarial values of 70 percent
and 80 percent;
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new text begin
(5) a cost allocation methodology to reimburse MNsure operations in lieu of the premium
withhold for qualified health plans under section 62V.05; and
new text end
new text begin
(6) establishment of mechanisms that mitigate the fiscal impact to the state budget.
new text end
new text begin
(d) Individuals who are determined eligible for enrollment in a qualified health plan
with or without advance payments of the premium tax credit and cost-sharing reductions
according to Code of Federal Regulations, title 45, section 155.305, paragraphs (a), (f), and
(g), are eligible to purchase and enroll in a plan established under this section through
MNsure, instead of purchasing a qualified health plan as defined under section 62V.02.
new text end
new text begin
(e) Individuals who are eligible under this section, and whose income is less than or
equal to 400 percent of the federal poverty guidelines, may qualify for advance premium
tax credits and cost-sharing reductions to purchase a plan established under this section.
new text end
new text begin
(f) There shall be no state subsidy to individuals eligible for the MinnesotaCare buy-in
option.
new text end
new text begin
(g) The MinnesotaCare buy-in option established under this section shall be considered
the MinnesotaCare program for purposes of the requirements for health maintenance
organizations under section 62D.04, subdivision 5, and providers under section 256B.0644.
new text end
new text begin
(h) The commissioner shall have authority to accept and expend all federal funds made
available under this section upon federal approval.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 64. new text begin RATE-SETTING ANALYSIS REPORT.
new text end
new text begin
The commissioner of human services shall conduct a comprehensive analysis report of
the current rate-setting methodology for outpatient, professional, and physician services
that do not have a cost-based, federally mandated, or contracted rate. The report shall include
recommendations for changes to the existing fee schedule that utilizes the Resource-Based
Relative Value System (RBRVS), and alternate payment methodologies for services that
do not have relative values, to simplify the fee for service medical assistance rate structure
and to improve consistency and transparency. In developing the report, the commissioner
shall consult with outside experts in Medicaid financing. The commissioner shall provide
a report on the analysis to the chairs of the legislative committees with jurisdiction over
health and human services finance by November 1, 2019.
new text end
Sec. 65. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2016, sections 256.9692; 256B.0625, subdivision 25a; and 256B.0659,
subdivision 22,
new text end
new text begin
are repealed.
new text end
ARTICLE 5
MANAGED CARE
Section 1.
new text begin
[256B.68] MANAGED CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
(a) The commissioner of human services shall utilize managed
care as an effective mechanism to ensure that all eligible individuals receive necessary
health care in a coordinated fashion while containing costs. Each individual who is eligible
for medical assistance must participate in managed care unless the individual meets the
exclusion criteria in subdivision 9.
new text end
new text begin
(b) If allowed by the commissioner, a managed care organization (MCO) may contract
with an insurer, health care provider, nonprofit health service plan corporation, or the
commissioner, to provide insurance or similar protection against the cost of care provided
by the managed care organization or to provide coverage against the risks incurred by the
managed care organization under this section. The recipients enrolled with a managed care
organization are a permissible group under group insurance laws and sections 62C.01 to
62C.23. Under this type of contract, the insurer or corporation may make benefit payments
to a participating provider for services rendered or to be rendered to a beneficiary. Any
insurer or nonprofit health service plan corporation licensed to conduct business in the state
is authorized to provide insurance or similar protection.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Abuse" means provider practices that are inconsistent with sound fiscal, business,
beneficiary, or medical practices, and result in an unnecessary cost to the Medicaid program,
or in reimbursement for services that are not medically necessary or that fail to meet
professionally recognized standards for health care.
new text end
new text begin
(c) "Access" means the timely use of services to achieve optimal outcomes, as evidenced
by managed care plans.
new text end
new text begin
(d) "Actuary" means an individual who meets the qualification standards established by
the American Academy of Actuaries for an actuary and follows the practice standards
established by the Actuarial Standards Board. For purposes of this section, actuary refers
to an individual who is acting on behalf of the state when used in reference to the
development and certification of capitation rates.
new text end
new text begin
(e) "Actuarial sound capitation rates" means actuarially sound capitation rates projected
to provide for all reasonable, appropriate, and attainable costs required under the terms of
the contract and for the operation of the MCO for the time period and the populations covered
under the terms of the contract.
new text end
new text begin
(f) "Actuarially sound principles" means generally accepted actuarial principles and
practices applied to determine aggregate utilization patterns, appropriate for the population
and services to be covered, and have been certified by an actuary.
new text end
new text begin
(g) "Adverse benefit determination" means:
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new text begin
(1) denial or limited authorization of a requested service, including determinations based
on the type or level of service, requirements for medical necessity, appropriateness, setting,
or effectiveness of a covered benefit;
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new text begin
(2) reduction, suspension, or termination of a previously authorized service;
new text end
new text begin
(3) denial, in whole or in part, of payment for a service;
new text end
new text begin
(4) failure to provide services in a timely manner, as defined by the commissioner;
new text end
new text begin
(5) failure of an MCO to act within the time frames provided in Code of Federal
Regulations, title 42, section 438.408(b)(1) and (2), regarding the standard resolution of
grievances and appeals;
new text end
new text begin
(6) For an enrollee of a rural area with only one MCO, the denial of an enrollee's request
to exercise the enrollee's right, under Code of Federal Regulations, title 42, section
438.52(b)(2)(ii), to obtain services outside the network; or
new text end
new text begin
(7) denial of an enrollee's request to dispute a financial liability, including cost sharing,
co-payments, premiums, deductibles, coinsurance, and other enrollee financial liabilities.
new text end
new text begin
(h) "Appeal" means a review by an MCO of an adverse benefit determination.
new text end
new text begin
(i) "Base amount" means the starting amount, calculated according to Code of Federal
Regulations, title 42, section 438.6(d)(2), available for pass-through payments to hospitals
in a contract year subject to the schedule in Code of Federal Regulations, title 42, section
438.6(d)(3).
new text end
new text begin
(j) "Beneficiary" means a person that is eligible for medical assistance benefits as defined
in sections 256B.055, 256B.056, and 256B.06. For purposes of this section, beneficiary and
recipient have the same meaning.
new text end
new text begin
(k) "Budget neutral" means a standard for any risk-sharing mechanism that recognizes
both higher and lower expected costs among contracted MCOs under a managed care
program and does not create a net aggregate gain or loss across all payments under the
managed care program.
new text end
new text begin
(l) "Capitation Payment" means a monthly payment made by the commissioner to an
MCO on behalf of each beneficiary enrolled in a contract and based on the actuarially sound
capitation rate for the provision of services under the state plan. The commissioner must
make the payment regardless of whether the particular beneficiary receives services during
the period covered by the payment.
new text end
new text begin
(m) "Choice counseling" means the provision of information and services designed to
assist a beneficiary in making enrollment decision, including answering questions and
identifying factors to consider when choosing a managed care plan. Choice counseling does
not include making recommendations for or against enrollment into a specific MCO.
new text end
new text begin
(n) "Cold-call marketing" means any unsolicited personal contact or communication by
the MCO with a Medicaid beneficiary who is not enrolled in that MCO that can reasonably
be interpreted as intended to influence the beneficiary to enroll in that particular MCO's
Medicaid product, or to not enroll in or to disenroll from another MCO's Medicaid product.
new text end
new text begin
(o) "Commissioner" means the commissioner of the Department of Human Services.
new text end
new text begin
(p) "Comprehensive risk contract" means a risk contract between the commissioner and
an MCO that covers comprehensive services, including inpatient hospital services and any
three or more of the following services:
new text end
new text begin
(1) outpatient hospital services;
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new text begin
(2) rural health clinic services;
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new text begin
(3) Federally Qualified Health Center (FQHC) services;
new text end
new text begin
(4) other laboratory and x-ray services;
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new text begin
(5) nursing facility services;
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new text begin
(6) early and periodic screening, diagnostic, and treatment (EPSDT) services;
new text end
new text begin
(7) family planning services;
new text end
new text begin
(8) physician services; or
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new text begin
(9) home health services.
new text end
new text begin
(q) "Cost sharing" means any co-payment, coinsurance, deductible, or other similar
charge.
new text end
new text begin
(r) "Credibility adjustment" means an adjustment to the minimum lost ratio (MLR) for
a partially credible MCO to account for the difference between the actual and target MLRs
that may be due to a random statistical variation.
new text end
new text begin
(s) "Emergency medical condition" means a medical condition manifesting itself by
acute symptoms of sufficient severity, including severe pain that a prudent layperson, who
possesses an average knowledge of health and medicine could reasonably expect the absence
of immediate medical attention to result in jeopardizing the health of the individual or in
the case of a pregnant women, seriously impairing bodily functions, or serious dysfunction
of a body organ or part.
new text end
new text begin
(t) "Emergency services" means covered inpatient and outpatient services that are:
new text end
new text begin
(1) furnished by a qualified provider under Code of Federal Regulations, title 42; and
new text end
new text begin
(2) needed to evaluate or stabilize an emergency medical condition.
new text end
new text begin
(u) "Enrollee" means a medical assistance or MinnesotaCare person who is currently
enrolled in an MCO.
new text end
new text begin
(v) "Enrollee encounter data" means the information relating to the receipt of any item
or service by an enrollee under a contract between the commissioner and an MCO that is
subject to Code of Federal Regulations, title 42, sections 438.242 and 438.818.
new text end
new text begin
(w) "External quality review (EQR)" means the analysis and evaluation by an EQRO
of the aggregated information on quality, timeliness, and access to the health care services
that an MCO or the MCO's contractor furnish to medical assistance managed care enrollees.
new text end
new text begin
(x) "External quality review organization (EQRO)" means an organization that meets
the competence and independence requirements in Code of Federal Regulations, title 42,
section 438.354, and performs external quality review, other EQR-related activities in Code
of Federal Regulations, title 42, section 438.358, or both.
new text end
new text begin
(y) "Fraud" means an intentional deception or misrepresentation by a person with the
knowledge that the deception may result in unauthorized benefit to the person or another
person. Fraud includes any act that constitutes health care fraud under federal or state law.
new text end
new text begin
(z) "Full credibility" means a standard for which the experience of an MCO for the
calculation of an MLR with a minimal chance that the difference between the actual and
target medical loss ratio is not statistically significant. An MCO is assigned full creditability
must not receive a creditability adjustment to an MCO's MLR.
new text end
new text begin
(aa) "Grievance" means an expression of dissatisfaction about any matter other than an
adverse benefit determination. A grievance includes but is not limited to the quality of care
or services provided; and aspects of interpersonal relationships, including rudeness of a
provider or employee; or failure to respect the enrollee's rights regardless of whether an
action is requested; or an enrollee's right to dispute an extension of time proposed by the
MCO to make an authorization decision.
new text end
new text begin
(bb) "Grievance and appeal system" means the processes an MCO implements to handle
appeals of an adverse benefit determination and grievances and the processes to collect and
track information about grievances.
new text end
new text begin
(cc) "Health care services" means all medical assistance provided by an MCO under
contract with the state Medicaid agency in any setting, including but not limited to medical
care, behavioral health care, and long-term services and supports.
new text end
new text begin
(dd) "Incentive arrangement" means any payment mechanism under which an MCO
may receive additional funds over and above the capitation rates an MCO was paid for
meeting targets in the contract.
new text end
new text begin
(ee) "Indian" means any individual defined in United States Code, title 25, section
1603(13), 1603(28), or 1679(a), or who was determined eligible as Indian, according to
Code of Federal Regulations, title 42, section 136.12. Indian also means the individual is a
member of a federally recognized tribe or resides in an urban center and is:
new text end
new text begin
(1) a member of a tribe, band, or other organized group of Indians, including tribes,
bands, groups terminated since 1940 and tribes recognized now or in the future by the state
in which they reside, or who is a descendant, in the first or second degree, of any such
member;
new text end
new text begin
(2) an Eskimo or Aleut or other Alaska native;
new text end
new text begin
(3) considered by the Secretary of the Interior to be an Indian for any purpose; or
new text end
new text begin
(4) considered by the Secretary of Health and Human Services to be an Indian for
purposes of eligibility for Indian health care services, including a California Indian, Eskimo,
Aleut, or other Alaska native.
new text end
new text begin
(ff) "Indian Health Care Provider" or "HCP" means a health care program operated by
the Indian Health Service (IHS) or by an Indian Tribe, Tribal Organization, or Urban Indian
Organization (I/T/U) as those terms are defined in section 4 of the Indian Health Care
Improvement Act, United States Code, title 25, section 1603.
new text end
new text begin
(gg) "Limited English proficient" or "LEP" means potential enrollees and enrollees who
do not speak English as the individual's primary language and who have a limited ability
to read, write, speak, or understand English may be LEP and may be eligible to receive
language assistance for a particular type of service, benefit, or encounter.
new text end
new text begin
(hh) "Long-term services and supports" or "LTSS" means services and supports provided
to a beneficiary of any age who has functional limitations or chronic illnesses that primarily
support the ability of the beneficiary to live or work in a setting of the beneficiary's choice,
including the beneficiary's home, a work site, a provider owned or controlled residential
setting, a nursing facility, or other institutional setting.
new text end
new text begin
(ii) "Managed care organization" or "MCO" means an entity that has, or is seeking to
qualify for, a comprehensive, and that is:
new text end
new text begin
(1) a federally qualified health maintenance organization (HMO) that meets the advance
directives requirements of Code of Federal Regulations, title 42, sections 489.100 to 489.104;
or
new text end
new text begin
(2) any public or private entity that meets the advance directives requirements and:
new text end
new text begin
(i) makes the services the entity provides to medical assistance enrollees as accessible,
including timeliness, amount, duration, and scope of services as services provided to other
medical assistance beneficiaries in the area served by the entity; and
new text end
new text begin
(ii) meets the solvency standards of Code of Federal Regulations, title 42, section 438.116.
A participating entity must meet the requirements of this section and section 256B.692.
new text end
new text begin
(jj) "Marketing" means any communication from an MCO to a Medicaid beneficiary
who is not enrolled in that MCO, that can reasonably be interpreted as intended to influence
the beneficiary to enroll in a particular MCO, or to not enroll or to disenroll from another
MCO. Marketing does not include communications about the qualified health plan to a
Medicaid beneficiary from the issuer of a qualified health plan, as defined in Code of Federal
Regulations, title 45, section 155.20.
new text end
new text begin
(kk) "Marketing materials" means materials that:
new text end
new text begin
(1) are produced in any medium, by or on behalf of an MCO; and
new text end
new text begin
(2) can reasonably be interpreted as intended to market the MCO to potential enrollees.
new text end
new text begin
(ll) "Medical loss ratio" or "MLR" means a basic financial measurement used in the
Affordable Care Act to provide value to enrollees. If an insurer uses 80 cents out of every
premium dollar to pay its enrollees' medical claims and activities that improve the quality
of care, the company has a medical loss ratio of 80 percent. A medical loss ratio of 80
percent indicates that the insurer is using the remaining 20 cents of each premium dollar to
pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent
commissions.
new text end
new text begin
(mm) "Member months" means the number of months an enrollee or a group of enrollees
is covered by an MCO over a specified period of time, such as a year.
new text end
new text begin
(nn) "Market loss ratio" or "MLR reporting year" means the period of 12 months
consistent with the rating period selected by the commissioner.
new text end
new text begin
(oo) "Network provider" means any provider, group of providers, entity with a network
provider agreement with an MCO, or a subcontractor, and that receives Medicaid funding
directly or indirectly to order, refer, or render covered services as a result of the
commissioner's contract with an MCO. A network provider is not a subcontractor by virtue
of the network provider agreement.
new text end
new text begin
(pp) "No credibility" means a standard for which the experience of an MCO is determined
to be insufficient for the calculation of an MLR. An MCO that is assigned no credibility
must not be measured against any MLR requirements.
new text end
new text begin
(qq) "Outcomes" means changes in patient health, functional status, satisfaction, or goal
achievement that result from health care or supportive services.
new text end
new text begin
(rr) "Overpayment" means any payment made by an MCO to a network provider that
the provider is not entitled to receive, or any payment to an MCO from the commissioner
that the MCO is not entitled to receive under title XIX of the Social Security Act.
new text end
new text begin
(ss) "Pass-through payment" means any amount required by the commissioner to be
added to the contracted payment rates, and considered in calculating the actuarially sound
capitation rate, between the MCO and a hospital, physician, or nursing facility that is not
for the following purposes:
new text end
new text begin
(1) specific service or benefit provided to a specific enrollee covered under the contract;
new text end
new text begin
(2) a provider payment methodology permitted under Code of Federal Regulations, title
42, sections 438.6(c)(1)(i) to (iii),
new text end
new text begin
(3) for services and enrollees covered under a contract;
new text end
new text begin
(4) a subcapitated payment arrangement for a specific set of services and enrollees
covered under the contract;
new text end
new text begin
(5) Graduate Medical Education (GME) payments; or
new text end
new text begin
(6) Federally Qualified Health Clinic (FQHC) or Rural Health Clinic (RHC) wrap around
payments.
new text end
new text begin
(tt) "Partial credibility" means a standard for which the experience of an MCO is
determined to be sufficient for the calculation of an MLR but with a non-negligible chance
that the difference between the actual and target medical loss ratios is statistically significant.
An MCO that is assigned partial credibility must receive a credibility adjustment to an
MCO's MLR.
new text end
new text begin
(uu) "Participating entity" means a health carrier as defined in section 62A.01, subdivision
2; a county-based purchasing plan established under section 256B.692; an accountable care
organization or other entity operating a health care delivery system demonstration project
authorized under section 256B.0755; an entity operating a county integrated health care
delivery network pilot project authorized under section 256B.0756; or a network of health
care providers established to offer services under MinnesotaCare.
new text end
new text begin
(vv) "Prevalent" means a non-English language determined to be spoken by a significant
number or percentage of potential enrollees and enrollees that are limited English proficient.
new text end
new text begin
(ww) "Primary care" means all health care services and laboratory services customarily
furnished by or through a general practitioner, family physician, internal medicine physician,
obstetrician, gynecologist, pediatrician, or other licensed practitioner as authorized by the
Minnesota medical assistance program, to the extent that providing the services is legally
authorized in the state in which the practitioner furnishes services.
new text end
new text begin
(xx) "Potential enrollee" means a medical assistance or MinnesotaCare person who is
subject to mandatory enrollment, or for medical assistance only may voluntarily elect to
enroll in an MCO, but is not yet an enrollee of an MCO.
new text end
new text begin
(yy) "Provider" means any individual or entity that is engaged in the delivery of services,
or ordering or referring for those services, and is legally authorized to do so by the state in
which the provider delivers services.
new text end
new text begin
(zz) "Post-stabilization care services" means covered services, related to an emergency
medical condition that are provided after an enrollee is stabilized to maintain the stabilized
condition, or according to Code of Federal Regulations, title 42, section 438.114(e).
new text end
new text begin
(aaa) "Quality" means the degree that an MCO increases the likelihood of desired
outcomes of an MCO's enrollees through:
new text end
new text begin
(1) an MCO's structural and operational characteristics;
new text end
new text begin
(2) the provision of services that are consistent with current professional, evidence-based
knowledge; and
new text end
new text begin
(3) interventions for performance improvement.
new text end
new text begin
(bbb) "Rate cell" means a set of mutually exclusive categories of enrollees that is defined
by one or more characteristics to determine the capitation rate and make a capitation payment.
Characteristics may include age, gender, eligibility category, and region or geographic area.
Each enrollee should be categorized in one of the rate cells for each unique set of mutually
exclusive benefits under the contract.
new text end
new text begin
(ccc) "Readily accessible" means electronic information and services which comply
with modern accessibility standards, including section 508 guidelines, section 504 of the
Rehabilitation Act, and W3C's Web Content Accessibility Guidelines (WCAG) 2.0 AA and
successor versions.
new text end
new text begin
(ddd) "Risk adjustment" is a methodology to account for the health status of an enrollee
via relative risk factors when predicting or explaining costs of services covered under the
contract for defined populations or for evaluating retrospectively the experience of the
MCOs contracted with the commissioner.
new text end
new text begin
(eee) "Risk contract" means a contract between the commissioner and an MCO in which
the contractor:
new text end
new text begin
(1) assumes risk for the cost of the services covered under the contract; and
new text end
new text begin
(2) incurs loss if the cost of furnishing the services exceeds the payments under the
contract.
new text end
new text begin
(fff) "Risk corridor" means a risk-sharing mechanism in which the commissioner and
MCOs may share in profits and losses under the contract outside of a predetermined threshold
amount.
new text end
new text begin
(ggg) "Rural area" means any county designated as "micro," "rural," or "County with
Extreme Access Considerations" in the Medicare Advantage Health Services Delivery
(HSD) Reference file for the applicable calendar year.
new text end
new text begin
(hhh) "State fair hearing" means the process set forth in subpart E of Code of Federal
Regulations, title 42, section 431.
new text end
new text begin
(iii) "Subcontractor" means an individual or entity that has a contract with an MCO that
relates directly or indirectly to the performance of the MCO's obligations under an MCO's
contract with the commissioner.
new text end
new text begin
(jjj) "Validation" means the review of information, data, and procedures to determine
the extent that information, data, and procedures are accurate, reliable, free from bias, and
according to standards for data collection and analysis.
new text end
new text begin
(kkk) "Withhold arrangement" means any payment mechanism under which a portion
of a capitation rate is withheld from an MCO, and a portion or all of the withheld amount
must be paid to the MCO for meeting targets specified in the contract. An arrangement that
withholds a portion of a capitation rate for noncompliance with general operational
requirements are a penalty and not a withhold arrangement.
new text end
new text begin Subd. 3. new text end
new text begin Service area. new text end
new text begin
Managed care shall be offered in each county in Minnesota.
new text end
new text begin Subd. 4. new text end
new text begin Procurement for managed care. new text end
new text begin
(a) The commissioner, when implementing
managed care within a county or a group of counties that have elected county-based
purchasing, must comply with applicable state laws in chapter 16C, and Code of Federal
Regulations, title 45, part 75. These counties shall participate in the procurement according
to this section. The commissioner shall procure for managed care contracts, at a minimum
of every five years according to section 16B.98, subdivision 5, and may conduct a statewide
procurement or procure for a limited number of counties within a specified region.
new text end
new text begin
(b) The commissioner shall coordinate the procurement of MinnesotaCare to the extent
practicable with medical assistance according to this subdivision.
new text end
new text begin
(c) The commissioner may consider a request from the county or group of counties
representing county-based purchasing to exclude price in the evaluation criteria. The
commissioner shall ensure that the payment made by the commissioner to any managed
care plan in these counties does not exceed payments that would otherwise be paid to any
other managed care organization providing medical assistance services for the same county,
region, or population. The procurement shall also consider the unique nature of the county
or group of counties in county-based purchasing and evaluate the responders on provider
network access, coordination, and integration with county services for the provision of
health care and other local community-based services.
new text end
new text begin
(d) The counties must be included in the process of development, and issuance of the
request for proposals to provide services to eligible individuals within the proposed county.
Counties must be given reasonable opportunity to make recommendations regarding the
development, issuance, and changes needed in the request for proposals before publication.
The recommendations must reflect neutrality towards all potential responders and be
reasonably related to the performance of managed care organization functions and within
the scope of the medical assistance benefit set. The commissioner must provide counties
the opportunity to review and score each responder's proposal based on the identification
of the counties' community needs under chapters 145A and 256E and county advocacy
activities. The counties shall consider the respondent's ability to fully and adequately deliver
required health care services, offer an adequate provider network, provide care coordination
with county services, and serve special populations, including enrollees with language and
cultural needs.
new text end
new text begin
(e) As part of the procurement process, a county may seek county board recommendations
based on the county's review and score of each proposal. A county board's recommendations
must be submitted to the commissioner for consideration in the overall decision of the
managed care organization selection process.
new text end
new text begin
(f) All county and state staff serving as evaluators of the proposals must sign a
confidentiality agreement that complies with the conflict of interest requirements in sections
15.43, 43A.48, 16C.04, and 256B.0914.
new text end
new text begin
(g) All responders seeking a contract to provide health care services under this section
are subject to the prohibition against conflict of interest in section 256B.0914, and must
comply with all applicable prohibitions and requirements for safeguards regarding conflict
of interest in Code of Federal Regulations, title 42, section 438.58.
new text end
new text begin
(h) Before the commissioner implements a new managed care program, or when an
MCO provides services to a new eligibility group, or contracting with a new MCO, the
commissioner shall conduct a readiness review according to Code of Federal Regulations,
title 42, section 438.66(d). The readiness review must be conducted at least three months
before the program implementation effective date and with sufficient time to ensure a smooth
transition and receive Centers for Medicare and Medicaid approval.
new text end
new text begin
(i) The commissioner shall provide a written report under section 3.195 to the chairs of
the legislative committees having jurisdiction over human services if a procurement results
in a significant change of new contracted entities, population shifts, new eligibility groups,
or a change in the number of contracted entities. The report shall be provided 60 days
following the effective date of the change.
new text end
new text begin
(j) If a county board or counties and the commissioner cannot reach agreement regarding
the selection of participating managed care organizations in that county or counties, the
commissioner shall resolve the dispute after considering the recommendation of a
three-person mediation panel. The panel shall be composed of three panelists: one designee
of the president of the Association of Minnesota Counties, one designee of the commissioner
of human services, and one designee selected jointly by the designee of the commissioner
of human services and the designee of the Association of Minnesota Counties. Within a
reasonable period of time before the hearing, the panelists must be provided all documents
and information relevant to the mediation. The parties to the mediation must be given 30
days' notice of a hearing before the mediation panel.
new text end
new text begin
(k) A contract between the commissioner and a managed care organization is exempt
from the set-aside and preference provisions of section 16C.16, subdivision 6.
new text end
new text begin Subd. 5. new text end
new text begin Competitive bidding. new text end
new text begin
(a) For managed care contracts, the commissioner may
utilize a competitive price bidding program for nonelderly, nondisabled adults and children
in medical assistance and MinnesotaCare. The managed care program must allow a minimum
of two managed care organizations in each county that is identified as a metropolitan
statistical area (MSA).
new text end
new text begin
(b) The pilot programs operating in Hennepin County and Ramsey County under section
256B.0756 are exempt from competitive bid.
new text end
new text begin Subd. 6. new text end
new text begin Enrollment. new text end
new text begin
(a) For populations required to enroll in a managed care
organization, the commissioner must ensure that an eligible beneficiary has a choice between
two managed care organizations. For an eligible beneficiary residing in a rural area, the
commissioner may limit a rural area beneficiary to a single managed care organization. For
a beneficiary living in a rural county with a single managed care organization, the rural
beneficiary:
new text end
new text begin
(1) must be allowed to choose from at least two primary care providers; and
new text end
new text begin
(2) is permitted to obtain services from any provider according to Code of Federal
Regulations, title 42, section 438.52(b).
new text end
new text begin
(b) The commissioner, in consultation with the tribal governments, shall develop a plan
for tribes to assist in the enrollment process for American Indian beneficiaries enrolled in
managed care under this section. This plan shall address how tribes shall be included in
ensuring the coordination of care for American Indian beneficiaries by Indian Health Care
Providers.
new text end
new text begin
(c) Each person who is eligible for medical assistance must participate in managed care
unless the person:
new text end
new text begin
(1) meets the exclusion criteria listed in subdivision 8;
new text end
new text begin
(2) is 65 years of age or older and eligible for Medicare and elects to enroll in the
Minnesota Senior Health Options program.
new text end
new text begin
(3) is 18 to 64 years of age and certified disabled, and does not opt out, is enrolled in
the Special Needs Basic Care Program.
new text end
new text begin
(d) A state plan that requires medical assistance beneficiaries to enroll in MCOs must
comply with Code of Federal Regulations, title 42, section 438.50, unless the commissioner
received federal waiver authority.
new text end
new text begin
(e) The enrollment system must comply with Code of Federal Regulations, title 42,
section 438.54, as applicable to mandatory, voluntary, and passive enrollments. For a
potential enrollee that does not select an MCO during the period allowed by the
commissioner, the commissioner must have a default enrollment process for assigning the
potential enrollee to an MCO and must consider priority enrollment and existing
provider-beneficiary relationships. The MCO must not be subject to an intermediate sanction
in Code of Federal Regulations, title 42, section 438.702(a)(4), and the MCO's capacity to
accept new enrollment.
new text end
new text begin
(1) The commissioner may consider additional reasonable criteria to conduct the default
process including the previous plan assignment of the beneficiary, quality assurance and
improvement performance, procurement evaluation elements, accessibility of provider
offices for people with disabilities, if appropriate, and other reasonable criteria that support
the objectives of the managed care program.
new text end
new text begin
(2) The commissioner must send a confirmation of the enrollee's managed care enrollment
to the enrollee within five calendar days of the date enrollment is processed by the
commissioner. The confirmation must clearly explain the enrollee's right to disenroll within
90 days from the effective date of enrollment.
new text end
new text begin
(3) The commissioner must provide an informational notice to each potential enrollee
who may enroll in an MCO. The notice must include the MCOs that are available to the
potential enrollee, how to select an MCO, explain the implications of making or not making
an active choice, explain the length of enrollment period and the disenrollment policies,
and comply with Code of Federal Regulations, title 42, sections 438.10 and 438.206.
new text end
new text begin Subd. 7. new text end
new text begin Prohibition against enrollment discrimination. new text end
new text begin
(a) The commissioner shall
ensure, through its contracts with the managed care organizations, compliance with all
federal and state anti-discrimination laws and regulations. A managed care organization
that contracts with the commissioner cannot discriminate or use any policy that has the
effect of discriminating against people on the basis of medical condition, health status,
receipt of health care services, claims experience, medical history, genetic information,
disability, including mental or physical impairment, marital status, age, race, color, religion,
creed, national origin, sex, including sex stereotypes and gender identity, sexual orientation,
political beliefs, or public assistance status.
new text end
new text begin
(b) The managed care organization must accept an individual eligible for enrollment in
the order that the individual applied or are assigned up to the limits set by the contract. The
commissioner may limit the number of enrollees in the MCO if in the commissioner's
judgment the MCO is unable to demonstrate the capacity to serve additional enrollees.
new text end
new text begin Subd. 8. new text end
new text begin Enrollment exclusions. new text end
new text begin
(a) The commissioner shall exclude the following
persons from enrollment in managed care:
new text end
new text begin
(1) a child who is receiving medical assistance through adoption assistance according
to section 256B.055, subdivision 1, is eligible to enroll in managed care on a voluntary
basis;
new text end
new text begin
(2) a person under 65 years of age that is eligible for medical assistance because of
blindness or disability as determined by the Social Security Administration or the medical
review team, except as permitted under subdivision 74;
new text end
new text begin
(3) a beneficiary who has private health care coverage through a health maintenance
organization (HMO) certified under chapter 62D. A beneficiary with this coverage may
enroll in managed care on a voluntary basis if the private HMO is the same as the managed
care organization the recipient will select under managed care;
new text end
new text begin
(4) a beneficiary who is eligible for medical assistance by spending down excess income
for medical expenses other than the nursing facility per diem expense, exceptions apply
under specific managed care programs;
new text end
new text begin
(5) a beneficiary who receives benefits under the Refugee Assistance Program, established
under United States Code, title 8, section 1522(e);
new text end
new text begin
(6) a child who is determined to be severely emotionally disturbed (SED) and eligible
to receive mental health targeted case management services according to section 245.4881,
is eligible to enroll in managed care on a voluntary basis;
new text end
new text begin
(7) an adult who is determined to be seriously and persistently mentally ill, according
to section 256B.0625, subdivision 20, and eligible to receive mental health targeted case
management services according to section 245.4711, is eligible to enroll in managed care
on a voluntary basis;
new text end
new text begin
(8) a beneficiary eligible for medical assistance through the breast and cervical cancer
control program according to section 256B.057, subdivision 10;
new text end
new text begin
(9) a beneficiary with cost-effective employer-sponsored private health insurance or a
beneficiary enrolled in a non-Medicare individual health plan determined to be cost-effective
according to section 256B.0625, subdivision 15;
new text end
new text begin
(10) a beneficiary who, before enrollment, is a resident of a state institution. A beneficiary
already enrolled in managed care who enter state institutions must remain enrolled if the
beneficiary's placement was approved by an MCO, including court ordered placements for
services covered under an MCO contract;
new text end
new text begin
(11) a beneficiary who, at the time of enrollment, has a terminal communicable disease
which may exceed six months, and has an established relationship with a primary physician
who is not a network provider in any of the managed care organizations and the physician
certifies that disruption of the physician-patient relationship is likely to result in the patient
becoming noncompliant with medication or other health services;
new text end
new text begin
(12) a beneficiary who, at the time of enrollment, has a terminal illness with a medical
prognosis of six months or less life expectancy and has a permanent relationship with a
primary physician who is not a network provider in any of the managed care organizations;
new text end
new text begin
(13) beneficiaries who are Qualified Medicare Beneficiaries (QMB) as defined in section
1905(p) of the Social Security Act, United States Code, section 1396d(p), and not eligible
for medical assistance;
new text end
new text begin
(14) beneficiaries who are Specified Low-Income Medicare Beneficiaries (SLMB) as
defined in section 1905(p) of the Social Security Act, United States Code, title 42, sections
1396a(a)(10)(E)(iii) and 1396d(p), and not eligible for medical assistance;
new text end
new text begin
(15) beneficiaries who are Qualified Working Disabled Adults (QWD) as defined in
United States Code, title 42, section 1396d(s), and not eligible for medical assistance;
new text end
new text begin
(16) a beneficiary receiving care and services from a nonprofit center established to
serve victims of torture;
new text end
new text begin
(17) a beneficiary who receives emergency medical assistance under section 256B.06,
subdivision 4;
new text end
new text begin
(18) a recipient eligible for the Minnesota family planning program (MFPP) under section
256B.78;
new text end
new text begin
(19) a beneficiary participating in the navigator pilot under section 254B.13; and
new text end
new text begin
(20) a beneficiary participating in the continuum of care pilot under section 254B.14.
new text end
new text begin
(b) Unless a newborn is determined to be excluded from managed care enrollment for
any reason identified in this section, the newborn who is determined eligible for and receiving
medical assistance must be enrolled in managed care retroactively from the birth month in
the same MCO as the mother, if applicable. For a birth reported within 90 days of birth
there will be continuous managed care enrollment from the birth month. For a birth reported
after 90 days from the birth month, enrollment will be the next available month following
the month that the birth was reported.
new text end
new text begin Subd. 9. new text end
new text begin Disenrollment. new text end
new text begin
(a) The commissioner shall establish procedures for when a
beneficiary may disenroll or change the beneficiary's MCO. The effective date of an approved
disenrollment must be no later than the first day of the second month following the month
that the beneficiary requests disenrollment.
new text end
new text begin
(b) A beneficiary may disenroll for cause at any time. Cause for disenrollment includes:
new text end
new text begin
(1) the enrollee moves outside of the MCO service area;
new text end
new text begin
(2) the MCO does not, because of moral or religious objections, cover the service the
enrollee seeks;
new text end
new text begin
(3) the enrollee needs related services to be performed at the same time and not all related
services are available within the provider network; and the enrollee's primary care provider
or another provider determines that receiving the services separately would subject the
enrollee to unnecessary risk;
new text end
new text begin
(4) an enrollee that uses MLTSS, the enrollee would have to change the enrollee's
residential, institutional, or employment supports provider based on that provider's change
in status from an in-network to an out-of-network provider with the MCO and, as a result,
would experience a disruption in the enrollee's residence or employment; or
new text end
new text begin
(5) reasons such as poor quality of care, lack of access to services covered under the
contract, or lack of access to providers experienced with the enrollee's care needs.
new text end
new text begin
(c) A beneficiary may disenroll without cause at the following times:
new text end
new text begin
(1) within 90 days following the date of the beneficiary's initial enrollment into a new
managed care organization or 90 days following the date the commissioner sends the
beneficiary notice of the enrollment, whichever is later;
new text end
new text begin
(2) in a county where there is a single plan, a beneficiary may change the beneficiary's
primary care clinic on a monthly basis;
new text end
new text begin
(3) at least once every 12 months following the beneficiary's initial enrollment;
new text end
new text begin
(4) upon automatic reenrollment, if the temporary loss of medical assistance eligibility
caused the beneficiary to miss the beneficiary's annual health plan selection opportunity;
new text end
new text begin
(5) if the commissioner imposes the intermediate sanction in Code of Federal Regulations,
title 42, section 438.702(a)(4);
new text end
new text begin
(6) if a managed care organization ends participation for any reason, a beneficiary
enrolled with that organization must select a new managed care organization but may change
managed care organizations without cause once more within the first 60 days after enrollment
with the second managed care organization;
new text end
new text begin
(7) because of substantial travel time or local agency error;
new text end
new text begin
(8) the beneficiary elects to change MCOs within 120 days following notice of a material
modification of an MCO's provider network; or
new text end
new text begin
(9) the beneficiary has a change in major medical program.
new text end
new text begin Subd. 10. new text end
new text begin Consumer safeguards. new text end
new text begin
The commissioner shall ensure safeguards against
conflict of interest of an individual who has responsibilities relating to the enrollment
processes.
new text end
new text begin Subd. 11. new text end
new text begin Transition services. new text end
new text begin
(a) The commissioner must have a transition of care
policy for managed care that ensures a beneficiary has continued access to medical assistance
services during the following transition periods:
new text end
new text begin
(1) moving from FFS to enrollment in an MCO;
new text end
new text begin
(2) changing from one MCO to another MCO;
new text end
new text begin
(3) the beneficiary's MCO contract is terminated; and
new text end
new text begin
(4) the beneficiary is disenrolled from managed care for any reason other than ineligibility
for Medicaid.
new text end
new text begin
(b) The commissioner's transition of care policy must ensure:
new text end
new text begin
(1) that a beneficiary has access to services consistent with the access the beneficiary
previously had and is permitted to retain the beneficiary's current provider for a period of
up to 120 days if that provider is not in the MCO network;
new text end
new text begin
(2) within the transition period the beneficiary is referred to appropriate a provider of
services that are in the MCO's network;
new text end
new text begin
(3) the commissioner, in the case of FFS, or the MCO that was previously serving the
enrollee, fully and timely complies with requests for historical utilization data from the new
MCO according to federal and state law;
new text end
new text begin
(4) the enrollee's new provider is able to obtain copies of the enrollee's medical records,
as appropriate and consistent with state and federal law.
new text end
new text begin
(5) access to other necessary procedures as specified by the Centers for Medicare and
Medicaid to ensure continued access to services to prevent serious detriment to the enrollee's
health or reduce the risk of hospitalization or institutionalization; and
new text end
new text begin
(6) that the policy is be publicly available to enrollees and potential enrollees on how
to access continued services during transition.
new text end
new text begin Subd. 12. new text end
new text begin Beneficiary support system. new text end
new text begin
(a) The commissioner shall have a beneficiary
support system that provides support to a beneficiary both before and after enrollment in a
managed care organization.
new text end
new text begin
(b) A state beneficiary support system must:
new text end
new text begin
(1) provide choice counseling for each potential enrollee, including an enrollee who
disenrolled from an MCO;
new text end
new text begin
(2) assist each enrollee in understanding managed care;
new text end
new text begin
(3) provide an access point for complaints and concerns about MCO enrollment, covered
services, and other related matters;
new text end
new text begin
(4) provide education on enrollee's grievance and appeal rights within the MCO, the
state fair hearing process, enrollee rights and responsibilities, and additional resources
outside of the MCO;
new text end
new text begin
(5) assist, if request, navigating the grievance and appeal process within the MCO and
appealing adverse benefit determinations by the MCO to a state fair hearing. The beneficiary
support system may not provide representation to the enrollee at a state fair hearing but may
refer an enrollee to legal representation sources;
new text end
new text begin
(6) perform outreach to a beneficiary or an authorized representative and be accessible
in multiple formats including telephone, internet, in-person, and via auxiliary aids and
services if requested; and
new text end
new text begin
(7) review and oversee LTSS program data to guide the state Medicaid agency on
identification, remediation, and resolution of systemic issues.
new text end
new text begin
(c) Federal financial participation is available only if:
new text end
new text begin
(1) costs must be supported by an allocation methodology that appears in the state's
approved Public Assistance Cost Allocation Plan in Code of Federal Regulations, title 42,
section 433.34; and
new text end
new text begin
(2) costs do not duplicate payment for activities that are already offered or should be
provided by other entities or paid by other programs.
new text end
new text begin
(d) The commissioner may designate a county coordinator to assist the department in
educating beneficiaries about selecting an MCO and providing necessary enrollment
information.
new text end
new text begin Subd. 13. new text end
new text begin Network adequacy. new text end
new text begin
(a) The commissioner shall develop and enforce time
and distance standards for provider types in clauses (1) to (9) that are covered under the
managed care organization contract with the commissioner and who is permitted to have
varying standards for the same provider type based on geographic areas:
new text end
new text begin
(1) primary care, adult and pediatric;
new text end
new text begin
(2) obstetrician/gynecologist;
new text end
new text begin
(3) adult and pediatric behavioral health, including mental health and substance use
disorder;
new text end
new text begin
(4) specialist, adult and pediatric;
new text end
new text begin
(5) hospital;
new text end
new text begin
(6) pharmacy;
new text end
new text begin
(7) pediatric dental;
new text end
new text begin
(8) LTSS providers that the enrollee travels to the provider; and for providers traveling
to an enrollee's home, the commissioner may set alternative standards; and
new text end
new text begin
(9) additional provider types as determined by the commissioner or the Centers for
Medicare and Medicaid if the commissioner promotes the objectives of the Medicaid
program.
new text end
new text begin
(b) In developing network standards for the providers in paragraph (a), the commissioner
must consider the elements in Code of Federal Regulations, title 42, section 438.68(c).
new text end
new text begin
(c) The commissioner may allow an exception to any of the provider-specific network
standards. The exception must be identified in the MCO contract and be based, at a minimum,
on the number of providers practicing that specialty in the managed care organization's
service area. The commissioner must monitor enrollee access to the provider on an ongoing
basis and report those findings to the Centers for Medicare and Medicaid in the managed
care program assessment report according to Code of Federal Regulations, title 42, section
438.68(d)(2).
new text end
new text begin
(d) The commissioner must publish on the department's Web site the network adequacy
standards developed according to this section. The network adequacy standards must also
be made available, upon request, at no cost to an enrollee with a disability in an alternate
format or through the provision of auxiliary aids and services.
new text end
new text begin Subd. 14. new text end
new text begin Provider selection. new text end
new text begin
(a) The commissioner must ensure that a contract with
an MCO requires the MCO to have written policies and procedures for selection and retention
of network providers and that the policies and procedures satisfy Code of Federal Regulations,
title 42, section 438.214.
new text end
new text begin
(b) The commissioner shall require an MCO to adopt a uniform credentialing and
recredentialing process and comply with the process consistent with state regulations and
current NCQA Standards and Guidelines for the Accreditation of Health Plans. The MCO
must follow the process for acute, primary care, behavioral, substance use, and LTSS
providers. For organizational providers, including hospitals, and Medicare certified home
health care agencies, an MCO shall adopt a uniform credentialing and recredentialing process
and comply with that process consistent with state regulations.
new text end
new text begin
(c) An MCO serving a county with a nonprofit community clinic or community health
services agency must contract with the clinic or agency to provide services to a client who
chooses to receive services from the clinic or agency, if the clinic or agency agrees to
payment rates that are competitive with rates paid to other health plan providers for the
same or similar services. For purposes of this subdivision, "nonprofit community clinic"
includes, but is not limited to, a community mental health center as defined in sections
245.62 and 256B.0625, subdivision 5.
new text end
new text begin
(d) An MCO may not discriminate in the participation, reimbursement, or indemnification
of any provider who is acting within the scope of the provider's license or certification under
applicable state law, solely on the basis of that license or certification. If an MCO declines
to include provider or groups of providers in an MCO's network, the MCO must give written
notice of the MCO's decision. An MCO is:
new text end
new text begin
(1) not required to contract with a provider beyond the amount necessary to meet the
needs of an MCO's enrollees;
new text end
new text begin
(2) not prohibited from using different reimbursement amounts for different specialties
or different practitioners in the same specialty; and
new text end
new text begin
(3) allowed to establish measures designed to maintain quality of services and control
costs.
new text end
new text begin
(e) The MCO may not employ or contract with a provider excluded from participation
in federal health care programs under the Social Security Act, United States Code, section
1128 or 1128A.
new text end
new text begin Subd. 15. new text end
new text begin Provider screening and enrollment. new text end
new text begin
(a) The commissioner, through the
commissioner's contract with the MCOs, must ensure all network providers are enrolled
with the Medicaid agency as a medical assistance provider and must comply with the provider
disclosure, screening, and enrollment requirements of part 455. A provider network is not
required to render services to a fee-for-service beneficiary.
new text end
new text begin
(b) An MCO may execute a network provider agreement pending the outcome of the
medical assistance provider enrollment process up to 120 days. An MCO must terminate
the network provider upon notification that the network provider cannot be enrolled or upon
expiration of the 120-day period and must notify each affected enrollee.
new text end
new text begin Subd. 16. new text end
new text begin Network and payment requirements for Indian health care providers. new text end
new text begin
(a)
Medical assistance shall cover health care services provided at Indian health services facilities
and facilities operated by a tribe or tribal organization under funding authorized under
United states Code, title 25, sections 450f to 450n, or title III of the Indian Self-Determination
and Education Assistance Act, Public Law 93-638, if services would otherwise be covered
under section 256B.0625. A payment for services provided under this subdivision shall be
made on a fee-for-service basis, and may, at the option of the tribe or tribal organization,
be made according to rates authorized under sections 256.969, subdivision 16, and
256B.0625, subdivision 34.
new text end
new text begin
(b) For an American Indian that enrolled in managed care, the commissioner must require
an MCO to ensure timely access to services available under the contract from IHCP providers
for an enrollee who is eligible to receive services. Timely access to services includes:
new text end
new text begin
(1) an MCO demonstrating it has sufficient Indian Health Care Providers (IHCP)
participating in the provider network;
new text end
new text begin
(2) an IHCP, whether in the network or not, must be paid:
new text end
new text begin
(i) at a rate negotiated between the MCO and the IHCP; and
new text end
new text begin
(ii) at a rate not less than the level and amount of payment that the MCO would pay for
the services to a participating provider that is not an IHCP;
new text end
new text begin
(3) making payment to all IHCPs in an MCO's network in a timely manner as required
for payment to practitioners in individual or group practices according to Code of Federal
Regulations, title 42, sections 447.45 and 447.46;
new text end
new text begin
(4) permitting an Indian enrolled in an MCO to choose an IHCP as the enrollee's primary
care provider participating as a network provider as long as the provider has the capacity
to provide the services;
new text end
new text begin
(5) permitting an Indian enrollee to obtain services covered under the contract from out
of network IHCPs for whom the enrollee is otherwise eligible to receive services; and
new text end
new text begin
(6) permitting an out-of-network IHCP to refer an Indian enrollee to a network provider.
new text end
new text begin
(c) In a state where timely access to covered services cannot be assured due to few or
no IHCPs, the MCO must be considered to have met the requirements of this section, if the
Indian enrollee is permitted access to an out of state IHCP or deemed to have good cause
for disenrollment.
new text end
new text begin
(d) When an IHCP is enrolled in medical assistance as a FQHC but not a participating
provider with the MCO, the IHCP must be paid an amount equal to the amount the MCO
would pay an FQHC within an MCO's network including any supplemental payment from
the commissioner to cover the difference in the amount the MCO paid and the amount the
IHCP FQHC would receive under FFS.
new text end
new text begin
(e) If an IHCP is not enrolled in medical assistance as a FQHC, regardless of an MCO's
participation in an MCO's network, the IHCP has the right to receive the encounter rate
published annually in the Federal Register by the IHS or if not published, the amount the
IHCP would receive if the services were provided under the commissioner's plan's FFS
methodology.
new text end
new text begin
(f) When the amount an ICHP receives from an MCO is less than the encounter rate,
the commissioner must pay a supplemental payment to the IHCP to cover the difference.
new text end
new text begin Subd. 17. new text end
new text begin MCO subcontractual relationships. new text end
new text begin
(a) The commissioner shall ensure that
all managed care organizations maintain ultimate responsibility for adhering to and otherwise
fully complying with all terms and conditions of an MCO's contract with the commissioner.
If an MCO chooses to delegate any of an MCO's responsibilities to a subcontractor, an
MCO must execute a valid contract between the MCO and an MCO's subcontractor. The
contract must be in writing and must specify:
new text end
new text begin
(1) the delegated activities or obligations, and related reporting responsibilities;
new text end
new text begin
(2) the subcontractor must perform the delegated activities and reporting responsibilities
specified, according to the MCO's contract obligations; and
new text end
new text begin
(3) the subcontractor must comply with all applicable Medicaid laws, regulations,
including applicable subregulatory guidance and contract provision.
new text end
new text begin
(b) The contract must either provide for revocation of the delegation of activities or
obligations, or specify other remedies and sanctions if the commissioner or the MCO
determines that the subcontractor failed to perform satisfactorily.
new text end
new text begin
(c) The commissioner, Centers for Medicare and Medicaid, Department of Health and
Human Services inspector general, comptroller general, or a designee has the right to audit,
evaluate, and inspect any books, records, contracts, computer or other electronic systems
of the subcontractor, or the subcontractor's contractor, that pertain to any aspect of services
and activities performed, or determination of amounts payable under the MCO's contract
with the commissioner.
new text end
new text begin
(d) The subcontractor will make available, for purposes of an audit, the subcontractor's
premises, physical facilities, equipment, books, records, contracts, and computer or other
electronic systems relating to the subcontractor's medical assistance enrollees. The right to
audit exists ten years from the final date of the contract or from the date of completion of
any audit, whichever is later.
new text end
new text begin
(e) If the commissioner, Centers for Medicare and Medicaid, or Department of Health
and Human Services inspector general determines that there is a reasonable possibility of
fraud or similar risk, the commissioner, Centers for Medicare and Medicaid, or Department
of Health and Human Services inspector general may inspect, evaluate, and audit the
subcontractor at any time.
new text end
new text begin Subd. 18. new text end
new text begin Information requirements for enrollees and potential enrollees. new text end
new text begin
(a) All
required information to enrollees and potential enrollees must be provided in a manner and
format that is easily understood and readily accessible. The information must be available
through the beneficiary support system, the department's Web site, and may link to individual
MCO Web sites with the required information including, at a minimum, the enrollee
handbook, the provider directory, and drug formulary.
new text end
new text begin
(b) The commissioner must ensure that MCOs provide each enrollee with:
new text end
new text begin
(1) an enrollee handbook, using the model provided by the department, within a
reasonable time after receiving notice of the beneficiary's enrollment. The handbook must
include information on benefits provided, how and where to access benefits, cost sharing,
how transportation is provided, and must, at a minimum, address other information required
by Code of Federal Regulations, title 42, section 438.10(g);
new text end
new text begin
(2) a provider directory that must include the provider's name, group affiliation, street
address, telephone number, Web site, specialty if applicable, whether the provider accepts
new enrollees, the provider's cultural and linguistic capabilities as identified in Code of
Federal Regulations, title 42, section 438.10(h), and whether the provider's office
accommodates people with disabilities. A provider directory must be provided for the
following provider types, physicians, specialists, hospitals, pharmacies, behavioral health
providers, and LTSS providers, as appropriate;
new text end
new text begin
(3) a formulary that includes both generic and name brand medications that are covered
and each medication tier;
new text end
new text begin
(4) written notice of termination of a contracted provider, within 15 calendar days after
receipt or issuance of the termination notice, to each enrollee who received and the enrollee's
primary care from, or was seen on a regular basis by, the terminated provider; and
new text end
new text begin
(5) the MCO's physician incentive plan, upon enrollee request.
new text end
new text begin
(c) The commissioner must provide the following information to each potential enrollee
to ensure an enrollee has sufficient information to make an informed selection on:
new text end
new text begin
(1) basic features of managed care;
new text end
new text begin
(2) whether a populations is excluded from enrollment, subject to mandatory enrollment,
or free to enroll voluntarily. For mandatory and voluntary populations, the length of the
enrollment period and all disenrollment opportunities available to the enrollee;
new text end
new text begin
(3) the service area covered by each MCO;
new text end
new text begin
(4) covered benefits, including benefits provided by the MCO and benefits provided
directly by the commissioner;
new text end
new text begin
(5) the provider directory and drug formulary;
new text end
new text begin
(6) cost sharing;
new text end
new text begin
(7) requirements for adequate access to network services, including network adequacy
standards;
new text end
new text begin
(8) an MCO's responsibility for coordination of enrollee care;
new text end
new text begin
(9) quality and performance indicators, including enrollee satisfaction for each MCO,
if available; and
new text end
new text begin
(10) information about the potential enrollee's right to disenroll according to Code of
Federal Regulations, title 42, section 438.56.
new text end
new text begin
(d) The commissioner and MCO must provide materials electronically to potential
enrollees and enrollees unless the enrollee requests the information in paper form. An
enrollee must be informed that the information is available in paper form without charge
upon request and must be provided within five business days of the request and mailed to
the enrollee's mailing address. Information provided electronically for potential enrollees
and enrollees must:
new text end
new text begin
(1) be readily accessible;
new text end
new text begin
(2) be placed in a prominent location on the commissioner's and MCO's Web site and
in a format that has the capability to be retained and printed;
new text end
new text begin
(3) if provided to the enrollee through e-mail, the MCO receive the enrollee's agreement
before providing the information by e-mail;
new text end
new text begin
(4) satisfy the requirements for content and language requirements according to Code
of Federal Regulations, title 42, section 438.10(d); and
new text end
new text begin
(5) inform the enrollee that the information is available on the Web site and includes
the applicable URL address in order to access the information. An enrollee with a disability
who cannot access the information online is provided auxiliary aids and services upon
request at no cost.
new text end
new text begin Subd. 19. new text end
new text begin Language and accessibility standards. new text end
new text begin
(a) Managed care contracts entered
into under sections 256B.69 and 256L.12 must require MCOs to provide language assistance,
auxiliary aids and services, to ensure meaningful access to an MCO's programs and services,
according to title VI of the Civil Rights Act, section 1557 of the Affordable Care Act, and
any other federal regulations or guidance from the United States Department of Health and
Human Services.
new text end
new text begin
(b) The commissioner must establish a methodology to identify the prevalent non-English
languages spoken by enrollees and potential enrollees throughout Minnesota and in each
MCO's service area.
new text end
new text begin
(c) The commissioner shall ensure that oral interpretation is provided in all languages
and written interpretation is provided in each prevalent non-English language and are
available to both enrollees and potential enrollees free of charge. Oral interpretation services
include the use of auxiliary aids, TTY/TDY, and American sign language.
new text end
new text begin
(d) Written materials that target potential enrollees must include "taglines" in an 18-point
font that explains the availability of interpretation services, and includes the toll-free
telephone number for the department's beneficiary support system.
new text end
new text begin
(e) All written materials, including a provider directory, enrollee handbook, an appeal
and grievance notice, and denial and termination notice, must:
new text end
new text begin
(1) be easily understood;
new text end
new text begin
(2) use at least 12-point font size;
new text end
new text begin
(3) be available in alternative formats and through the provision of auxiliary aids and
services that consider the special needs of the beneficiary, including a beneficiary with a
disability or limited English proficiency;
new text end
new text begin
(4) include taglines in an 18-point font that explains the availability of interpreter services
and how to request auxiliary aids and services, including the provision of the materials in
alternative formats and the TTY/TDY telephone number of the MCO's customer service
unit; and
new text end
new text begin
(5) notify a beneficiary on how to access the oral interpretation services, written
translations, and the auxiliary aids and services.
new text end
new text begin Subd. 20. new text end
new text begin Enrollee communication. new text end
new text begin
(a) The commissioner shall ensure, through contracts
with the MCOs, that the MCOs:
new text end
new text begin
(1) submit all marketing materials to the commissioner for approval before distribution;
new text end
new text begin
(2) distribute marketing materials to an MCO's entire service area and as otherwise
permitted by contract;
new text end
new text begin
(3) comply with the information requirements in Code of Federal Regulations, title 42,
section 438.10;
new text end
new text begin
(4) does not seek to influence enrollment with the sale or offering of any private
insurance;
new text end
new text begin
(5) does not directly, or indirectly, engage in door-to-door, telephone, e-mail, texting,
or other cold-call marketing activities;
new text end
new text begin
(6) marketing materials are accurate, do not mislead, confuse, or defraud a beneficiary
or the department.
new text end
new text begin Subd. 21. new text end
new text begin State monitoring. new text end
new text begin
(a) The commissioner must establish a monitoring system
that addresses all aspects of managed care programs including each MCO's performance
according to Code of Federal Regulations, title 42, section 438.66(b).
new text end
new text begin
(b) The commissioner must use data identified in Code of Federal Regulations, title 45,
section 438.66(c), collected from its monitoring activities to improve the performance of
its managed care program.
new text end
new text begin
(c) The commissioner is responsible to assess the readiness of each MCO with which it
contracts as follows:
new text end
new text begin
(1) before implementing a managed care program, whether an MCO is voluntary or
mandatory; or
new text end
new text begin
(2) if the specific MCO has not previously contracted with the commissioner; or
new text end
new text begin
(3) if an MCO currently contracting with the commissioner provides or arranges for the
provision of covered benefits to new eligibility groups.
new text end
new text begin
(d) The commissioner shall conduct a readiness review of each MCO that contracts with
the commissioner within the timelines and receives the Centers for Medicare and Medicaid
approval of the resulting contract or amendment.
new text end
new text begin
(e) The commissioner's readiness review must assess the areas defined in Code of Federal
Regulations, title 42, section 438.66(d), for the MCO's ability and capacity to perform
satisfactorily in each area.
new text end
new text begin
(f) Annually, no later than 180 days after the contract year, the commissioner must
submit a report on each managed care program administered by the commissioner regardless
of the authority that the program operates under, following the release of the Centers for
Medicare and Medicaid guidance. The report:
new text end
new text begin
(1) must provide assessment of the operation of the managed care program in the areas
identified in Code of Federal Regulations, title 42, section 438.66(e)(2);
new text end
new text begin
(2) may be substituted with the commissioner's obligation to report under the
commissioner's waiver authority for managed care program;
new text end
new text begin
(3) must be posted on the department's Web site;
new text end
new text begin
(4) must be provided to the Medical Care Advisory Committee according to Code of
Federal Regulations, title 42, section 431.12;
new text end
new text begin
(5) must be provided to the stakeholder consultation group according to Code of Federal
Regulations, section 438.70, to the extent the managed care program includes LTSS.
new text end
new text begin
(g) The commissioner must have in effect safeguards against conflict of interest on
behalf of state and local officers and employees and agents of the state who have
responsibilities relating to MCO contracts. The safeguards must be at least as effective as
the safeguards specified in section 27 of the Office of Federal Procurement Policy Act,
United States Code, title 41, section 423. The commissioner must comply with Code of
Federal Regulations, title 42, section 438.58, and section 1902(a)(4)(c) of the Social Security
Act applicable to contracting officers, employees, or independent contractors
new text end
new text begin Subd. 22. new text end
new text begin Enrollee rights and protections. new text end
new text begin
(a) The commissioner shall ensure that each
MCO, an MCO's employees, and contracted providers comply with applicable federal and
state laws that pertain to an enrollee's rights and that each MCO's employees and contracted
providers:
new text end
new text begin
(1) receive information according to Code of Federal Regulations, title 42, section 438.10;
new text end
new text begin
(2) be treated with respect and with due consideration for the enrollee's dignity and
privacy;
new text end
new text begin
(3) receive information on available treatment options and alternatives, presented in a
manner appropriate to the beneficiary's condition and ability to understand;
new text end
new text begin
(4) participate in decisions regarding the enrollee's health care, including the right to
refuse treatment;
new text end
new text begin
(5) be free from any form of restraint or seclusion used as a means of coercion, discipline,
convenience, or retaliation, as specified in other federal regulations on the use of restraints
and seclusion;
new text end
new text begin
(6) receive a copy of the enrollee's medical records, and request that the records be
corrected, according to Code of Federal Regulations, title 45, sections 164.524 and 164.526;
new text end
new text begin
(7) receive health care services according to Code of Federal Regulations, title 42,
sections 438.206 to 438.210.
new text end
new text begin
(b) The commissioner shall ensure that each enrollee is free to exercise the enrollee's
rights, and that the exercise of the enrollee's rights does not adversely affect the way the
MCO, the MCO's network providers, or the state Medicaid agency treats the enrollee.
new text end
new text begin
(c) The commissioner shall ensure that the MCO complies with all federal and state
antidiscrimination laws and regulations. An MCO that contracts with the commissioner
cannot discriminate or use any policy that has the effect of discriminating against people
on the basis of medical condition, health status, receipt of health care services, claims
experience, medical history, genetic information, disability, including mental or physical
impairment, marital status, age, race, color, religion, creed, national origin, sex, including
sex stereotypes and gender identity, sexual orientation, political beliefs, or public assistance
status.
new text end
new text begin
(d) The commissioner must ensure, through contracts with the MCO, that for medical
records and any other health and enrollment information that identifies a particular enrollee,
each MCO uses and discloses individually identifiable health information according to the
privacy requirements in Code of Federal Regulations, title 45, parts 160 and 164, subparts
A and E, to the extent that these requirements are applicable.
new text end
new text begin Subd. 23. new text end
new text begin Liability for payment. new text end
new text begin
(a) The commissioner shall require that the MCO
ensure the enrollee is held harmless of payment liability for covered services provided to
the enrollee, if:
new text end
new text begin
(1) MCO debt in the event of insolvency;
new text end
new text begin
(2) lack of payment to the MCO;
new text end
new text begin
(3) lack of payment to the provider by the MCO or the commissioner for services
furnished under a contract, referral, or other arrangement; or
new text end
new text begin
(4) payments for services covered under the contract, referral, or other arrangement, to
the extent that those payments are in excess of the amount that the enrollee would owe if
the MCO covered the services directly.
new text end
new text begin
(b) An MCO may limit any reimbursement an MCO may be required to pay to a provider
for services to a beneficiary not enrolled in the MCO.
new text end
new text begin
(c) An MCO must comply with the standards for claims settlement under section 72A.201,
subdivisions 4, 5, 7, and 8, if contracting with other health care and social service
practitioners to provide services to enrollees. An MCO must pay a clean claim, as defined
in Code of Federal Regulations, title 42, section 447.45(b), within 30 business days of the
date of acceptance of the claim.
new text end
new text begin Subd. 24. new text end
new text begin Cost sharing. new text end
new text begin
(a) The commissioner may impose cost sharing according to
Code of Federal Regulations, title 42, sections 447.50 through 447.57, and may set limits
or waive the cost sharing for specific population groups.
new text end
new text begin
(b) The commissioner must exempt from cost sharing an American Indian who receives
or has received an item or service furnished by Indian Health Services 638 facilities, IHCP,
or through referral under contract health services according to Code of Federal Regulations,
title 42, section 447.56(a)(1)(x).
new text end
new text begin Subd. 25. new text end
new text begin Provider enrollee communications. new text end
new text begin
(a) The commissioner shall ensure the
managed care organizations do not prohibit, or otherwise restrict, an MCO provider, who
is acting within the lawful scope of the provider's practice, from advising or advocating on
behalf of the enrollee regarding:
new text end
new text begin
(1) the enrollee's health status, medical care, or treatment options, including any
alternative treatment that may be self-administered;
new text end
new text begin
(2) any information the enrollee needs to decide among all relevant treatment options;
new text end
new text begin
(3) the risks, benefits, and consequences of treatment or nontreatment; or
new text end
new text begin
(4) the enrollee's right to participate in decisions regarding the enrollee's health care,
including the right to refuse treatment, and to express preferences about future treatment
decisions.
new text end
new text begin
(b) The commissioner must ensure that the MCO inform enrollees of how and where to
obtain any services excluded by MCOs on the basis of moral or religious grounds. The
enrollee notification must satisfy the requirements in Code of Federal Regulations, title 42,
section 438.102(b).
new text end
new text begin Subd. 26. new text end
new text begin Stakeholder and enrollee engagement. new text end
new text begin
(a) The commissioner shall establish
a stakeholder group to solicit the views of beneficiaries, individuals representing
beneficiaries, providers, and other stakeholders to provide advice on managed care programs
for persons using LTSS. The stakeholder group shall provide advice on:
new text end
new text begin
(1) design and implementation efforts;
new text end
new text begin
(2) consumer protections; and
new text end
new text begin
(3) oversight of the LTSS program, including quality assurance measures, data collection
and reporting, and evaluation of costs, quality, and results.
new text end
new text begin
(b) Each MCO under contract shall establish and maintain an enrollee advisory committee
that includes a representative sample of the LTSS population and other individuals
representing this population.
new text end
new text begin Subd. 27. new text end
new text begin Covered services. new text end
new text begin
(a) The commissioner must ensure that all services covered
under the state plan are available and accessible to each enrollee of the MCOs. The MCO
shall authorize and arrange for the provision of all medically necessary health services, and
unless otherwise specified by law or contract, the MCO is exempt from the commissioner's
authorization requirements.
new text end
new text begin
(b) An MCO's provider network must meet the standards developed by the commissioner
according to Code of Federal Regulations, title 42, section 438.68, and an MCO must meet
the following requirements:
new text end
new text begin
(1) maintain and monitor a network of appropriate providers that are supported by written
agreements and sufficient to provide adequate access to all services covered under the
contract for each enrollee;
new text end
new text begin
(2) provide female enrollees with direct access to a women's health specialist that provides
women's routine and preventive health services. This is in addition to the enrollee's designated
source of primary care if that source is not a women's health specialist;
new text end
new text begin
(3) provide for a second medical opinion from a network provider unless otherwise not
available within the network or required by state law, at no cost to the enrollee;
new text end
new text begin
(4) adequately and timely provide covered services for an enrollee out of network for
as long as the MCO provider network is unable to provide them;
new text end
new text begin
(5) require an out-of-network provider coordinate with the MCO for payment and ensure
that the cost to the enrollee is no greater than the cost would be if the services were furnished
within the MCO's network;
new text end
new text begin
(6) provide to the commissioner the MCO's documented process for credentialing and
recredentialing of the MCO's network providers according to Code of Federal Regulations,
title 42, section 438.206(b)(6); and
new text end
new text begin
(7) ensure that the MCO's network includes sufficient family planning providers for
timely access to covered services.
new text end
new text begin
(c) The commissioner shall ensure through contracts that the managed care organization
is responsible for payment of emergency and post stabilization services. The MCO must
cover and pay for emergency services regardless of whether the provider is within the
managed care organizations network.
new text end
new text begin
(d) The MCO may not deny payment for treatment obtained:
new text end
new text begin
(1) by an enrollee with an emergency medical condition as defined in subdivision 2; or
new text end
new text begin
(2) by an enrollee who was instructed to seek emergency services by a representative
of the MCO.
new text end
new text begin
The MCO may not limit what constitutes an emergency medical condition on the basis of
lists of diagnoses or symptoms or refuse to cover emergency services based on the emergency
room provider, hospital, or fiscal agent not notifying the MCO of the enrollee's screening
and treatment within ten calendar days of presentation for emergency services.
new text end
new text begin
(e) An enrollee who has an emergency medical condition must not be held liable for
payment of subsequent screening and treatment needed to diagnose the specific condition
or stabilize the enrollee.
new text end
new text begin
(f) The attending emergency physician, or provider treating the enrollee, is responsible
for determining when the enrollee is sufficiently stabilized for transfer or discharge, and
that determination is binding on the MCO for coverage and payment. Post stabilization care
services are covered and paid for by the MCO in accordance with the provisions in Code
of Federal Regulations, title 42, section 422.113(c).
new text end
new text begin
(g) The commissioner must have methods to promote access and delivery of services in
a culturally competent manner to each beneficiary, including a beneficiary with limited
English proficiency, diverse cultural and ethnic background, disability, and regardless of
gender, sexual orientation, or gender identity. The commissioner must ensure a beneficiary
has access to covered services that are delivered in a manner that meets the beneficiary's
needs.
new text end
new text begin
(h) The commissioner must ensure, through contracts, that each MCO meets the standards
for timely access, cultural competency, and accessibility according to Code of Federal
Regulations, title 42, section 438.206(c).
new text end
new text begin Subd. 28. new text end
new text begin Adequate capacity and services assurances. new text end
new text begin
(a) The MCO must provide
supporting documentation that an MCO has the capacity to serve the expected enrollment
in an MCO's service area according to Code of Federal Regulations, title 42, section
438.207(c), and ensure the commissioner that the MCO:
new text end
new text begin
(1) offers an appropriate range of preventive, primary care, specialty services, and LTSS;
and
new text end
new text begin
(2) maintains a network of providers that is sufficient in number, mix, and geographic
distribution.
new text end
new text begin
(b) After reviewing the MCO's submitted documentation the commissioner must submit
an assurance of compliance to the Centers for Medicare and Medicaid that the MCO meets
the requirements for availability of services according to Code of Federal Regulations, title
42, sections 438.68 and 438.206. The submission to the Centers for Medicare and Medicaid
must include an analysis that supports the assurance of the adequacy of the network for
each contracted MCO's provider network. The Centers for Medicare and Medicaid may
request all documentation collected by the commissioner from the MCO.
new text end
new text begin Subd. 29. new text end
new text begin Coordination of services and continuity of care. new text end
new text begin
(a) For each MCO that
serves an enrollee who is also enrolled in and receives Medicare benefits from a Medicare
advantage organization, the commissioner shall determine to what extent the MCO meets
the identification, assessment, and treatment planning provisions in this section for a dually
eligible enrollee.
new text end
new text begin
(b) The MCO must implement procedures to deliver care to and coordinate services for
each MCO enrollee, including the following:
new text end
new text begin
(1) an ongoing source of care appropriate to the enrollee's needs and a person or entity
formally designated as primarily responsible for coordinating the services;
new text end
new text begin
(2) coordination of the services the MCO furnishes to the enrollee between settings of
care, including appropriate discharge planning for short-term and long-term hospital and
institutional stays;
new text end
new text begin
(3) coordination with any covered services the enrollee receives through a different
managed care organization or on a fee-for-service basis; and
new text end
new text begin
(4) coordination with the services the enrollee receives from community and social
support providers.
new text end
new text begin
(c) The MCO must make a best effort to conduct an initial screening within 90 days of
enrollment for each enrollee.
new text end
new text begin
(d) The MCO must share with the commissioner or another MCO serving the enrollee
the results of any identification and assessment of the enrollee's needs to prevent duplicating
activities.
new text end
new text begin
(e) The MCO shall ensure that each provider furnishing services to an enrollee maintains
and shares an enrollee health record and in the process of coordinating care protecting each
enrollee's privacy according to Code of Federal Regulations, title 45, parts 160 and 164.
new text end
new text begin Subd. 30. new text end
new text begin
Additional services for enrollees with special health care needs or who
need LTSS.
new text end
new text begin
(a) The commissioner, or the commissioner's designee, must implement
mechanisms to identify persons who need LTSS or persons with special health care needs
to MCOs. The mechanisms must be identified in the commissioner's quality strategy.
new text end
new text begin
(b) The MCO must implement mechanisms to assess each identified enrollee needing
LTSS or having special health care needs that require a course of treatment or regular care
monitoring using appropriate providers or individuals for the assessment.
new text end
new text begin
(c) The MCO must produce a treatment or service plan for an enrollee who requires
LTSS and, if the commissioner requires, for an enrollee with special health care needs. The
treatment or service plan must:
new text end
new text begin
(1) be developed by an appropriate individual of LTSS services, with enrollee
participation, and with each provider caring for the enrollee;
new text end
new text begin
(2) be developed by a person trained in person-centered planning using a person-centered
process and plan as defined in Code of Federal Regulations, title 42, section 441.301(c)(1)
and (2);
new text end
new text begin
(3) be approved by the MCO, in a timely manner, if approval is required by the MCO;
new text end
new text begin
(4) comply with any applicable state quality assurance and utilization review standards;
and
new text end
new text begin
(5) be reviewed and revised upon reassessment of functional need, at least annually, or
if the enrollee's circumstances or needs change significantly, or at the request of the enrollee
according to Code of Federal Regulations, title 42, section 441.301(c)(3).
new text end
new text begin
(d) The MCO must have a mechanism to allow an enrollee with special health care needs
to directly access a specialist, through a standing referral or approved number of visits, as
appropriate for the enrollee's condition and identified needs.
new text end
new text begin Subd. 31. new text end
new text begin Coverage and authorization of services. new text end
new text begin
(a) The commissioner must ensure
that all contracts with the MCOs identify, define, and specify the amount, duration, and
scope of each covered service and are furnished in an amount, duration, and scope that is
no less than what is provided under FFS Medicaid.
new text end
new text begin
(b) The MCO must ensure that the covered services are sufficient in amount, duration,
or scope to reasonably achieve the purpose for the services and must not arbitrarily deny
or reduce the amount, duration, or scope solely because of diagnosis, type of illness, or
condition of the enrollee.
new text end
new text begin
(c) The commissioner shall permit the MCO to limit a service based on criteria applied
under the state plan, including but not limited to medical necessity or utilization control if
the service meets the criteria in Code of Federal Regulations, title 42, section 438.210(a)(4).
new text end
new text begin
(d) The commissioner shall identify in the MCO contract what constitutes medically
necessary services that:
new text end
new text begin
(1) are no more restrictive than those used in medical assistance, including quantitative
and nonquantitative treatment limits, as indicated in state statutes and regulations, the state
plan, or other state policies and procedures;
new text end
new text begin
(2) address the extent to which the MCO is responsible for covering services that address
the criteria in Code of Federal Regulations, title 42, section 438.210(a)(5)(ii).
new text end
new text begin
(e) The commissioner must ensure the MCO contract requires the MCO and an MCO's
subcontractors to have and follow written policies and procedures on processing requests
for initial and continuing authorization of services. The MCO must:
new text end
new text begin
(1) ensure consistent application of review criteria for authorization decisions;
new text end
new text begin
(2) consult with the requesting provider for medical services, if appropriate;
new text end
new text begin
(3) authorize LTSS based on an enrollee's current needs assessment and consistent with
the person-centered service plan; and
new text end
new text begin
(4) notify the requesting provider and the enrollee of any decision of the MCO to deny
a service authorization or to authorize the service in an amount, duration, or scope that is
less than requested.
new text end
new text begin
(f) Any decision to deny a service authorization request or to authorize a service in an
amount, duration, or scope that is less than requested, by an individual who has appropriate
expertise in addressing the enrollee's medical behavioral health or long-term services and
support needs.
new text end
new text begin
(g) The MCO contract must include time frames for standard authorizations that are ten
business days following the receipt of the request and no later than 72 hours of a receipt for
an expedited authorization. For both standard and expedited authorizations the MCO may
extend the time frame 14 additional calendar days, if the enrollee or a provider requests an
extension. Upon a request from the commissioner the MCO must justify the need for
additional information and how the extension is in the enrollee's best interest.
new text end
new text begin
(h) For all covered outpatient drug authorization decisions, provide notice within 24
hours of a request according to section 1927(d)(5)(A) of the Social Security Act.
new text end
new text begin
(i) The contract must ensure that compensation to an individual or entity that conducts
utilization management activities is not structured to provide incentives for the individual
or entity to deny, limit, or discontinue medically necessary services to an enrollee.
new text end
new text begin
(j) The commissioner shall require that managed care organizations use the assessment
and authorization processes, forms, timelines, standards, documentation, and data reporting
requirements, protocols, billing processes, and policies consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements consistent with
medical assistance fee-for-service or the Department of Human Services contract
requirements for all personal care assistance services under section 256B.0659.
new text end
new text begin Subd. 32. new text end
new text begin Prescription drugs. new text end
new text begin
The commissioner may exclude or modify coverage for
prescription drugs from the prepaid managed care contracts entered into under this section
to increase savings to the commissioner by collecting additional prescription drug rebates.
The contracts must maintain incentives for the managed care plan to manage drug costs and
utilization and may require that the managed care plans maintain an open drug formulary.
To manage drug costs and utilization, a contract must authorize the managed care
organizations to use preferred drug lists and prior authorization. This subdivision is contingent
on federal approval of the managed care contract changes and the collection of additional
prescription drug rebates. A contracted MCO must comply with the standards in section
1927 of the Social Security Act.
new text end
new text begin Subd. 33. new text end
new text begin Additional and in lieu of services. new text end
new text begin
(a) An MCO may choose to provide
services in addition to services required under the terms of the contract. If an MCO chooses
to provide an enrollee eligible for medical assistance with additional services, the cost of
the additional services cannot be included in determining the capitated payment rate.
new text end
new text begin
(b) An MCO may provide any service necessary to comply with the Mental Health Parity
Act, Code of Federal Regulations, title 42, section 438.910.
new text end
new text begin
(c) An MCO may cover services or settings that are in lieu of services and settings
covered under the state plan as follows:
new text end
new text begin
(1) medically appropriate and cost-effective substitute for the covered service or setting
under the state plan;
new text end
new text begin
(2) the enrollee is not required by the MCO to use the alternative service or setting;
new text end
new text begin
(3) authorized and identified in the MCO contract and must be offered to enrollees at
the option of the MCO; and
new text end
new text begin
(4) the utilization and actual cost of the in lieu of service is considered in developing
the component of the capitation rates that represents the covered date plan service.
new text end
new text begin Subd. 34. new text end
new text begin
Prohibition of additional payments for services covered under the MCO
contract.
new text end
new text begin
The commissioner must ensure that no payment is made to a network provider
other than by the MCO for services covered under the MCO's contract with the commissioner,
except when payments by the commissioner are required to be made according to title XIX
of the Social Security Act, or if the commissioner makes direct payments to network
providers for graduate medical education costs approved under the state plan.
new text end
new text begin Subd. 35. new text end
new text begin Quality assessment and performance improvement program. new text end
new text begin
(a) The
commissioner must require the managed care organizations to establish and implement an
ongoing comprehensive quality assessment and performance improvement program for the
services furnished to medical assistance enrollees according to Code of Federal Regulations,
title 42, section 438.330(b).
new text end
new text begin
(b) The commissioner shall ensure that the MCO conduct performance improvement
projects that focus on both clinical and nonclinical measures, designed to achieve significant
improvement, sustained over time, in health outcomes and enrollee satisfaction and must
meet the elements in Code of Federal Regulations, title 42, section 438.330(d)(2).
new text end
new text begin
(c) The commissioner may permit an MCO exclusively serving dual eligible enrollees
to substitute a Medicare Advantage organization quality improvement project for one or
more of the required performance improvement projects.
new text end
new text begin
(d) The commissioner, or the Centers for Medicare and Medicaid, may identify standard
performance measures including measures relating to quality of life, rebalancing, and
community integration activities for enrollees receiving long term services and supports.
new text end
new text begin
(e) The MCOs must annually measure and report on the MCO's performance using the
standard measures as required by the commissioner and submit the data to the commissioner
to calculate the MCO's performance.
new text end
new text begin
(f) The commissioner shall review annually the impact and the effectiveness of the
quality assessment and performance improvement program of each MCO, outcomes and
trended results of the MCO performance improvement projects, and identify the results of
any efforts to support community integration for an enrollee using LTSS.
new text end
new text begin
(g) The commissioner shall ensure, through contracts with MCOs, that each MCO adopt
practice guidelines that satisfy Code of Federal Regulations, title 42, section 438.236(b),
and disseminate the guidelines to each affected provider and upon request, to an enrollee
or potential enrollee.
new text end
new text begin Subd. 36. new text end
new text begin MCO health information system. new text end
new text begin
(a) The commissioner shall ensure the
MCOs maintain a health information system that collects, analyzes, integrates, and reports
data. The systems must provide information on areas including but not limited to utilizations,
claims, grievances and appeals, and enrollments and disenrollments.
new text end
new text begin
(b) The commissioner shall require each MCO to collect data elements necessary to
enable the mechanized claims processing retrieval systems operated by the commissioner
according to section 1903(r)(1)(f) of the Social Security Act.
new text end
new text begin
(c) Collect data on enrollee and provider characteristics and on all services furnished to
enrollees through an encounter data system or other methods as specified by the
commissioner. The MCO must ensure that data received from a provider is accurate and
complete, verifying the accuracy and timeliness of the reported data and screening the data
for completeness, logic, and consistency.
new text end
new text begin
(d) Collecting data from a provider in a standardized format to the extent feasible and
appropriate, including secure information exchanges and technologies utilized for medical
assistance quality improvement and care coordination efforts.
new text end
new text begin
(e) Make all collected data available to the commissioner and upon request to the Centers
for Medicare and Medicaid.
new text end
new text begin
(f) The commissioner must ensure through contract with MCOs that an MCO provides
for:
new text end
new text begin
(1) collection and maintenance of sufficient enrollee encounter data to identify the
provider who delivers any items or services to enrollees;
new text end
new text begin
(2) submission of enrollee encounter data to the commissioner at a frequency and level
of detail to be specified by the Centers for Medicare and Medicaid and the commissioner,
based on program administration, oversight, and program integrity needs;
new text end
new text begin
(3) submission of all enrollee encounter data to the commissioner that satisfies Code of
Federal Regulations, title 42, section 438.818. Federal financial participation is available
if the commissioner meets the requirements for providing enrollee encounter data to the
Centers for Medicare and Medicaid.
new text end
new text begin
(4) specifications for submitting encounter data to the commissioner in standardized
ASC X12 N837 and NCPDP formats, and the ASC X12 N8355 format.
new text end
new text begin
(g) The commissioner must establish procedures and quality assurance protocols to
review and validate the encounter data collected, maintained, and submitted to the
commissioner, and is a complete and accurate representation of the services provided to
enrollees under the contract between the commissioner and MCO.
new text end
new text begin Subd. 37. new text end
new text begin Accreditation status of MCOs. new text end
new text begin
(a) Each MCO shall notify the commissioner
whether the MCO was accredited by a private independent accrediting entity. The MCO
must authorize the accrediting entity to provide the commissioner with a copy of the MCO's
most recent accreditation review. The accreditation review must include:
new text end
new text begin
(1) the accreditation status, survey type, and level, if applicable;
new text end
new text begin
(2) accreditation results, including recommended actions or improvements, corrective
action plans, and summaries of findings; and
new text end
new text begin
(3) the expiration date of the accreditation.
new text end
new text begin
(b) Annually, the commissioner must make available on the department's Web site
whether an MCO was accredited, and if applicable, the name of the accrediting entity,
accreditation program, and accreditation level.
new text end
new text begin Subd. 38. new text end
new text begin Quality rating system. new text end
new text begin
(a) The commissioner shall adopt and implement a
Medicaid managed care quality rating system developed by the Centers for Medicare and
Medicaid within three years of the date of a final notice being published in the Federal
Register. The commissioner may submit a request to the Centers for Medicare and Medicaid
to use an alternative Medicaid managed care quality rating system that utilizes different
performance measures or applies a different methodology from that published in the Federal
Register provided that:
new text end
new text begin
(1) the ratings generated by the alternative Medicaid managed care quality rating system
must yield information regarding the MCO performance that is substantially comparable
to the information yielded by the Centers for Medicare and Medicaid system published in
the Federal Register; and
new text end
new text begin
(2) the commissioner receives the Centers for Medicare and Medicaid approval, before
implementing, the quality rating system or modifications.
new text end
new text begin
(b) Before submitting for the Centers for Medicare and Medicaid approval, the
commissioner:
new text end
new text begin
(1) must obtain input from the Medical Care Advisory Committee; and
new text end
new text begin
(2) provide an opportunity for public comment of at least 30 days on the proposed
alternative Medicaid managed care quality rating system or modification; and
new text end
new text begin
(3) must document in the commissioner's request for approval comments received from
the public and the Medical Care Advisory Committee and explain any revisions made in
response to comments and rationale for comments not accepted.
new text end
new text begin
(c) Once the quality rating system has been implemented, each year the commissioner
must collect data from each MCO and issue an annual quality rating for each MCO based
on the data collected, using the quality rating system that was adopted. Annually, the
commissioner must prominently display the quality rating given by the commissioner to
each MCO on the department's Web site.
new text end
new text begin Subd. 39. new text end
new text begin State-managed care quality strategy. new text end
new text begin
(a) The commissioner must draft and
implement a written quality strategy for accessing and improving the quality of health care
and services provided by the MCOs. At a minimum, the quality strategy must include the
following:
new text end
new text begin
(1) the commissioner's defined network adequacy and availability of services standards
for MCOs and examples of evidence-based clinical practice guidelines;
new text end
new text begin
(2) the goals and objectives for continuous quality improvement that are measurable
and consider the health status of all populations in Minnesota served by the MCO;
new text end
new text begin
(3) a description of:
new text end
new text begin
(i) the quality metrics and performance targets used in measuring the performance and
improvement of each MCO;
new text end
new text begin
(ii) the quality measures and performance outcomes that must be annually published on
the department's Web site; and
new text end
new text begin
(iii) the performance improvement projects including a description of any interventions
the commissioner proposes to improve access, quality, or timeliness of care for enrollees;
new text end
new text begin
(4) annual, external independent reviews, of the quality outcomes and timelines of, and
access to, the services covered by an MCO;
new text end
new text begin
(5) a description of the transition of care policy;
new text end
new text begin
(6) the commissioner's plan to identify, evaluate, and reduce, to the extent practicable,
health disparities based on age, race, ethnicity, sex, primary language, and disability status,
and must provide this demographic information to the MCO at the time of enrollment;
new text end
new text begin
(7) appropriate use of intermediate sanctions imposed on a managed care organization;
new text end
new text begin
(8) the mechanisms implemented to identify persons who need LTSS or persons with
special health care needs; and
new text end
new text begin
(9) information related to nonduplication of the external quality review activities found
in Code of Federal Regulations, title 42, section 438.360(c).
new text end
new text begin
(b) In drafting or revising the quality strategy, the commissioner must:
new text end
new text begin
(1) make the strategy available for public comment before submitting to the Centers for
Medicare and Medicaid for review;
new text end
new text begin
(2) obtain input from the Medical Care Advisory Committee, beneficiaries, and other
stakeholders; and
new text end
new text begin
(3) if an Indian enrolls in the MCO, consult with the tribes according to the tribal
consultation policy;
new text end
new text begin
(4) review and update the quality strategy as needed, but no less than once every three
years;
new text end
new text begin
(5) evaluate the effectiveness of the quality strategy conducted within the previous three
years;
new text end
new text begin
(6) make the results of the review available on the department's Web site;
new text end
new text begin
(7) must consider the recommendations from the External Quality Review Organization
for improving the quality of health care services furnished by the MCO;
new text end
new text begin
(8) submit a copy of the initial strategy to the Centers for Medicare and Medicaid for
comment and feedback before adopting the initial strategy as final;
new text end
new text begin
(9) a copy of the revised strategy whenever significant changes are made; and
new text end
new text begin
(10) make the final quality strategy available on the department's Web site.
new text end
new text begin Subd. 40. new text end
new text begin External quality reviews. new text end
new text begin
(a) The commissioner shall ensure that an annual
external quality review (EQR) is conducted of each managed care organization by an external
quality review organization (EQRO) that satisfies Code of Federal Regulations, title 42,
section 438.354.
new text end
new text begin
(1) The commissioner must contract with one EQRO to conduct the EQR and may
contract with the same EQRO or other EQROs to perform other EQR-related activities. The
information provided to the EQRO for the EQRO's review is obtained according to Code
of Federal Regulations, title 42, section 438.352.
new text end
new text begin
(2) The EQRO is permitted to use subcontractors that must meet the requirements for
independence, but the EQRO is accountable for and must oversee all subcontractor functions.
new text end
new text begin
(3) The commissioner must follow an open, competitive procurement process according
to state and federal law for any contract with an EQRO.
new text end
new text begin
(b) The commissioner, the commissioner's agent, or an EQRO may perform the mandatory
and optional EQR activities. The following mandatory EQR-related activities must be
performed for each MCO:
new text end
new text begin
(1) using the preceding 12 months, validation of performance improvement projects,
performance measures, and network adequacy, including compliance with a sufficient
number of IHCPs that ensure timely access to services from these providers, if Indians are
enrolled; and
new text end
new text begin
(2) review of the MCO's compliance with Code of Federal Regulations, title 42, Subpart
D and section 438.330 for the preceding three years.
new text end
new text begin
(c) The commissioner may elect to incorporate any optional activity listed in Code of
Federal Regulations, title 42, section 438.358(c) in the EQR. The commissioner may grant
the EQRO permission to provide technical assistance to the MCOs related to the mandatory
and optional activities included in the EQR.
new text end
new text begin
(e) The commissioner may use information from a Medicare or private accreditation
review of an MCO to provide information for the annual EQR instead of conducting one
or more of the mandatory EQR activities to avoid duplication. This information must satisfy
Code of Federal Regulations, title 42, section 438.360(a)(1) to (3), to meet the nonduplication
standard.
new text end
new text begin
(f) The commissioner must ensure that all information is furnished to the EQRO for
analysis and inclusion in the EQR technical report.
new text end
new text begin
(g) The commissioner may accept the data, correspondence, information, and findings
pertaining to the MCO's compliance with a Medicare quality review if the conditions in
Code of Federal Regulations, title 42, section 438.362, are met in lieu of performing an
EQR.
new text end
new text begin
(h) The commissioner must obtain from each MCO that the commissioner exempts from
EQR the most recent Medicare review findings or Medicare information from a private
national accrediting organization that the Centers for Medicare and Medicaid approves and
recognizes for Medicare Advantage Organization deeming.
new text end
new text begin
(i) The commissioner must contract with a qualified EQRO to produce an annual EQR
technical report that satisfies Code of Federal Regulations, title 42, section 438.364. The
content of the final EQR report may be revised if there is evidence of error or omission.
The commissioner must post the final technical report to the department's Web site by April
30 of each year. The technical report must summarize findings on access and quality of care
and must make copies of the information available upon request and available in alternative
formats. Information in the report may not disclose the identity or other protected health
information of any enrollee.
new text end
new text begin Subd. 41. new text end
new text begin Appeals and grievance system. new text end
new text begin
(a) Each MCO must have a grievance and
appeals system for enrollees. An enrollee may file a grievance and request an appeal with
the MCO. The MCO may only offer one level of appeal to enrollees. An enrollee may
request a state fair hearing only after receiving written notice of resolution on the enrollee's
appeal from the MCO, or after the enrollee was deemed to have exhausted the MCO's
appeals process, meaning the MCO has failed to adhere to the notice and timing requirements.
An enrollee is not allowed to request a state fair hearing based on the MCO's resolution of
a grievance.
new text end
new text begin
(b) With the enrollee's written consent, the provider or authorized representative may
file an appeal or grievance or request a state fair hearing on behalf of an enrollee. When the
term enrollee is used throughout Code of Federal Regulations, title 42, sections 438.400 to
438.424, it includes providers and authorized representatives with the exception that providers
cannot request continuation of benefits.
new text end
new text begin
(c) The commissioner may offer and arrange for an external medical review if the review:
new text end
new text begin
(1) is at the enrollee's option and the review must not be required before or used as a
deterrent to proceed to a state fair hearing;
new text end
new text begin
(2) is independent of the department and MCO;
new text end
new text begin
(3) is offered to the enrollee at no cost to the enrollee; and
new text end
new text begin
(4) does not extend any time frame for resolution and does not disrupt the continuation
of benefits.
new text end
new text begin
(d) An enrollee may file a grievance at any time either orally or in writing with the MCO.
new text end
new text begin
(e) An enrollee must file an appeal with the MCO within 60 calendar days from the date
on the adverse benefit determination notice. An enrollee may file an appeal with the MCO
orally or in writing. Unless the enrollee requested an expedited appeal, the enrollee must
follow an oral appeal with a written, signed appeal.
new text end
new text begin Subd. 42. new text end
new text begin Timely and adequate notice of adverse benefit determination. new text end
new text begin
(a) An MCO
must give enrollees timely and adequate notice of an adverse benefit determination in writing
consistent this section and Code of Federal Regulations, title 42, section 438.10.
new text end
new text begin
(b) The adverse benefit determination notice must contain the following:
new text end
new text begin
(1) the adverse benefit determination the MCO made or intends to make;
new text end
new text begin
(2) the reasons for the adverse benefit determination, including but not limited to medical
necessity criteria. An enrollee may request, free of charge, reasonable access to and copies
of all documents and records relevant to the enrollee's adverse benefit determination;
new text end
new text begin
(3) the enrollee's right to request an appeal of the MCO's adverse benefit determination,
including information about exhausting the MCO's one level of appeal and the enrollee's
right to request a state fair hearing;
new text end
new text begin
(4) the procedures for exercising the rights specified in this section;
new text end
new text begin
(5) a description of when an appeal can be expedited and how to request an expedited
appeal; and
new text end
new text begin
(6) the enrollee's right to have benefits continue pending resolution of the appeal, how
to request continued benefits, and the circumstances under which the enrollee may be
required to pay for the cost of continued benefits.
new text end
new text begin
(c) The MCO must mail the notice of adverse benefit determination to the enrollee or
the enrollee's authorized representative according to the following:
new text end
new text begin
(1) termination, suspension, or reduction of previously authorized covered services, the
notice of adverse benefit determination must be mailed at least ten days before the proposed
date of termination, suspension, or reduction, unless the MCO satisfies an exception in Code
of Federal Regulations, title 42, section 431.213;
new text end
new text begin
(2) denial of payment, at the time of any action affecting the claim; and
new text end
new text begin
(3) a standard service authorization decision that denies or limits services, within ten
calendar days from the date the MCO receives the enrollee's request for the service.
new text end
new text begin
(d) If the MCO extends the time frame 14 calendar days, the MCO must:
new text end
new text begin
(1) provide the enrollee written notice of the reason for the decision to extend the time
frame and inform the enrollee of the right to file a grievance if the enrollee disagrees with
the decision; and
new text end
new text begin
(2) issue and carry out the determination as expeditiously as the enrollee's health condition
requires and no later than the date the extension expires.
new text end
new text begin
(e) A service authorization decision not made within the required time frame, constitutes
a denial and is an adverse benefit determination by the MCO. For expedited service
authorization decisions within 72 hours from the time of the request.
new text end
new text begin
(f) The commissioner must conduct random reviews of each MCO and the MCO's
providers or subcontractors delegated for the responsibility of sending the notice of adverse
benefit determination to ensure that the MCOs are notifying enrollees in a timely manner.
new text end
new text begin Subd. 43. new text end
new text begin Handling of grievances and appeals. new text end
new text begin
(a) The MCO must give an enrollee
reasonable assistance for filing a grievance or an appeal, including assistance completing
required forms and other required procedural steps. The MCO must provide auxiliary aids
and services upon request, including interpreter services and toll-free TTY/TTD, and
interpreter capability.
new text end
new text begin
(b) The MCO must acknowledge the receipt of each grievance and appeal.
new text end
new text begin
(c) The MCO must ensure that the individuals who make decisions on grievances and
appeals are individuals:
new text end
new text begin
(1) who were neither involved in any previous level of review or decision-making nor
a subordinate of any such individual;
new text end
new text begin
(2) who have the appropriate clinical expertise in treating the enrollee's condition or
disease if deciding:
new text end
new text begin
(i) an appeal of a denial that is based on lack of medical necessity;
new text end
new text begin
(ii) a grievance regarding denial of expedited resolution of an appeal; or
new text end
new text begin
(iii) a grievance or appeal that involves clinical issues; and
new text end
new text begin
(3) who consider all comments, documents, records, and other information submitted
by the enrollee or the enrollee's representative without regard to whether the information
was submitted or considered in the initial adverse benefit determination.
new text end
new text begin
(d) The MCO must provide that oral inquiries seeking to appeal an adverse benefit
determination are treated as appeals to establish the earliest possible filing date for the
appeal.
new text end
new text begin
(e) The MCO must provide the enrollee with a reasonable opportunity, in person and in
writing, to present evidence and testimony and make legal and factual arguments. The MCO
must provide the enrollee sufficient notice of the time frame for resolution for appeals,
including expedited appeals.
new text end
new text begin
(f) The MCO must provide the enrollee and the enrollee's representative with the enrollee's
case file, including medical records, other documents, and any new or additional evidence
considered, relied upon, or generated by the MCO for the appeal. This information must be
provided free of charge and sufficiently in advance of the resolution time frame for appeals.
new text end
new text begin
(g) The MCO must include the following as parties to the appeal:
new text end
new text begin
(1) the enrollee and the enrollee's representative; or
new text end
new text begin
(2) the legal representative of a deceased enrollee's estate.
new text end
new text begin Subd. 44. new text end
new text begin Resolution and notification of grievances and appeals. new text end
new text begin
(a) The MCO must
resolve each grievance and appeal, and provide notice of resolution, as expeditiously as the
enrollee's health condition requires within the following time frames:
new text end
new text begin
(1) for grievances, within 90 calendar days from the day the MCO receives the grievance;
new text end
new text begin
(2) for standard appeals, within 30 calendar days from the day the MCO receives the
appeal; and
new text end
new text begin
(3) for expedited appeals, within 72 hours from the time the MCO receives the expedited
appeal.
new text end
new text begin
(b) The MCO may extend the time frame for standard and expedited appeals by an
additional 14 calendar days, if:
new text end
new text begin
(1) the enrollee requests the extension; or
new text end
new text begin
(2) the MCO justifies to the commissioner that there is a need for additional information
and that the delay is in the enrollee's interest.
new text end
new text begin
(c) If the extension is not at the request of the enrollee, the MCO must:
new text end
new text begin
(1) make reasonable efforts to give the enrollee prompt oral notice of the delay;
new text end
new text begin
(2) within two calendar days give the enrollee written notice of the decision to extend
the time frame and if the enrollee disagrees with that decision inform the enrollee of the
right to file a grievance; and
new text end
new text begin
(3) resolve the appeal as expeditiously as the enrollee's health condition requires and no
later than the date the extension expires.
new text end
new text begin
(d) The commissioner must establish the method that the MCO must use to notify the
enrollee of the resolution of the grievance, and ensure that the notice meets the information
requirements in Code of Federal Regulations, title 42, section 438.10.
new text end
new text begin
(e) For appeals, the MCO must provide written notice of the resolution according to
Code of Federal Regulations, title 42, section 438.10.
new text end
new text begin
(f) For expedited appeals, the MCO must provide oral notice of the resolution.
new text end
new text begin
(g) The written notice for appeals must include the results of the resolution process and
the date it was completed. For appeals not resolved wholly in favor of the enrollee, the
notice must also contain:
new text end
new text begin
(1) instructions on how to request a state fair hearing;
new text end
new text begin
(2) instructions on the right to receive continued benefits during the pending state fair
hearing; and
new text end
new text begin
(3) information on when an enrollee must be held liable for the costs of continued
benefits.
new text end
new text begin
(h) An enrollee must request a state fair hearing no later than 120 calendar days from
the date of the MCO's notice of resolution or when the enrollee is deemed to have exhausted
the MCO's appeals process.
new text end
new text begin
(i) The parties to the state fair hearing include the MCO, the enrollee and the enrollee's
representative, or the representative of a deceased enrollee's estate.
new text end
new text begin Subd. 45. new text end
new text begin Expedited resolution of appeals. new text end
new text begin
(a) MCOs must establish and maintain an
expedited review process for appeals. When the MCO determines based on the request of
an enrollee, or the provider indicates when making an appeal on behalf of the enrollee, that
the time frame for a standard appeal could seriously jeopardize the enrollee's life, physical
or mental health, or ability to attain, maintain, or regain maximum function.
new text end
new text begin
(b) The MCO must ensure that no punitive action is taken against a provider who requests
an expedited resolution or supports an enrollee's appeal.
new text end
new text begin
(c) If the MCO denies a request for an expedited appeal, the MCO must:
new text end
new text begin
(1) transfer the appeal to the standard time frame for resolution of appeals; and
new text end
new text begin
(2) follow the process for seeking an extension of the standard time frame for resolution
of appeals.
new text end
new text begin Subd. 46. new text end
new text begin Provider and subcontractor information. new text end
new text begin
The MCO is required to provide
information about the MCO's grievance and appeals systems to the MCO's providers and
subcontractors at the time a contract is entered.
new text end
new text begin Subd. 47. new text end
new text begin Record-keeping requirements. new text end
new text begin
(a) The commissioner must require MCOs
to maintain records of all grievances and appeals and must monitor the information and
update and revise the quality strategy accordingly.
new text end
new text begin
(b) A record of each grievance and appeal must contain, at a minimum, information that
satisfies Code of Federal Regulations, title 42, section 438.4416(b) and (c).
new text end
new text begin Subd. 48. new text end
new text begin Continuation of benefits. new text end
new text begin
(a) The MCO must continue the enrollee's benefits
if:
new text end
new text begin
(1) the enrollee files a request for an appeal timely and requests continued benefits on
or before the later of the following:
new text end
new text begin
(i) within ten calendar days of the MCO sending the notice of the adverse benefit
determination; or
new text end
new text begin
(ii) the intended effective date of the MCO's proposed adverse benefit determination;
new text end
new text begin
(2) the appeal involves the termination, suspension, or reduction of previously authorized
services;
new text end
new text begin
(3) the services were ordered by an authorized provider; and
new text end
new text begin
(4) the period covered by the original service authorization has not expired.
new text end
new text begin
(b) If the MCO continues or reinstates benefits at the enrollee's request while the appeal
or state fair hearing is pending, the benefits must be continued until:
new text end
new text begin
(1) the enrollee withdraws the appeal or request for state fair hearing;
new text end
new text begin
(2) the enrollee fails to request a state fair hearing and continuation of benefits within
ten calendar days after the MCO sends the notice of an adverse resolution; or
new text end
new text begin
(3) a state fair hearing office issues a hearing decision adverse to the enrollee.
new text end
new text begin
(c) If the final resolution of the appeal or state fair hearing is adverse to the enrollee, the
MCO may, consistent with the policies on recoveries under Code of Federal Regulations,
title 42, section 431.230(b), and as specified in the commissioner's contract with the MCO,
recover the cost of services furnished to the enrollee while the appeal and state fair hearing
was pending.
new text end
new text begin Subd. 49. new text end
new text begin Effectuation of reversed appeal resolutions. new text end
new text begin
(a) If the MCO or the state fair
hearing officer reverses a decision to deny, limit, or delay services that were not furnished
while the appeal was pending, the MCO must authorize or provide the disputed services
promptly and as expeditiously as the enrollee's health condition requires but no later than
72 hours from the date the MCO receives notice reversing the MCO's adverse benefit
determination.
new text end
new text begin
(b) If the MCO or the state fair hearing officer reverses a decision to deny authorization
of service, and the enrollee received the disputed services while the appeal was pending,
the MCO or the commissioner must pay according to department policy and regulations.
new text end
new text begin Subd. 50. new text end
new text begin Ombudsperson. new text end
new text begin
(a) The commissioner shall designate an ombudsperson to
advocate for persons required to enroll in an MCO through an appeal and grievance process.
The ombudsperson shall advocate for recipients enrolled in an MCO through complaint and
appeal procedures and ensure that necessary medical services are provided either by the
MCO directly or by referral to appropriate social services. Before enrollment in an MCO,
an enrollee is provided information about managed care including the ombudsman person
program and the enrollee's right to a resolution of an appeal or grievance. The local agency
shall inform a recipient about the ombudsperson program and the recipient right to a
resolution of a complaint by the MCO if recipient experiences a problem with the plan or
the MCO's providers.
new text end
new text begin
(b) The provider or MCO must respond directly to the managed care ombudspersons
and county advocates regarding service delivery and must be accountable to the commissioner
regarding contracts with medical assistance funds.
new text end
new text begin Subd. 51. new text end
new text begin Program integrity. new text end
new text begin
(a) The commissioner must review the ownership and
control disclosures submitted by the MCO and any MCO subcontractors.
new text end
new text begin
(b) The commissioner must confirm through routine checks of the Federal databases the
identity and determine the exclusion status of the MCO, any subcontractor, and any person
with an ownership of five percent or control interest, or who is an agent or managing
employee of the MCO. This includes the Social Security Administration's Death Master
File, the National Plan and Provider Enumeration System (NPPES), the list of Excluded
Individuals/Entities (LEIE), the System for Award Management (SAM), and any other
databases that the Centers for Medicare and Medicaid may prescribe. The databases listed
in this paragraph must be consulted upon contract initiation and renewal and monthly
thereafter. If, upon review of the databases listed in this paragraph, an excluded party is
identified, the commissioner must notify the MCO and take action consistent with Code of
Federal Regulations, title 42, section 438.610(d).
new text end
new text begin
(c) The commissioner must, at least every three years, conduct, or contract for, an
independent audit of the accuracy, truthfulness, and completeness of the encounter and
financial data submitted by each MCO. The commissioner shall receive and investigate
information from whistleblowers relating to the integrity of the MCO, subcontractors, or
network providers receiving federal funds.
new text end
new text begin
(e) The commissioner shall post on the department's Web site:
new text end
new text begin
(1) the MCO contract;
new text end
new text begin
(2) the documentation required by Code of Federal Regulations, title 42, section
438.207(b), that the commissioner based its certification that the MCO complies with the
commissioner's availability and accessibility of services requirements, including the provider
network adequacy requirements;
new text end
new text begin
(3) the name and title of any person with an ownership or control interest of the MCO
or any MCO subcontractors according to Code of Federal Regulations, title 42, section
455.104; and
new text end
new text begin
(4) a copy of the audit results conducted pursuant to Code of Federal Regulations, title
42, section 438.602(e).
new text end
new text begin
(f) The commissioner must ensure that an MCO is not located outside of the United
States and no claims are paid by an MCO to a network provider, out-of-network provider,
subcontractor, or financial institution located outside of the United States.
new text end
new text begin
(g) Federal financial participation is only available if the commissioner excludes from
the MCO contracts all of the entities listed in Code of Federal Regulations, title 42, section
438.808(b).
new text end
new text begin Subd. 52. new text end
new text begin Data, information, and documentation requirements. new text end
new text begin
(a) The commissioner
must require each MCO to submit the following data:
new text end
new text begin
(1) encounter data according to the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) security and privacy standards and must be submitted in the format
required by the Medicaid Statistical Information System or a format required by any successor
system to the Medicaid Statistical Information System;
new text end
new text begin
(2) data on the basis that the commissioner certifies the actuarial soundness of capitation
rates to an MCO according to Code of Federal Regulations, title 42, section 438.4, including
base data described in Code of Federal Regulations, title 42, section 438.5(c) that is generated
by the MCO;
new text end
new text begin
(3) data on the basis that the commissioner determines MCO compliance with the medical
loss ratio requirements;
new text end
new text begin
(4) data on the basis that the commissioner determines that the MCO made adequate
provision against the risk of insolvency as required under Code of Federal Regulations, title
42, section 438.116;
new text end
new text begin
(5) documentation, in a format specified by the commissioner according to Code of
Federal Regulations, title 42, section 438.207(b), that the MCO complied with the
commissioner's requirements for availability and accessibility of services, including the
adequacy of the provider network in Code of Federal Regulations, title 42, section 438.206;
new text end
new text begin
(6) information from the MCO on ownership and control interest according to Code of
Federal Regulations, title 42, section 455.104, and subcontractors according to Code of
Federal Regulations, title 42, section 438.230; and
new text end
new text begin
(7) an annual report of the MCO's recoveries of overpayments.
new text end
new text begin
(b) The commissioner shall require that data submitted under Code of Federal
Regulations, title 42, section 438.604, by the MCO must be certified by the MCO's chief
executive officer (CEO), chief financial officer (CFO), or an individual who reports directly
to the CEO or CFO with delegated authority to sign on their behalf. The certification must
include an attestation by the CEO or CFO that the information submitted is based on the
CEO's or CFO's knowledge and belief that the data is accurate, complete, and truthful, and
must be submitted concurrently with the data.
new text end
new text begin Subd. 53. new text end
new text begin MCO program integrity requirements. new text end
new text begin
(a) The commissioner must require
the MCO, or any MCO subcontractor delegated responsibility for coverage of services and
payment of claims, to implement and maintain procedures designed to detect and prevent
fraud, waste, and abuse. The MCO must include the procedures in a compliance plan that
includes:
new text end
new text begin
(1) written policies, procedures, and standards of conduct that articulate the MCO's
commitment to comply with applicable federal and state requirements regarding fraud,
waste, and abuse;
new text end
new text begin
(2) the designation of a compliance officer responsible for developing and implementing
policies, procedures, and practices designed to ensure compliance with the requirements of
the contract and who reports directly to the CEO and the board of directors;
new text end
new text begin
(3) the establishment of a Regulatory Compliance Committee on the Board of Directors
and at the senior management level charged with overseeing the MCO's compliance program;
new text end
new text begin
(4) a system for training and education for the compliance officer, the MCO's senior
management, and employees for federal and state standards and develop a procedure for
effective lines of communication between the groups;
new text end
new text begin
(5) enforcement of standards and implementation of procedures for routine internal
monitoring and auditing of compliance according to Code of Federal Regulations, title 42,
section 438.608(a)(1)(vii), to reduce the potential for recurrence and promote ongoing
compliance;
new text end
new text begin
(6) a provision for prompt reporting of all overpayments identified or recovered,
specifying the overpayments due to potential fraud, to the commissioner;
new text end
new text begin
(7) a provision for prompt reporting to the commissioner when the MCO receives
information that may affect an enrollee's eligibility;
new text end
new text begin
(8) a provision for notification to the commissioner if the MCO receives information
about a change in a network provider's circumstances that may affect the network provider's
eligibility to participate in the managed care program, including termination of the provider
agreement with the MCO;
new text end
new text begin
(9) a provision for a method to verify, on a regular basis, that services represented as
delivered by a network provider were received by the enrollees;
new text end
new text begin
(10) for an MCO contract that has an annual payment or receipt of at least $5,000,000,
a provision for written policies for all employees of the MCO, or subcontractor, that provides
detailed information about the False Claims Act and other federal and state laws described
in section 1902(a)(68) of the Social Security Act, including information about rights of
employees to be protected as whistleblowers;
new text end
new text begin
(11) a provision for the prompt referral of any potential fraud, waste, or abuse identified
by the MCO to the Medicaid Program Integrity Unit, and any potential fraud directly to the
Medicaid Fraud Control Unit; and
new text end
new text begin
(12) a provision for the suspension of payments to a network provider that the
commissioner determines there is a credible allegation of fraud according to Code of Federal
Regulations, title 42, section 455.23.
new text end
new text begin
(b) The commissioner shall ensure that each MCO and any subcontractor:
new text end
new text begin
(1) provides written disclosure of any prohibited affiliation according to Code of Federal
Regulations, title 42, section 438.610;
new text end
new text begin
(2) provides written disclosures of information on ownership and control required by
Code of Federal Regulations, title 42, section 455.104; and
new text end
new text begin
(3) reports to the commissioner within 60 calendar days when the MCO or subcontractor
identifies that capitation payments or other payments were in excess of the amounts specified
in the contract.
new text end
new text begin
(c) The commissioner must ensure the MCO contracts specify:
new text end
new text begin
(1) the retention policies for treatment of all overpayments from the MCO to a provider,
including the retention policies for the treatment of recoveries of overpayments due to fraud,
waste, and abuse;
new text end
new text begin
(2) the process, time frames, and documentation required for reporting the recovery of
all overpayments, including situations of recoveries of overpayments to the commissioner
where the MCO is not permitted to retain some or all of the recoveries of overpayments;
and
new text end
new text begin
(3) the treatment of recoveries does not apply to any amount of recovery to be retained
under the False Claims Act or through other investigations.
new text end
new text begin
(d) The commissioner shall ensure each MCO has a mechanism for a network provider
to report to the MCO when the MCO has received an overpayment, to return the overpayment
to the MCO within 60 calendar days after the date the overpayment was identified, and to
notify the MCO in writing of the reason for the overpayment.
new text end
new text begin
(e) The commissioner shall require each MCO to submit an annual report to the
commissioner on the MCO's recoveries of overpayments. The commissioner must use the
information to set actuarially sound capitation rates.
new text end
new text begin
(f) An MCO may not knowingly have a relationship with any of the types identified in
Code of Federal Regulations, title 42, section 438.610(c), if the following occurs:
new text end
new text begin
(1) an individual or entity is debarred, suspended, or otherwise excluded from
participating in procurement activities under the Federal Acquisition Regulation or from
participating in nonprocurement activities under regulations issued under Executive Order
No. 12549 or under guidelines implementing Executive Order No. 12549; or
new text end
new text begin
(2) an individual or entity is an affiliate, as defined in Code of Federal Regulations, title
42, section 2.101, of a person described in clause (1).
new text end
new text begin
(g) An MCO may not have a relationship with an individual or entity that is excluded
from participation in any federal health care program under section 1128 or 1128A of the
Social Security Act.
new text end
new text begin
(h) If the commissioner determines that an MCO fails to comply with paragraphs (f)
and (g), the commissioner:
new text end
new text begin
(1) must notify the Centers for Medicare and Medicaid of the MCO's noncompliance;
new text end
new text begin
(2) may continue an existing agreement with the MCO unless the Centers for Medicare
and Medicaid directs otherwise; and
new text end
new text begin
(3) may not renew or otherwise extend the duration of an existing agreement with the
MCO unless the Centers for Medicare and Medicaid provides a written statement to the
commissioner and congress describing compelling reasons that exist for renewing or
extending the agreement despite the prohibited affiliations;
new text end
new text begin
Nothing in this section must be construed to limit or otherwise affect any remedies available
under sections 1128, 1128A, or 1128B of the Social Security Act.
new text end
new text begin Subd. 54. new text end
new text begin Sanctions. new text end
new text begin
(a) The commissioner must establish intermediate sanctions if the
commissioner makes a determination that the MCO :
new text end
new text begin
(1) failed to substantially provide medically necessary services to an enrollee that is
covered under law or under the contract with the commissioner;
new text end
new text begin
(2) imposed premiums or charges that exceed premiums or charges permitted under
medical assistance;
new text end
new text begin
(3) discriminated against an enrollee on the basis of the enrollee's health status or need
for health care services, including:
new text end
new text begin
(i) termination of enrollment or refusal to reenroll a beneficiary, except as permitted
under medical assistance; or
new text end
new text begin
(ii) any practice that would reasonably be expected to discourage enrollment by a
beneficiary whose medical condition or history indicates probable need for substantial future
medical services;
new text end
new text begin
(4) misrepresented or falsified information to the Centers for Medicare and Medicaid
or the commissioner;
new text end
new text begin
(5) misrepresented or falsified information furnished to an enrollee, potential enrollee,
or health care provider;
new text end
new text begin
(6) failed to comply with the requirements for physician incentive plans, as set forth in
according to Code of Federal Regulations, title 42, sections 422.208 and 422.210;
new text end
new text begin
(7) the MCO distributed directly, or indirectly through any agent or independent
contractor, marketing materials that were not approved by the commissioner or that contained
false or materially misleading information; or
new text end
new text begin
(8) the MCO violated any of the other requirements of section 1903(m) or 1932 of the
Social Security Act, or any implementing regulations.
new text end
new text begin
(b) Only the sanctions listed in Code of Federal Regulations, title 42, section
438.702(a)(3), (4), and (5), may be imposed.
new text end
new text begin Subd. 55. new text end
new text begin Types of intermediate sanctions. new text end
new text begin
(a) The commissioner may:
new text end
new text begin
(1) impose civil money penalties according to Code of Federal Regulations, title 42,
section 438.704;
new text end
new text begin
(2) appoint of temporary management for an MCO as provided in Code of Federal
Regulations, title 42, section 438.706;
new text end
new text begin
(3) grant an enrollee the right to terminate enrollment without cause and notifying the
affected enrollee of the enrollee's right to disenroll;
new text end
new text begin
(4) suspend new enrollment, including default enrollment, after the date the Centers for
Medicare and Medicaid or the commissioner notifies the MCO of a determination of a
violation under sections 1903(m) or 1932 of the Social Security Act; or
new text end
new text begin
(5) suspend payment for a beneficiary enrolled after the effective date of the sanction
and until the Centers for Medicare and Medicaid or the commissioner is satisfied that the
reason for imposition of the sanction no longer exists and is not likely to recur.
new text end
new text begin
(b) The commissioner may impose additional sanctions for an MCO's noncompliance
according to Code of Federal Regulations, title 42, section 438.700.
new text end
new text begin Subd. 56. new text end
new text begin Special rules for temporary management. new text end
new text begin
(a) The commissioner may impose
temporary management of the MCO according to Code of Federal Regulations, title 42,
section 438.702(a)(2), only if the commissioner finds through on-site surveys, enrollee or
other complaints, financial status, or any other source the following:
new text end
new text begin
(1) continued egregious behavior by the MCO including but not limited to behavior
described in Code of Federal Regulations, title 42, section 438.700, or behavior that violates
sections 1903(m) and 1932 of the Social Security Act;
new text end
new text begin
(2) there is substantial risk to the enrollee's health; or
new text end
new text begin
(3) the sanction is necessary to ensure the health of the enrollee while improvements
are made to remedy the violations or until there is an orderly termination or reorganization
of the MCO.
new text end
new text begin
(b) The commissioner must impose temporary management of the MCO, regardless of
the imposition of any other sanction, if the commissioner finds that an MCO repeatedly
failed to meet substantive requirements of section 1903(m) or 1932 of the Social Security
Act or Code of Federal Regulations, title 42, section 438. The commissioner must grant an
enrollee the right to terminate enrollment without cause and notify the affected enrollee of
the enrollee's right to disenroll.
new text end
new text begin
(c) The commissioner shall not delay imposition of temporary management pending a
hearing. Temporary management must remain in place until the commissioner determines
that the sanctioned behavior will not recur.
new text end
new text begin Subd. 57. new text end
new text begin Termination of the MCO contract. new text end
new text begin
The commissioner may terminate an
MCO contract and enroll that MCO's enrollees in different MCOs, or provide the enrollee's
medical assistance benefits through other options included in the state plan, if the
commissioner determines that the MCO failed to either carry out the substantive terms of
the MCO's contract or satisfy sections 1932, 1903(m), and 1905(t) of the Social Security
Act.
new text end
new text begin Subd. 58. new text end
new text begin Notice of sanction and pretermination. new text end
new text begin
(a) Except as provided in Code of
Federal Regulations, title 42, section 438.706(c), the commissioner, before imposing any
intermediate sanctions, must give the affected MCO timely written notice that explains the
basis and nature of the sanction and any other appeal rights that the commissioner elects to
provide.
new text end
new text begin
(b) Before terminating an MCO contract, the commissioner must provide the MCO:
new text end
new text begin
(1) with a pretermination hearing;
new text end
new text begin
(2) written notice of its intent to terminate, the reason for termination, and the time and
place of the hearing; and
new text end
new text begin
(3) written notice of the decision affirming or reversing the proposed termination of the
contract.
new text end
new text begin
(c) If the contract is terminated, the commissioner must specify the effective date of the
termination and provide the MCO's enrollees notice of the termination and information
according to Code of Federal Regulations, title 42, section 438.10, on the enrollee's options
for receiving medical assistance services following the effective date of the termination.
The MCO's enrollees may be allowed to disenroll immediately without cause.
new text end
new text begin Subd. 59. new text end
new text begin Notice to the Centers for Medicare and Medicaid. new text end
new text begin
(a) The commissioner
must notify the Centers for Medicare and Medicaid in writing if the commissioner imposes
or lifts a sanction for a violation of Code of Federal Regulations, title 42, section 438.700.
new text end
new text begin
(b) The notice must be given no later than 30 days after the commissioner imposes or
lifts a sanction and must specify the affected MCO, the kind of sanction, and the reason for
the commissioner's decision.
new text end
new text begin Subd. 60. new text end
new text begin State plan requirements. new text end
new text begin
(a) The commissioner must include a plan to monitor
MCO violations.
new text end
new text begin
(b) The MCO contract must provide that payments made pursuant to the contract must
be denied for a new enrollee if, and for so long as, payment for the enrollee is denied by
the Centers for Medicare and Medicaid according to Code of Federal Regulations, title 42,
section 438.730(e).
new text end
new text begin Subd. 61. new text end
new text begin Sanctions by the Centers for Medicare and Medicaid. new text end
new text begin
(a) The commissioner
may recommend that the Centers for Medicare and Medicaid impose a denial of payment
sanction on an MCO if the commissioner determines that an MCO acted or failed to act
according to Code of Federal Regulations, title 42, section 438.700(b)(1) to (6). The
commissioner's determination or recommendation to impose the denial of payment sanction
becomes the Centers for Medicare and Medicaid's decision for purposes of section
1903(m)(5)(A)and(B) unless the Centers for Medicare and Medicaid rejects it within 15
days.
new text end
new text begin
(b) If the commissioner's determination becomes the Centers for Medicare and Medicaid's
decision, the commissioner must:
new text end
new text begin
(1) provide written notice of the nature and basis of the proposed sanction to the MCO;
new text end
new text begin
(2) allow the MCO 15 days from the date the MCO receives the notice to provide
evidence that the MCO did not act or failed to act in the manner that is the basis for the
recommended sanction;
new text end
new text begin
(c) The initial 15 days may be extended 15 days if:
new text end
new text begin
(1) the MCO submits a written request that includes a credible explanation of why the
MCO needs additional time;
new text end
new text begin
(2) the request is received by the Centers for Medicare and Medicaid before the end of
the initial period; or
new text end
new text begin
(3) the Centers for Medicare and Medicaid has not determined that the MCO's conduct
poses a threat to an enrollee's health or safety.
new text end
new text begin
(d) If the MCO submits a timely response to the notice of sanction, the commissioner
must:
new text end
new text begin
(1) conduct an informal reconsideration including review of the evidence by a staff
member who did not participate in the original recommendation;
new text end
new text begin
(2) provide the MCO a concise written decision setting forth the factual and legal basis
for the decision. The commissioner's decision becomes the Centers for Medicare and
Medicaid's decision unless the Centers for Medicare and Medicaid reverses or modifies the
decision within 15 days of the date of receipt by the Centers for Medicare and Medicaid. If
the Centers for Medicare and Medicaid reverses or modifies the commissioner's decision
the commissioner must send the MCO a copy of the Centers for Medicare and Medicaid's
decision; and
new text end
new text begin
(3) provide the decision to the Centers for Medicare and Medicaid.
new text end
new text begin
(d) Upon the recommendation of the commissioner, the Centers for Medicare and
Medicaid may deny payment to the department for new enrollees of the MCO under section
1903(m)(5)(B)(ii) of the Social Security Act, if:
new text end
new text begin
(1) a Centers for Medicare and Medicaid determination that an MCO has acted or failed
to act is affirmed under review;
new text end
new text begin
(2) the Centers for Medicare and Medicaid determination is not timely contested by the
MCO; or
new text end
new text begin
(3) the Centers for Medicare and Medicaid's denial of payment for a new enrollee
automatically results in a denial of payment to the MCO for the enrollee.
new text end
new text begin
(f) If the MCO does not seek reconsideration, the sanction is effective 15 days following
the MCO's notification of the decision to impose the sanction. If the MCO seeks
reconsideration, the sanction is effective on the date specified in the Centers for Medicare
and Medicaid's reconsideration notice. If the MCO's conduct poses a serious threat to an
enrollee's health or safety, the sanction may be made effective earlier than the date of the
commissioner's reconsideration.
new text end
new text begin
(g) If the commissioner sends notice of the sanction to the MCO, the Centers for Medicare
and Medicaid must forward a copy of the notice to the Office of Inspector General for
consideration of possible civil money penalties according to section 1903(m)(5)(A) of the
Social Security Act and Code of Federal Regulations, title 42, section 1003.
new text end
new text begin Subd. 62. new text end
new text begin Managed care rates. new text end
new text begin
(a) The commissioner shall establish the method and
amount of payments for services covered under the managed care contract. The final
capitation rate must be:
new text end
new text begin
(1) specifically identified in the applicable contract submitted for Centers for Medicare
and Medicaid review and approval;
new text end
new text begin
(2) based solely upon services covered under the state plan and additional services
deemed by the commissioner to be necessary to comply with mental health parity
requirements; and
new text end
new text begin
(3) adequate to allow the MCO to efficiently deliver covered services to individuals
eligible for medical assistance in a manner compliant with contractual requirements.
new text end
new text begin
(b) Payments for elderly waiver services and 180 days of nursing home care may be
included in the capitation payments for a beneficiary 65 years of age and older.
new text end
new text begin Subd. 63. new text end
new text begin Actuarial soundness. new text end
new text begin
(a) Capitation rates for MCOs must be reviewed and
approved by the Centers for Medicare and Medicaid as actuarially sound. To be approved
by the Centers for Medicare and Medicaid, capitation rates must:
new text end
new text begin
(1) be developed according to the rates standards in Code of Federal Regulations, title
42, section 438.5, and generally accepted actuarial principles and practices. Any proposed
differences among capitation rates according to covered populations must be based on valid
rate development standards and not based on the rate of federal financial participation
associated with the covered populations;
new text end
new text begin
(2) be appropriate for the populations covered and the services furnished under the
contract;
new text end
new text begin
(3) meet the requirements on MCOs for availability of services, assurance of adequate
capacity and services, and coordination and continuity of care according to Code of Federal
Regulations, title 42, sections 438.206, 438.207, and 438.208;
new text end
new text begin
(4) be specific to payments for each rate cell under the contract, and must not
cross-subsidize or be cross-subsidized by payments for any other rate cell;
new text end
new text begin
(5) be certified by an independent actuary. The actuary shall certify that the rates were
developed according to Code of Federal Regulations, title 42, section 438.3(c)(1)(ii)(e);
new text end
new text begin
(6) meet any special contract provisions according to Code of Federal Regulations, title
42, section 438.6;
new text end
new text begin
(7) be provided to the Centers for Medicare and Medicaid in a format and within a time
frame according to Code of Federal Regulations, title 42, section 438.7; and
new text end
new text begin
(8) be developed for the MCO to reasonably achieve a medical loss ratio standard of at
least 85 percent for the rate year. The capitation rates may be developed for the MCO to
achieve a medical loss ratio greater than 85 percent as long as the capitation rates are adequate
for reasonable, appropriate, and attainable nonbenefit costs.
new text end
new text begin Subd. 64. new text end
new text begin Rate development standards. new text end
new text begin
(a) The commissioner shall establish actuarially
sound capitation rates and must:
new text end
new text begin
(1) identify and develop base utilization and price data including validated encounter
data and audited financial reports received from the MCOs that demonstrate experience for
the populations served by the MCOs, for the three most recent and complete years before
the rating period;
new text end
new text begin
(2) develop and apply reasonable trend factors, including cost and utilization, to base
data that are developed from actual experience of the Medicaid population or a similar
population according to generally accepted actuarial practices and principles;
new text end
new text begin
(3) develop the nonbenefit component of the rate to account for reasonable expenses
related to the MCO's administration; taxes; licensing and regulatory fees; contribution to
reserves; risk margin; cost of capital and other operational costs associated with the MCO's
provision of covered services to beneficiaries;
new text end
new text begin
(4) pay administrative costs to MCOs not to exceed 6.6 percent of total payments made
to all MCOs in aggregate across all state public health care programs. The commissioner
may reduce or eliminate administrative requirements to meet the administrative cost limit.
For purposes of this paragraph, administrative costs do not include premium taxes paid
under section 297I.05, subdivision 5, provider surcharges paid under section 256.9657,
subdivision 3, or health insurance fees under section 9010 of the Affordable Care Act;
new text end
new text begin
(5) consider investment income and interest earnings as income to the same extent that
investment-related expenses are treated as administrative expenditures;
new text end
new text begin
(6) consider the value of cost sharing for rate development purposes, regardless of
whether the MCO imposes the cost sharing on the MCO's beneficiary or the cost sharing
is collected;
new text end
new text begin
(7) make appropriate and reasonable adjustments to account for changes to the base data,
programmatic changes, non-benefit components, and any other adjustment necessary to
establish actuarially sound rates. Each adjustment must reasonably support the development
of an accurate base data set for purposes of rate setting, reflect the health status of the
enrolled population, and be developed in accordance with generally accepted actuarial
principles and practices;
new text end
new text begin
(8) consider the MCO's past medical loss ratio in the development of the capitation rates
and consider the projected medical loss ratio; and
new text end
new text begin
(9) select a prospective or retrospective risk adjustment methodology that must be
developed in a budget-neutral manner consistent with generally accepted actuarial principles
and practices.
new text end
new text begin
(b) The base data must be derived from the Medicaid population, or, if data on the
Medicaid population is not available, derived from a similar population and adjusted to
make the utilization and price data comparable to data from the Medicaid population. Data
must be in accordance with actuarial standards for data quality and an explanation of why
that specific data is used must be provided in the rate certification. If the commissioner is
unable to base the rates on data that are within the three most recent and complete years
before the rating period, the commissioner may request an approval for an exception. The
request must describe why an exception is necessary and describe the actions that the
commissioner intends to take to come comply with.
new text end
new text begin
(c) Notwithstanding paragraph (a), the commissioner shall reduce administrative expenses
paid to managed care plans by one-half percent for contracts beginning January 1, 2016,
and ending December 31, 2017. To meet the administrative reductions under this paragraph,
the commissioner may reduce or eliminate administrative requirements, exclude additional
unallowable administrative expenses resulting from the financial audits, and utilize
competitive bidding to gain efficiencies through economies of scale from increased
enrollment. If the total reduction cannot be achieved through administrative reduction, the
commissioner may limit total rate increases on payments to MCOs.
new text end
new text begin
(d) Where reasonably possible, expenses for an administrative item shall be directly
allocated so as to assign costs for an item to an individual state public health care program
when the cost can be specifically identified with and benefits the individual state public
health care program. For administrative services expensed to the state's public health care
programs, managed care organizations must clearly identify and separately record expense
items in the MCO's accounting systems in a manner that allows for independent verification
of unallowable expenses for purposes of determining payment rates for state public health
care programs.
new text end
new text begin
(e) The following expenses are not allowable administrative expenses for rate-setting
purposes under this section:
new text end
new text begin
(1) charitable contributions made by the managed care organization. Charitable
contributions include payments for or to any organization or entity selected by the managed
care plan or county-based purchasing plan that is operated for charitable, educational,
political, religious, or scientific purposes, that are not related to medical and administrative
services covered under state public health care programs;
new text end
new text begin
(2) compensation of individuals within the organization in excess of $200,000 such that
the allocation of compensation for an individual across all state public health care programs
in total cannot exceed $200,000. For the purposes of this subdivision, compensation includes
salaries, bonuses and incentives, other reportable compensation on an IRS 990 form,
retirement and other deferred compensation, and nontaxable benefits;
new text end
new text begin
(3) any penalties or fines assessed against the MCO;
new text end
new text begin
(4) any indirect marketing or advertising expenses of the MCO, including but not limited
to costs to promote the MCO, costs of facilities used for special events, and costs of displays,
demonstrations, donations, and promotional items such as memorabilia, models, gifts, and
souvenirs. The commissioner may classify an item listed as an allowable administrative
expense for rate-setting purposes, if the commissioner determines that the expense is
incidental to an activity related to state public health care programs that is an allowable cost
for purposes of rate setting;
new text end
new text begin
(5) any lobbying and political activities, events, or contributions;
new text end
new text begin
(6) administrative expenses related to the provision of services not covered under the
state plan or waiver;
new text end
new text begin
(7) alcoholic beverages and related costs;
new text end
new text begin
(8) membership in any social, dining, or country club or organization; and
new text end
new text begin
(9) entertainment, including but not limited to amusement, diversion, and social activities,
and any costs directly associated with these costs, tickets to shows or sporting events, meals,
lodging, rentals, transportation, and gratuities.
new text end
new text begin
(f) Payments to a quality improvement organization are an allowable administrative
expense for rate-setting purposes under this section, to the extent are allocated to a state
public health care program and approved by the commissioner.
new text end
new text begin
(g) Within the limit of available appropriations, the commissioner shall work with the
commissioner of health to identify and collect data on administrative spending for state
public health care programs reported to the commissioner of health by managed care
organizations, provided that data are consistent with guidelines and standards for
administrative spending that are developed by the commissioner of health, and reported to
the legislature under Laws 2008, chapter 364, section 12. Data provided to the commissioner
under this subdivision are nonpublic data as defined in section 13.02.
new text end
new text begin
(h) The commissioner, in consultation with an actuary, shall evaluate the regional rate
relationships based on actual health plan costs for state public health care programs. The
commissioner shall establish, based on the actuary's recommendation, new rate regions that
recognize metropolitan areas outside of the seven-county metropolitan area.
new text end
new text begin Subd. 65. new text end
new text begin Payment limits. new text end
new text begin
(a) The commissioner shall reduce payments and limit future
rate increases paid to managed care plans and county-based purchasing plans. The limits
in paragraphs (a) to (f) shall be achieved on a statewide aggregate basis by program. The
commissioner may use competitive bidding, payment reductions, or other reductions to
achieve the reductions and limits in this subdivision.
new text end
new text begin
(b) The commissioner shall reduce payments to managed care organizations as follows:
new text end
new text begin
(1) 2.0 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
new text end
new text begin
(2) 2.82 percent for medical assistance families and children;
new text end
new text begin
(3) 10.1 percent for medical assistance adults without children; and
new text end
new text begin
(4) 6.0 percent for MinnesotaCare families and children.
new text end
new text begin
(c) The commissioner shall limit rates paid to managed care plans and county-based
purchasing plans for calendar year 2012 to a percentage of the rates in effect on August 31,
2011, as follows:
new text end
new text begin
(1) 98 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
new text end
new text begin
(2) 97.18 percent for medical assistance families and children;
new text end
new text begin
(3) 89.9 percent for medical assistance adults without children; and
new text end
new text begin
(4) 94 percent for MinnesotaCare families and children.
new text end
new text begin
(d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit the
maximum annual trend increases to rates paid to managed care plans and county-based
purchasing plans as follows:
new text end
new text begin
(1) 7.5 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
new text end
new text begin
(2) 5.0 percent for medical assistance special needs basic care;
new text end
new text begin
(3) 2.0 percent for medical assistance families and children;
new text end
new text begin
(4) 3.0 percent for medical assistance adults without children;
new text end
new text begin
(5) 3.0 percent for MinnesotaCare families and children; and
new text end
new text begin
(6) 3.0 percent for MinnesotaCare adults without children.
new text end
new text begin
(e) The commissioner may limit trend increases to less than the maximum. Beginning
July 1, 2014, the commissioner shall limit the maximum annual trend increases to rates paid
to managed care plans and county-based purchasing plans as follows for calendar years
2014 and 2015:
new text end
new text begin
(1) 7.5 percent for medical assistance elderly basic care. This shall not apply to Medicare
cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
new text end
new text begin
(2) 5.0 percent for medical assistance special needs basic care;
new text end
new text begin
(3) 2.0 percent for medical assistance families and children;
new text end
new text begin
(4) 3.0 percent for medical assistance adults without children; (5) 3.0 percent for
MinnesotaCare families and children; and
new text end
new text begin
(6) 4.0 percent for MinnesotaCare adults without children. The commissioner may limit
trend increases to less than the maximum. For calendar year 2014, the commissioner shall
reduce the maximum aggregate trend increases by $47,000,000 in state and federal funds
to account for the reductions in administrative expenses in subdivision 15b.
new text end
new text begin Subd. 66. new text end
new text begin Special contract requirements related to payment. new text end
new text begin
(a) If the commissioner
uses risk-sharing mechanisms such as reinsurance, risk corridors, or stop-loss limits, they
must be described in the contract, and must be developed according to the rate development
standards and generally accepted actuarial principles and practices.
new text end
new text begin
(b) The commissioner may utilize incentive payment arrangements in MCO contracts.
The payment may not exceed 105 percent of the approved capitation payments attributable
to the enrollees or services covered by the incentive arrangement and must be considered
within actuarial soundness. For all incentive arrangements the contract must provide that
the arrangement is:
new text end
new text begin
(1) for a fixed period of time and performance is measured during the rating period in
which the incentive arrangement is applied;
new text end
new text begin
(2) not to be renewed automatically;
new text end
new text begin
(3) made available to both public and private contractors under the same terms of
performance; and
new text end
new text begin
(4) specified activities, targets, performance measures, or quality-based outcomes in the
state's quality strategy.
new text end
new text begin
The incentive payment arrangement must not condition the MCO's participation in the
incentive arrangement on entering into or adhering to intergovernmental transfer agreements.
new text end
new text begin
(c) The commissioner must provide that any withholding arrangement must ensure that
the capitation payment minus any portion of the withheld funds that is not reasonably
achievable is actuarially sound. The total amount of the withheld funds, achievable or not,
must be reasonable and take into consideration each MCO's financial operating needs
accounting for the size and characteristics of the populations covered under the contract, as
well as the MCO's capital reserves, as measured by the risk based capital level, months of
claims reserve, or other appropriate measure of reserves. The data, assumptions, and
methodologies used to determine the portion of the withhold that is reasonably achievable
must be submitted as part of the documentation required by Code of Federal Regulations,
title 42, section 438.7(b)(6); for all withhold arrangements the contract must provide that
the arrangement is :
new text end
new text begin
(1) for a fixed period of time and performance is measured during the rating period in
which the withhold arrangement is applied
new text end
new text begin
(2) not to be renewed automatically;
new text end
new text begin
(3) made available to both public and private contractors under the same terms of
performance;
new text end
new text begin
(4) specified activities, targets, performance measures, or quality-based outcomes in the
state's quality strategy.
new text end
new text begin
The withhold payment arrangement must not condition the managed care organization's
participation in the withhold arrangement on entering into or adhering to intergovernmental
transfer agreements;
new text end
new text begin
(d) Each performance target must be quantifiable, objective, measurable, and reasonably
attainable. The withheld funds must be returned no sooner than July of the following year
if performance targets in the contract are achieved. The commissioner may exclude special
demonstration projects under subdivisions 18 and 19. A managed care plan or a county-based
purchasing plan under section 256B.692 may include as admitted assets under section
62D.044 any amount withheld under this section that is reasonably expected to be returned.
new text end
new text begin Subd. 67. new text end
new text begin Managed care withhold requirements. new text end
new text begin
(a) The commissioner shall withhold
five percent of managed care plan payments under this section and county-based purchasing
plan payments under section 256B.692 for the prepaid medical assistance program pending
completion of performance targets. Each performance target must be quantifiable, objective,
measurable, and reasonably attainable, except in the case of a performance target based on
a federal or state law or rule. Criteria for assessment of each performance target must be
outlined in writing prior to the contract effective date. Clinical or utilization performance
targets and their related criteria must consider evidence-based research and reasonable
interventions when available or applicable to the populations served, and must be developed
with input from external clinical experts and stakeholders, including managed care plans,
county-based purchasing plans, and providers. The managed care or county-based purchasing
plan must demonstrate, to the commissioner's satisfaction, that the data submitted regarding
attainment of the performance target is accurate. The commissioner shall periodically change
the administrative measures used as performance targets in order to improve plan performance
across a broader range of administrative services. The performance targets must include
measurement of plan efforts to contain spending on health care services and administrative
activities. The commissioner may adopt plan-specific performance targets that take into
account factors affecting only one plan, including characteristics of the plan's enrollee
population. The withheld funds must be returned no sooner than July of the following year
if performance targets in the contract are achieved. The commissioner may exclude special
demonstration projects under subdivisions 75 and 76.
new text end
new text begin
(b) The commissioner shall include as part of the performance targets described in
paragraph (a) a reduction in the health plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, as determined by the commissioner. To
earn the return of the withhold each subsequent year, the managed care plan or county-based
purchasing plan must achieve a qualifying reduction of no less than ten percent of the plan's
emergency department utilization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 75 and 76, compared to the
previous measurement year until the final performance target is reached. When measuring
performance, the commissioner must consider the difference in health risk in a managed
care or county-based purchasing plan's membership in the baseline year compared to the
measurement year, and work with the managed care or county-based purchasing plan to
account for differences that they agree are significant.
new text end
new text begin
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
new text end
new text begin
The withheld funds shall continue for each consecutive contract period until the plan's
emergency room utilization rate for state health care program enrollees is reduced by 25
percent of the plan's emergency room utilization rate for medical assistance and
MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the health
plans in meeting this performance target and shall accept payment withholds that may be
returned to the hospitals if the performance target is achieved.
new text end
new text begin
(c) The commissioner shall include as part of the performance targets described in
paragraph (a) a reduction in the plan's hospitalization admission rate for medical assistance
and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the
withhold each year, the managed care plan or county-based purchasing plan must achieve
a qualifying reduction of no less than five percent of the plan's hospital admission rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 75 and 76, compared to the previous calendar year until the final performance
target is reached. When measuring performance, the commissioner must consider the
difference in health risk in a managed care or county-based purchasing plan's membership
in the baseline year compared to the measurement year, and work with the managed care
or county-based purchasing plan to account for differences that they agree are significant.
new text end
new text begin
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
new text end
new text begin
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (d). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
new text end
new text begin
(d) The commissioner shall include as part of the performance targets described in
paragraph (a) a reduction in the plan's hospitalization admission rates for subsequent
hospitalizations within 30 days of a previous hospitalization of a patient regardless of the
reason, for medical assistance and MinnesotaCare enrollees, as determined by the
commissioner. To earn the return of the withhold each year, the managed care plan or
county-based purchasing plan must achieve a qualifying reduction of the subsequent
hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees
in programs described in subdivisions 75 and 76, of no less than five percent compared to
the previous calendar year until the final performance target is reached.
new text end
new text begin
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
new text end
new text begin
The withheld funds must continue for each consecutive contract period until the plan's
subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding
enrollees in programs described in subdivisions 74 and 75, is reduced by 25 percent of the
plan's subsequent hospitalization rate for calendar year 2011. Hospitals shall cooperate with
the plans in meeting this performance target and shall accept payment withholds that must
be returned to the hospitals if the performance target is achieved.
new text end
new text begin
(e) The commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivisions 75 and 76.
new text end
new text begin
(f) The commissioner shall withhold three percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivisions 75 and 76.
new text end
new text begin
(g) The return of the withhold under paragraphs (d)(v) and (d)(vi) is not subject to the
requirements of paragraph (d)(i).
new text end
new text begin Subd. 68. new text end
new text begin Medical education and research fund. new text end
new text begin
(a) The commissioner shall transfer
each year to the medical education and research fund established under section 62J.692, an
amount specified in this subdivision.
new text end
new text begin
(b) The commissioner shall calculate the following:
new text end
new text begin
(1) an amount equal to the reduction in the prepaid medical assistance payments as
specified in this clause. The county medical assistance capitation base rate before plan
specific adjustments is reduced 6.3 percent for Hennepin County, two percent for the
remaining metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties.
Nursing facility and elderly waiver payments and demonstration project payments operating
under subdivisions 78 and 79 are excluded from this reduction. The amount calculated under
this clause shall not be adjusted for periods already paid due to subsequent changes to the
capitation payments;
new text end
new text begin
(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this section;
new text end
new text begin
(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates paid
under this section; and
new text end
new text begin
(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid under
this section.
new text end
new text begin
(c) This subdivision shall be effective upon approval of a federal waiver which allows
federal financial participation in the medical education and research fund. The amount
specified under paragraph (b) shall not exceed the total amount transferred for fiscal year
2009. Any excess shall first reduce the amounts specified under paragraph (b). Any excess
following this reduction shall proportionally reduce the amount specified under paragraph
(b).
new text end
new text begin
(d) Of the amount in clause (1), the commissioner shall transfer $21,714,000 each fiscal
year to the medical education and research fund.
new text end
new text begin
(e) Of the amount in clause (1), following the transfer under clause (3), the commissioner
shall transfer to the medical education research fund $23,936,000 in fiscal years 2012 and
2013 and $49,552,000 in fiscal year 2014 and thereafter.
new text end
new text begin
(f) Beginning July 1, 2002, the capitation rates paid under this section are increased by
$12,700,000 per year. Beginning July 1, 2003, the capitation rates paid under this section
are increased by $4,700,000 per year.
new text end
new text begin
(g) Beginning July 1, 2009, the capitation rates paid under this section are increased
each year by the lesser of $21,714,000 or an amount equal to the difference between the
estimated value of the reductions described in clause (1), item (i), and the amount of the
limit described in clause (2).
new text end
new text begin
(h) Capitation payments for services provided in the month of June for which payment
shall be made no earlier than the first day of the following month and no later than the last
day of that month.
new text end
new text begin
(i) The commissioner shall not direct MCO expenditures under the contract, except in
the following situations:
new text end
new text begin
(1) implementation of a value-based purchasing model for provider reimbursement, such
as pay-for-performance arrangements, bundled payments, or other service payments intended
to recognize value or outcomes over volume of services;
new text end
new text begin
(2) participation in a multipayer or medical assistance specific delivery system reform
or performance improvement initiative;
new text end
new text begin
(3) implementation of a minimum or maximum fee schedule, or a uniform dollar or
percentage increase for network providers that provide a particular service. The maximum
fee schedule must allow the MCO the ability to reasonably manage risk and provide discretion
in accomplishing the goals of the contract; and
new text end
new text begin
(4) the MCO contract that directs the MCO expenditures under clauses (1) to (3) must
be developed according to Code of Federal Regulations, title 42, section 438.5, comply with
actuarial soundness, and generally accepted actuarial principles and practices and have
written approval from the Centers for Medicare and Medicaid before implementation. To
obtain approval the commissioner must demonstrate in writing that the contract arrangements:
new text end
new text begin
(i) are based on the utilization and delivery of services;
new text end
new text begin
(ii) directs expenditures equally, using the same terms of performance for a class of
providers providing service under the contract;
new text end
new text begin
(iii) expects to advance at least one of the goals and objectives in the commissioner's
quality strategy;
new text end
new text begin
(iv) has an evaluation plan that measures the degree to which the arrangement advances
at least one of the goals in the commissioner's quality strategy;
new text end
new text begin
(v) does not condition network provider participation on the network provider entering
into or adhering to an intergovernmental transfer agreement; and
new text end
new text begin
(vi) are not renewed automatically; and
new text end
new text begin
(5) for contract arrangements identified in clauses (1) and (2), the commissioner shall:
new text end
new text begin
(i) make participation in the value-based purchasing initiative delivery system reform
or performance improvement initiative available, using the same terms of performance, to
a class of providers providing services under the contract related to the reform or
improvement initiatives;
new text end
new text begin
(ii) use a common set of performance measures across all of the payers and providers;
new text end
new text begin
(iii) not set the amount or frequency of the expenditures; and
new text end
new text begin
(iv) not allow the state to recoup from the MCO any unspent funds allocated for these
arrangements.
new text end
new text begin
(j) The commissioner may require MCOs to make pass-through payments to network
providers that are hospitals, physicians, and nursing facilities satisfy Code of Federal
Regulations, title 42, section 438.6(d), until the commissioner must phase out pass-through
payments. Pass-through payments for hospitals may be required under the contract but must
be phased out no longer than on the 10-year schedule, beginning with contracts that start
on or after July 1, 2017 and ending on July 1, 2027. Pass-through payments for physicians
and nursing facilities may be required under the contract but must be phased out no longer
than on the 5-year schedule, beginning with contracts that start on or after July 1, 2017 and
ending on July 1, 2022.
new text end
new text begin
(k) The commissioner may make a monthly capitation payment to an MCO for an enrollee
21 to 64 years of age receiving inpatient treatment for psychiatric or substance use disorder
in an institution for mental diseases for a short term stay of no more than 15 days during
the period of the monthly capitation payment. The provision of psychiatric or substance use
disorder treatment in an institution for mental diseases must meet the requirements for in
lieu of services in subdivision 33.
new text end
new text begin Subd. 69. new text end
new text begin Rate certification submission. new text end
new text begin
(a) The commissioner must submit to the
Centers for Medicare and Medicaid for review and approval the commissioner's rate
certifications at the same time as the commissioner's managed care contracts.
new text end
new text begin
(b) The rate certification must satisfy Code of Federal Regulations, title 42, section
438.7(b) and must:
new text end
new text begin
(1) base data used in the rate setting process;
new text end
new text begin
(2) trend, including changes in the utilization and the price of services;
new text end
new text begin
(3) nonbenefit component of the rate;
new text end
new text begin
(4) adjustments;
new text end
new text begin
(5) prospective and retrospective risk adjustment methodology; and
new text end
new text begin
(6) special contract provisions related to payment.
new text end
new text begin
(c) An actuary must certify the final capitation rates paid per rate cell under each risk
contract and document the underlying data, assumptions and methodologies.
new text end
new text begin
(d) The commissioner may pay each MCO a capitation rate under the contract that is
different than the capitation rate paid to a different MCO, if each capitation rate per rate
cell that is paid is independently developed and set in according to Code of Federal
Regulations, title 42, sections 438.4, 438.5, 438.6, and 438.8.
new text end
new text begin
(e) If the commissioner determines that a retroactive adjustment to the capitation rate is
necessary, the retroactive adjustment must be supported by a rationale for the adjustment
and the data. Assumptions and methodologies used to develop the adjustment must be
described with enough detail to allow the Centers for Medicare and Medicaid or an actuary
to determine the reasonableness of the adjustment. Any retroactive adjustments must be
certified by an actuary in a revised rate certification and submitted to the Centers for Medicare
and Medicaid for approval as a contract amendment. All adjustments are subject to timely
claim filing requirements.
new text end
new text begin
(f) The commissioner may increase or decrease the capitation rate per rate cell according
to Code of Federal Regulations, title 42, sections 438.4(b)(4) and 438.7(c), up to 1.5 percent
without submitting a revised rate certification.
new text end
new text begin
(g) The commissioner must, upon request from the Centers for Medicare and Medicaid,
provide additional information if the Centers for Medicare and Medicaid determines the
information is pertinent to certification approval. The commissioner must identify whether
the additional information is offered by the commissioner, the actuary, or another party.
new text end
new text begin
(h) Each year, within 30 days of the establishment of MCO rates, the commissioner shall
submit a report on the certification and how each condition is met by the new payment rates
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services finance.
new text end
new text begin Subd. 70. new text end
new text begin Medical loss ratio. new text end
new text begin
(a) The commissioner must ensure through contracts that
each MCO calculate and report an MLR for each contract year. The commissioner may
mandate a minimum MLR that must be equal to or higher than 85 percent.
new text end
new text begin
(b) The calculation of the MLR in a MLR reporting year is the ratio of the numerator to
the denominator. The numerator includes the sum of the MCO's incurred claims, the MCO's
expenditures for activities that improve health care quality, and fraud prevention activities.
The denominator includes the MCO's adjusted premium revenue minus the MCO's federal,
state, and local taxes and licensing and regulatory fees. The MCO must aggregate the data
for all eligibility groups covered under the contract unless the commissioner requires separate
reporting and a separate MLR calculation for specific populations.
new text end
new text begin
(c) Incurred claims are identified by the expenditures, liabilities, reserves, deductions,
and exclusions according to Code of Federal Regulations, title 42, section 438.8(e)(2).
new text end
new text begin
(d) Activities that improve health care quality must be in one category according to Code
of Federal Regulations, title 42, section 438.8(e)(3).
new text end
new text begin
(e) Fraud prevention activities include MCO expenditures on activities related to fraud
prevention according to Code of Federal Regulations, title 45, section 158.
new text end
new text begin
(f) Premium revenue includes state capitation payments; state-developed onetime
payments for specific life events of enrollees; other payments to the MCO according to
Code of Federal Regulations, title 42, section 438.6(b)(3); unpaid cost-sharing amounts;
and changes to unearned premium reserves, net payments, and receipts related to risk sharing
mechanisms.
new text end
new text begin
(g) Taxes, licensing, and regulatory fees identified in Code of Federal Regulations, title
42, section 438.8(f)(3).
new text end
new text begin
(h) The total amount of the denominator for an MCO that is later assumed by another
entity must be reported by the assuming MCO for the entire MLR reporting year.
new text end
new text begin
(i) Each expense must be included under only one type of expense, unless a portion of
the expense fits under the definition of, or criteria for, one type of expense and the remainder
fits into a different type of expense, in which case the expense must be prorated between
types of expenses. Expenditures that benefit multiple contracts or populations, or contracts
other than those being reported must be reported on a pro rata basis. Expenses must be
allocated using the methods described in Code of Federal Regulations, title 42, section
438.8(g)(2).
new text end
new text begin
(j) Credibility adjustment means an adjustment to the MLR for a partially credible MCO
to account for a difference between the actual and target MLRs that may be due to random
statistical variation. The calculation of an MLR is based on the MCO's member months and
may be determined as credible, partially credible, or no credibility. An MCO that is assigned
no credibility or full credibility to the MCO's MLR calculation must not receive a credibility
adjustment.
new text end
new text begin
(k) The commissioner may require the MCO to provide a remittance if the MLR for the
MLR reporting year does not meet the minimum MLR standard of 85 percent or higher as
set by the commissioner.
new text end
new text begin
(l) The commissioner through contracts must require each MCO to submit a report to
the commissioner for each MLR reporting year that includes the information identified in
Code of Federal Regulations, title 42, section 438.8(k). The report must be submitted within
12 months of the end of the MLR reporting year. The MCO must require any third-party
vendor providing claims adjudication to provide all underlying data associated with MLR
reporting to the MCO within 180 days of the end of the MLR reporting year or within 30
days of being requested by the MCO to calculate and validate the accuracy of MLR reporting.
The MCO must include an attestation with the MLR report as to the accuracy of the
calculation of the MLR.
new text end
new text begin
(m) The commissioner must annually submit to the Centers for Medicare and Medicaid
a summary description of the reports received from the MCOs according to Code of Federal
Regulations, title 42, section 438.8(k), along with the required rate certification. The summary
description must include, at a minimum, the amount of the numerator, the amount of the
denominator, the MLR percentage achieved, the number of member months, and any
remittances owed by each for the MLR reporting year. If the commissioner requires the
MCO to pay remittances through the contract for not meeting the minimum MLR the state
must reimburse the Centers for Medicare and Medicaid the federal share, considering
differences in the federal matching rate. If a remittance is owed, the commissioner must
submit a separate report describing the methodology used to determine the state and federal
shares of the remittance with the required report.
new text end
new text begin
(n) The commissioner may exclude a newly contracted MCO from calculating and
reporting an MLR for the first year of the MCO's operation. MCOs must be required to
comply with the requirements in this section during the next MLR reporting year.
new text end
new text begin
(o) If the commissioner makes a retroactive change to the capitation payments for a
MLR reporting year where the report was already submitted to the commissioner, the MCO
must recalculate the MLR for all affected by the change and submit a new report meeting
the reporting requirements in paragraph (l).
new text end
new text begin Subd. 71. new text end
new text begin Solvency standards. new text end
new text begin
(a) Each MCO must provide assurances satisfactory to
the commissioner showing that the MCO's provision against the risk of insolvency is adequate
to ensure that the MCO's medical assistance enrollees are not be liable for the MCO's debts
if the MCO becomes insolvent.
new text end
new text begin
(b) The MCO must meet the solvency standards established by the commissioner for
private health maintenance organizations, or be licensed or certified by the commissioner
as a risk-bearing entity.
new text end
new text begin Subd. 72. new text end
new text begin Managed care financial reporting. new text end
new text begin
(a) The commissioner shall collect detailed
data regarding financials, provider payments, provider rate methodologies, and other data
as determined by the commissioner. The commissioner shall set uniform criteria, definitions,
and standards for the data to be submitted, and shall require managed care organizations to
comply with these criteria, definitions, and standards when submitting data. The
commissioner shall ensure that the data collection is implemented in an integrated and
coordinated manner that avoids unnecessary duplication of effort. To the extent possible,
the commissioner shall use existing data sources and streamline data collection in order to
reduce public and private sector administrative costs. Nothing in this subdivision shall allow
release of information that is nonpublic data pursuant to section 13.02.
new text end
new text begin
(b) Each MCO must provide quarterly to the commissioner the following information
on state public programs, in the form and manner specified by the commissioner:
new text end
new text begin
(1) an income statement by program;
new text end
new text begin
(2) financial statement footnotes;
new text end
new text begin
(3) quarterly profitability by program and population group;
new text end
new text begin
(4) a medical liability summary by program and population group;
new text end
new text begin
(5) received but unpaid claims report by program;
new text end
new text begin
(6) services versus payment lags by program for hospital services, outpatient services,
physician services, other medical services, and pharmaceutical benefits;
new text end
new text begin
(7) utilization reports that summarize utilization and unit cost information by program
for hospitalization services, outpatient services, physician services, and other medical
services;
new text end
new text begin
(8) pharmaceutical statistics by program and population group for measures of price and
utilization of pharmaceutical services;
new text end
new text begin
(9) subcapitation expenses by population group;
new text end
new text begin
(10) third-party payments by program;
new text end
new text begin
(11) all new, active, and closed subrogation cases by program;
new text end
new text begin
(12) all new, active, and closed fraud and abuse cases by program;
new text end
new text begin
(13) medical loss ratios by program;
new text end
new text begin
(14) administrative expenses by category and subcategory by program that reconcile to
other state and federal regulatory agencies, including Minnesota Supplement Report #1A;
new text end
new text begin
(15) revenues by program, including investment income;
new text end
new text begin
(16) nonadministrative service payments, provider payments, and reimbursement rates
by provider type or service category, by program, paid by the managed care plan under this
section or the county-based purchasing plan under section 256B.692 to providers and vendors
for administrative services under contract with the plan, including but not limited to:
new text end
new text begin
(i) individual-level provider payment and reimbursement rate data;
new text end
new text begin
(ii) provider reimbursement rate methodologies by provider type, by program, including
a description of alternative payment arrangements and payments outside the claims process;
new text end
new text begin
(iii) data on implementation of legislatively mandated provider rate changes; and
new text end
new text begin
(iv) individual-level provider payment and reimbursement rate data and plan-specific
provider reimbursement rate methodologies by provider type, by program, including
alternative payment arrangements and payments outside the claims process, provided to the
commissioner under this subdivision are nonpublic data as defined in section 13.02;
new text end
new text begin
(17) data on the amount of reinsurance or transfer of risk by program; and
new text end
new text begin
(18) contribution to reserve, by program.
new text end
new text begin
(c) If a report is published or released based on data provided under this subdivision,
the commissioner shall provide the report to MCOs 15 days before the publication or release
of the report. MCOs shall have 15 days to review the report and provide comment to the
commissioner. The quarterly reports shall be submitted to the commissioner no later than
60 days after the end of the previous quarter, except the fourth-quarter report, which shall
be submitted by April 1 of each year. The fourth-quarter report shall include audited financial
statements, parent company audited financial statements, an income statement reconciliation
report, and any other documentation necessary to reconcile the detailed reports to the audited
financial statements.
new text end
new text begin
(d) MCOs shall certify to the commissioner for the purpose of financial reporting for
state public health care programs under this subdivision that costs reported for state public
health care programs include:
new text end
new text begin
(1) only services covered under the state plan and waivers, and related allowable
administrative expenses; and
new text end
new text begin
(2) the dollar value of unallowable and nonstate plan services, including both medical
and administrative expenditures, that have been excluded.
new text end
new text begin Subd. 73. new text end
new text begin Financial and data quality assurance audits. new text end
new text begin
(a) The commissioner shall
require, in the request for bids and resulting contracts with MCOs under this section and
section 256B.692, that each MCO submit to and fully cooperate with the independent
third-party financial audits by the legislative auditor under of the information required under
subdivision 70, paragraph (b). Each contract with an MCO under this section or section
256B.692 must provide the commissioner, the legislative auditor, and vendors contracting
with the legislative auditor, access to all data required to complete audits under this
subdivision.
new text end
new text begin
(b) The legislative auditor shall conduct or contract with vendors to conduct independent
third-party financial audits of the information required to be provided by managed care
organizations under subdivision 70, paragraph (b). The audits by the vendors shall be
conducted as vendor resources permit and according to generally accepted government
auditing standards issued by the Government Accountability Office. The contract with the
vendors shall be designed and administered to render the independent third-party audits
eligible for a federal subsidy, if available. The contract shall require the audits to include a
determination of compliance with the Medicaid rate certification process. For purposes of
this subdivision, "independent third-party" means a vendor that is independent according
to government auditing standards issued by the Government Accountability Office.
new text end
new text begin
(c) Each MCO providing services shall provide to the commissioner biweekly encounter
data and claims data for state public health care programs and shall participate in a quality
assurance program that verifies the timeliness, completeness, accuracy, and consistency of
the data provided. The commissioner shall develop written protocols for the quality assurance
program and shall make the protocols publicly available. The commissioner shall contract
for an independent third-party audit to evaluate the quality assurance protocols as to the
capacity of the protocols to ensure complete and accurate data and to evaluate the
commissioner's implementation of the protocols.
new text end
new text begin
(d) Upon completion of the evaluation under paragraph (c), the commissioner shall
provide copies of the report to the legislative auditor and the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and financing.
new text end
new text begin
(e) Any actuary under contract with the commissioner to provide actuarial services must
meet the independence requirements under the professional code for fellows in the Society
of Actuaries and must not have provided actuarial services to an MCO that is under contract
with the commissioner during the period in which the actuarial services are being provided.
An actuary or actuarial firm meeting the requirements of this paragraph must certify and
attest to the rates paid to the MCOs, and the certification and attestation must be auditable.
new text end
new text begin
(f) The commissioner shall conduct or contract for the performance of an audit of state
public health care program administrative and medical expenses reported by the MCOs at
least every three years. This includes: financial and encounter data reported to the
commissioner under subdivision 70, including payments to providers and subcontractors;
supporting documentation for expenditures; categorization of administrative and medical
expenses; and allocation methods used to attribute administrative expenses to state public
health care programs. These audits also must monitor compliance with data and financial
report certification requirements established by the commissioner for the purposes of
managed care capitation payment rate-setting. The MCOs shall fully cooperate with the
audits. The commissioner shall report to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services policy and finance
by February 1, 2016, and each February 1 thereafter, the number of ad hoc audits conducted
in the past calendar year and the results of these audits.
new text end
new text begin
(g) Nothing in this subdivision shall allow the release of information that is nonpublic
data according to section 13.02.
new text end
new text begin Subd. 74. new text end
new text begin Prior approval. new text end
new text begin
(a) Federal financial participation (FFP) is available under
a comprehensive risk contract if:
new text end
new text begin
(1) the Centers for Medicare and Medicaid confirmed that the contractor meets the
definition of an MCO; and
new text end
new text begin
(2) the MCO contract meets all of the requirements of sections 1903(m)(2)(A) and 1932
of the Social Security Act.
new text end
new text begin
(b) Prior approval by the Centers for Medicare and Medicaid is a condition for FFP
under any MCO contract that extends for less than one full year or that has a value equal
to or greater than the following threshold amounts:
new text end
new text begin
(1) for 1998, the threshold is $1,000,000; or
new text end
new text begin
(2) for subsequent years, the amount is increased by the percentage increase in the
Consumer Price Index.
new text end
new text begin
(c) The commissioner must submit all MCO contracts to the Centers for Medicare and
Medicaid for review 90 days before the effective date of the contracts.
new text end
new text begin Subd. 75. new text end
new text begin Standard contract requirements. new text end
new text begin
(a) Managed care contracts under this
section and section 256L.12 shall be entered into or renewed on a calendar year basis.
new text end
new text begin
(b) The commissioner may issue separate contracts with requirements specific to services
to medical assistance recipients 65 years of age and older and persons with disabilities 18
to 64 years of age as described in section 256B.055, subdivision 7.
new text end
new text begin
(c) Requirements applicable to managed care programs under chapters 256B and 256L
established after the effective date of a contract with the commissioner take effect when the
contract is next issued or renewed.
new text end
new text begin
(d) The commissioner shall ensure that contracts with MCOs comply with:
new text end
new text begin
(1) all applicable federal and state laws and regulations, including Title VI of the Civil
Rights Act of 1964; Title IX of the Education Amendments of 1972; the Age Discrimination
Act of 1975; the Rehabilitation Act of 1973; the Americans with Disabilities Act of 1990
as amended; and section 1557 of the Patient Protection and Affordable Care Act;
new text end
new text begin
(2) conflict of interest safeguards in Code of Federal Regulations, title 42, section 438.58,
and with conflict of interest prohibitions for contracting officers, employees, or independent
contractors in section 1902(a)(4)(C) of the Social Security Act;
new text end
new text begin
(3) requirements mandating provider identification of provider-preventable conditions
as a condition of payment, and the prohibition against payment for provider-preventable
conditions in sections 256.969 subdivision 3b, paragraph (c), and 256B.0625 subdivision
3, and Code of Federal Regulations, title 42, sections 434.6(a)(12) and 447.26;
new text end
new text begin
(4) inspections and audits of records and access to facilities according to Code of Federal
Regulations, title 42, section 438.3(h);
new text end
new text begin
(5) physician incentive requirements according to Code of Federal Regulations, title 42,
sections 422.208 and 422.210;
new text end
new text begin
(6) maintaining policies and procedures for advance directives according to Code of
Federal Regulations, title 42, section 422.128. The contract must also provide adult enrollees
with written information on advance directive policies, and include a description of applicable
state law. The information must reflect changes in state law as soon as possible but no later
than 90 days after the effective date of the change;
new text end
new text begin
(7) requirements for subcontracts in Code of Federal Regulations, title 42, section
438.230;
new text end
new text begin
(8) requirements for enrollee's choice of network provider;
new text end
new text begin
(9) annual submission requirements for audited financial reports specific to the medical
assistance contract;
new text end
new text begin
(10) parity requirements for mental health and substance use disorders, if applicable;
new text end
new text begin
(11) for LTSS services covered under the contract that could be authorized by a waiver
in section 1915(c) of the Social Security Act or a state plan amendment authorized by section
1915(i) or 1915(k) of the Social Security Act must be delivered according to Code of Federal
Regulations, title 42, section 441.301(c)(4);
new text end
new text begin
(12) requirements of Code of Federal Regulations, title 42, section 438.3(s), for coverage
of outpatient drugs;
new text end
new text begin
(13) responsibility for coordination of benefits for individuals dually eligible for medical
assistance and Medicare. MCOs must enter a coordination of benefits agreement with
Medicare and participate in the automated claims crossover process; and
new text end
new text begin
(14) enrollee grievance and appeal records requirements in Code of Federal Regulations,
title 42, section 438.416, base data requirements in Code of Federal Regulations, title 42,
section 438.5(c), MLR reports requirements in Code of Federal Regulations, title 42, 438.8(k),
and the data information and documentation requirements in Code of Federal Regulations,
title 42, sections 438.604, 438.606, 438.608, and 438.610, for a period of ten years plus the
current contract year.
new text end
new text begin Subd. 76. new text end
new text begin Alternative services; elderly and disabled persons. new text end
new text begin
(a) The commissioner
may create alternative integrated delivery systems for acute and long-term care services to
elderly persons and people with disabilities that provide increased coordination, improve
access to quality services, and mitigate future cost increases. The commissioner may seek
federal authority to combine Medicare and Medicaid capitation payments for the
demonstrations and may contract with Medicare-approved special needs plans that are
offered by a demonstration provider or by an entity that is directly or indirectly wholly
owned or controlled by a demonstration provider to provide Medicaid services. Medicare
funds and services shall be administered according to the terms and conditions of the federal
contract and demonstration provisions. For the purpose of administering medical assistance
funds, demonstrations under this subdivision are subject to subdivisions 1 to 22. All
enforcement and rulemaking powers available under chapters 62D, 62M, and 62Q are hereby
granted to the commissioner of health with respect to Medicare-approved special needs
plans with which the commissioner contracts to provide Medicaid services under this section.
An initial open enrollment period may be provided. Persons who disenroll from
demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450
to 9500.1464. When a person is enrolled in a health plan under these demonstrations and
the health plan's participation is subsequently terminated for any reason, the person shall
be provided an opportunity to select a new health plan and shall have the right to change
health plans within the first 60 days of enrollment in the second health plan. Persons required
to participate in health plans under this section who fail to make a choice of health plan
shall not be randomly assigned to health plans under these demonstrations. Notwithstanding
section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, subpart 1, item A,
if adopted, for the purpose of demonstrations under this subdivision, the commissioner may
contract with MCOs, including counties, to serve only elderly persons eligible for medical
assistance, elderly and disabled persons, or disabled persons only.
new text end
new text begin
(b) Before implementation of a demonstration project for persons with a disability, the
commissioner must provide information to appropriate committees of the house of
representatives and senate and must involve representatives of affected disability groups in
the design of the demonstration projects.
new text end
new text begin
(c) The commissioner, in consultation with the commissioners of commerce and health,
may approve and implement programs for all-inclusive care for the elderly (PACE) according
to federal laws and regulations governing that program and state laws or rules applicable
to participating providers. A PACE provider is not required to be licensed or certified as a
health plan company as defined in section 62Q.01, subdivision 4. A person 55 years of age
and older who was screened by the county and found eligible for services under the elderly
waiver or community access for disability inclusion or who is already eligible for medical
assistance but meets level of care criteria for receipt of waiver services may choose to enroll
in the PACE program. Medicare and Medicaid services must be provided according to this
subdivision and federal Medicare and Medicaid requirements governing PACE providers
and programs. PACE enrollees must receive Medicaid home and community-based services
through the PACE provider as an alternative to services for which the person would otherwise
be eligible through home and community-based waiver programs and medical assistance.
The commissioner shall establish medical assistance rates for PACE providers that do not
exceed costs that would have been incurred under fee-for-service or other relevant managed
care programs operated by the department.
new text end
new text begin
(d) Costs for home and community-based services for people with disabilities must not
exceed costs that would have been incurred under the fee-for-service program. In developing
program specifications for expansion of integrated programs, the commissioner shall involve
and consult the state-level stakeholder group established in subdivision 75, paragraph (d),
including consultation on whether and how to include home and community-based waiver
programs. Plans to create alternative integrated delivery systems shall be presented to the
chairs of the house of representatives and senate committees with jurisdiction over health
and human services policy and finance before implementation.
new text end
new text begin
(e) Notwithstanding section 256B.0621, health plans providing services under this section
are responsible for home care targeted case management and relocation targeted case
management. Services must be provided according to the terms of the waivers and contracts
approved by the federal government.
new text end
new text begin
(f) Except as applicable to the project's operation, the provisions of sections 256.975
and 256B.0911 are waived for the purposes of this section for recipients enrolled in the
managed care program for seniors.
new text end
new text begin
(g) The commissioner shall ensure the views of beneficiaries, individuals representing
beneficiaries, providers, and other stakeholders are solicited and addressed during the design,
implementation, and oversight of the managed LTSS program. The composition of the
stakeholder group and frequency of meetings must be sufficient to ensure meaningful
stakeholder engagement.
new text end
new text begin Subd. 77. new text end
new text begin Medicare special needs plans; medical assistance basic health care. new text end
new text begin
(a)
The commissioner may contract with demonstration providers and current or former sponsors
of qualified Medicare-approved special needs plans, to provide medical assistance basic
health care services to persons with disabilities, including those with developmental
disabilities. Basic health care services include:
new text end
new text begin
(1) services covered by medical assistance, except for ICF/DD services, home and
community-based waiver services, case management for persons with developmental
disabilities under section 256B.0625, subdivision 20a, and personal care and certain home
care services defined by the commissioner in consultation with the stakeholder group
established under paragraph (d); and
new text end
new text begin
(2) risk for up to 100 days of nursing facility services for persons who reside in a
noninstitutional setting and home health services related to rehabilitation as defined by the
commissioner after consultation with the stakeholder group.
new text end
new text begin
The commissioner may exclude other medical assistance services from the basic health
care benefit set. Enrollees in these plans can access any excluded services on the same basis
as other medical assistance recipients who have not enrolled.
new text end
new text begin
(b) The commissioner may contract with demonstration providers and current and former
sponsors of qualified Medicare special needs plans, to provide basic health care services
under medical assistance to persons who are dually eligible for both Medicare and Medicaid
and those Social Security beneficiaries eligible for Medicaid but in the waiting period for
Medicare. The commissioner shall consult with the stakeholder group under paragraph (d)
to develop program specifications for these services. Payment for Medicaid services provided
under this subdivision for the months of May and June will be made no earlier than July 1
of the same calendar year.
new text end
new text begin
(c) The commissioner shall enroll a person with a disability in managed care under this
section, unless the person chooses to opt out of enrollment. The commissioner shall establish
enrollment and opt-out procedures consistent with applicable enrollment procedures under
this section.
new text end
new text begin
(d) The commissioner shall establish a state-level stakeholder group to provide advice
on managed care programs for persons with disabilities, including both integrated programs
and contracts with special needs plans that provide basic health care services as described
in paragraphs (a) and (b). The stakeholder group shall provide advice on program expansions
under this subdivision and subdivision 18, including:
new text end
new text begin
(1) implementation efforts;
new text end
new text begin
(2) consumer protections; and
new text end
new text begin
(3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.
new text end
new text begin
(e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the counties
covered by the plan, members, consumer advocates, and providers, for advice on issues that
arise in the local or regional area.
new text end
new text begin
(f) The commissioner is prohibited from providing the names of potential enrollees to
health plans for marketing purposes. The commissioner shall mail no more than two sets
of marketing materials per contract year to potential enrollees on behalf of health plans, at
the health plan's request. The marketing materials shall be mailed by the commissioner
within 30 days of receipt of these materials from the health plan. The health plans shall
cover any costs incurred by the commissioner for mailing marketing materials.
new text end
new text begin Subd. 78. new text end
new text begin Home and community-based waiver services. new text end
new text begin
(a) For individuals 65 years
of age and older enrolled in prepaid managed care programs including demonstration projects
authorized under subdivision 74, elderly waiver services shall be covered.
new text end
new text begin
(b) For individuals younger than 65 years of age enrolled in demonstrations authorized
under subdivision 18, home and community-based waiver services shall be covered according
to the terms and conditions of the federal agreement governing that demonstration project.
new text end
new text begin Subd. 79. new text end
new text begin Nursing home services. new text end
new text begin
(a) Notwithstanding Minnesota Rules, part 9500.1457,
subpart 1, item B, up to 180 days of nursing facility services as defined in section 256B.0625,
subdivision 2, which are provided in a nursing facility certified by the Department of Health
for services provided and eligible for payment under Medicaid, shall be covered under the
managed care program for individuals who are not residing in a nursing facility at the time
of enrollment in the managed care program.
new text end
new text begin
(b) For individuals enrolled in the Minnesota senior health options project or in other
programs authorized under subdivision 75, nursing facility services shall be covered
according to the terms and conditions of the federal agreement governing that demonstration
project.
new text end
new text begin
(c) For individuals enrolled in programs authorized under subdivision 75, services in an
intermediate care facility for persons with developmental disabilities shall be covered
according to the terms and conditions established in the MCO's contract with the
commissioner.
new text end
new text begin Subd. 80. new text end
new text begin Additional managed care reporting. new text end
new text begin
(a) The commissioner shall require
MCOs, as a condition of contract, to implement strategies that facilitate access to periodic
developmental and social-emotional screenings for children between the ages of one and
three years of age. The commissioner shall also ensure children who do not meet milestones
have access to appropriate evaluation and assessment, including treatment recommendations,
expected to improve the child's functioning, with the goal of meeting milestones by five
years of age.
new text end
new text begin
(b) The following information from encounter data provided to the commissioner shall
be reported on the department's public Web site for each MCO annually by July 31 of each
year:
new text end
new text begin
(1) the number of children who received a diagnostic assessment;
new text end
new text begin
(2) the total number of children one to six years of age with a diagnosis of autism
spectrum disorder who received treatments;
new text end
new text begin
(3) the number of children identified under this paragraph reported by each 12-month
age group beginning with age one and ending with age six; and
new text end
new text begin
(4) the types of treatments provided to children identified under this paragraph listed by
billing code, including the number of units billed for each child.
new text end
new text begin
(c) Each MCO shall also report any barriers to providing screening, diagnosis, and
treatment of children between one and three years of age, any strategies implemented to
address barriers, and make recommendations on how to measure and report on the
effectiveness of the strategies implemented to facilitate access for the children to provide
developmental and social-emotional screening, diagnosis, and treatment as described in
paragraph (a).
new text end
new text begin
(d) Each MCO shall submit information as required by the commissioner, including data
required for assessing client satisfaction, quality of care, cost, and utilization of services for
purposes of project evaluation. The commissioner shall develop methods of data reporting
and collection to provide aggregate enrollee information on encounters and outcomes to
determine access and quality assurance. Required information shall be specified before the
commissioner contracts with an MCO.
new text end
new text begin
(e) Aggregate nonpersonally identifiable health plan encounter data, aggregate spending
data for major categories of service as reported to the commissioners of health and commerce
under section 62D.08, subdivision 3, clause (a), and criteria for service authorization and
service use are public data that the commissioner shall make available and use in public
reports. The commissioner shall require each MCO to provide:
new text end
new text begin
(1) encounter data for each service provided, using standard codes and unit of service
definitions set by the commissioner, in a form that the commissioner can report by age,
eligibility groups, and health plan; and
new text end
new text begin
(2) criteria, written policies, and procedures to determine the medical necessity,
appropriateness, and efficacy of a procedure or service required to be disclosed under section
62M.10, subdivision 7, and Code of Federal Regulations, title 42, part 438.210(b)(1), used
for each type of service for which authorization is required.
new text end
new text begin
(f) Each MCO shall report to the commissioner the extent that providers employed by
or under contract with the MCO use patient-centered decision-making tools or procedures
designed to engage patients early in the decision-making process and the steps taken by the
MCO to encourage their use.
new text end
new text begin
(g) Each MCO shall submit drug utilization data as specified by the commissioner in
the MCO's contract to allow the commissioner to bill drug manufacturers for rebates
according to section 1927 of the Social Security Act, in a time frame established by the
commissioner. Each MCO shall exclude from this report utilization data for covered
outpatient drugs that are subject to discounts under the 340B Drug Pricing Program.
new text end
new text begin Subd. 81. new text end
new text begin Supplemental recovery program. new text end
new text begin
The commissioner shall conduct a
supplemental recovery program for third-party liabilities identified through coordination
of benefits not recovered by MCOs for state public health programs. Any third-party liability
identified through coordination of benefits and recovered by the commissioner more than
eight months after the date an MCO adjudicates a health care claim shall be retained by the
commissioner and deposited in the general fund. The commissioner shall establish a
mechanism, including a reconciliation process, for MCOs to coordinate third-party liability
collections efforts resulting from coordination of benefits under this subdivision with the
commissioner to ensure there is no duplication of efforts. The coordination mechanism must
be consistent with the reporting requirements in subdivision 70. The commissioner shall
share accurate and timely third-party liability data with MCOs.
new text end
new text begin Subd. 82. new text end
new text begin
Individualized education program and individualized family service plan
services.
new text end
new text begin
The commissioner shall separate out individualized education program (IEP) and
individualized family service plan (IFSP) services for children enrolled in the managed care
and the MinnesotaCare program. Medical assistance coverage of eligible IEP and IFSP
services shall not be included in the capitated services for children enrolled in MCOs through
managed care and the MinnesotaCare program. Local school districts shall bill the
commissioner for these services, and claims shall be paid on a fee-for-service basis.
new text end
Sec. 2. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2016, section 256B.69, subdivisions 1, 2, 3, 3a, 3b, 4, 4b, 5, 5a, 5b,
5c, 5d, 5f, 5g, 5h, 5i, 5j, 5k, 6, 6a, 6b, 6d, 7, 8, 9, 9a, 9c, 9d, 9e, 10, 11, 16, 17, 18, 19, 20,
21, 22, 23, 25, 26, 27, 28, 29, 30, 31, 32a, 33, 34, and 35,
new text end
new text begin
are repealed.
new text end
Sec. 3. new text begin REVISOR'S INSTRUCTION.
new text end
new text begin
In Minnesota Statutes and Minnesota Rules, the revisor of statutes, in consultation with
the Department of Human Services, shall make necessary cross-reference changes resulting
from implementing this article and repealing Minnesota Statutes, section 256B.69.
new text end
ARTICLE 6
DIRECT CARE AND TREATMENT
Section 1.
Minnesota Statutes 2016, section 246.014, is amended to read:
246.014 SERVICES.
The measure of services are:
(a) The commissioner of human services shall develop and maintain state-operated
services in a manner consistent with sections 245.461 and 245.487 and chapters 252, 254A,
and 254B. State-operated services shall be provided in coordination with counties and other
vendors. State-operated services shall include regional treatment centers, specialized inpatient
or outpatient treatment programs, enterprise services, community-based services and
programs, community preparation services, consultative services, and other services
consistent with the mission of the Department of Human Services. These services deleted text begin shalldeleted text end new text begin maynew text end
include crisis beds, waivered homes, intermediate care facilities, and day training and
habilitation facilities. The administrative structure of state-operated services must be
statewide in character. The state-operated services staff may deliver services at any location
throughout the state.
(b) The commissioner of human services shall create and maintain forensic services
programs. Forensic services shall be provided in coordination with counties and other
vendors. Forensic services shall include specialized inpatient programs at secure treatment
facilities as defined in sections 253B.02, subdivision 18a, and 253D.02, subdivision 13,
consultative services, aftercare services, community-based services and programs, transition
services, nursing home services, or other services consistent with the mission of the
Department of Human Services.
(c) Community preparation services as identified in paragraphs (a) and (b) are defined
as specialized inpatient or outpatient services or programs operated outside of a secure
environment but are administered by a secured treatment facility.
(d) The commissioner of human services may establish policies and procedures which
govern the operation of the services and programs under the direct administrative authority
of the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2016, section 246B.05, is amended to read:
246B.05 MINNESOTA SEX OFFENDER PROGRAM; VOCATIONAL WORK
PROGRAM OPTION.
Subdivision 1.
Vocational work program option.
The commissioner deleted text begin of human servicesdeleted text end
shall develop a vocational work program for persons admitted to the Minnesota sex offender
program. The vocational work program is an extension of therapeutic treatment deleted text begin in orderdeleted text end for
civilly committed sex offenders to learn valuable work skills deleted text begin and work habits while
contributing to their cost of care. The vocational work program may include work maintaining
the center or work that is brought to the center by an outside source.deleted text end new text begin training and educational
training, and to develop proper work habits and extended treatment services. The industrial
and commercial activities authorized by this section are designated Minnesota state industries.new text end
The earnings generated from the vocational work program must be deposited into the account
created in subdivision 2.
Subd. 2.
Minnesota sex offender program; vocational work program account.
A
vocational work program account is created in the state treasury. Money collected by the
commissioner deleted text begin of human servicesdeleted text end for the program under this section must be deposited in
this account. Money in the account is appropriated to the commissioner deleted text begin for purposes of this
section.deleted text end new text begin to be used for the vocational work program authorized under this section, including
the purchase of equipment and raw materials, the payment of salaries and wages, and other
necessary expenses as determined by the commissioner. The purchase of a service, material,
and commodity used in and held for resale is not subject to the competitive bidding
procedures of section 16C.06, but is subject to all other provisions of chapters 16B and 16C.
If practical, a purchase must be made from a small targeted group business designated under
section 16C.16.
new text end
Subd. 3.
Money.
The commissioner has the authority to collect money resulting from
the vocational work program for reinvestment within the program.
new text begin Subd. 4. new text end
new text begin Wages. new text end
new text begin
Notwithstanding section 177.24 or any other law, the commissioner
has the discretion to set the pay rate for an individual participating in the vocational work
program. The commissioner has the authority to retain up to 50 percent of a payment made
to an individual participating in the vocational work program to reduce state costs associated
with operating the Minnesota sex offender program.
new text end
new text begin Subd. 5. new text end
new text begin Status of civilly committed sex offenders. new text end
new text begin
A civilly committed sex offender
participating in the vocational work program is not an employee of the Minnesota sex
offender program, the Department of Human Services, or the state, and is not subject to fair
labor standards under sections 177.21 to 177.35; workers' compensation under sections
176.011 to 176.862; the Minnesota Human Rights Act under sections 363A.01 to 363A.44;
laws governing state employees under chapter 43A; the Public Employment Labor Relations
Act under chapter 179A; or the successors to any of these sections and any other laws
pertaining to employees and employment.
new text end
new text begin Subd. 6. new text end
new text begin Claims. new text end
new text begin
A claim or demand arising out of injury to or death of a civilly
committed sex offender while the individual is participating in the vocational work program
or performing a work assignment maintaining the facility must be presented to, heard by,
and determined exclusively by the legislature as provided in section 3.738.
new text end
new text begin Subd. 7. new text end
new text begin Indirect costs and reimbursements. new text end
new text begin
The commissioner is not required to
include indirect costs as defined in section 16A.127 in work activity contracts for a client
of the Minnesota sex offender program and is not required to reimburse the general fund
for indirect costs related to work activity programs.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2016, section 246B.10, is amended to read:
246B.10 LIABILITY OF COUNTY; REIMBURSEMENT.
new text begin (a) new text end The civilly committed sex offender's county shall pay to the state a portion of the
cost of care provided in the Minnesota sex offender program to a civilly committed sex
offender who has legally settled in that county. A county's payment must be made from the
county's own sources of revenue and payments must equal 25 percent of the cost of care,
as determined by the commissioner, for each day or portion of a day, deleted text begin that thedeleted text end new text begin for which the new text end
civilly committed sex offender deleted text begin spends at the facilitydeleted text end new text begin receives services, either within a
Minnesota sex offender program facility or while on provisional dischargenew text end .
new text begin (b)new text end If payments received by the state under this chapter exceed 75 percent of the cost of
carenew text begin for an individual admitted to the program after August 1, 2011new text end , the county is responsible
for paying the state the remaining amount.
new text begin
(c) If payments received by the state under this chapter exceeds 90 percent of the cost
of care for an individual admitted to the program before August 1, 2011, the county is
responsible for paying the state the remaining amount.
new text end
new text begin (d)new text end The county is not entitled to reimbursement from the civilly committed sex offender,
the civilly committed sex offender's estate, or from the civilly committed sex offender's
relatives, except as provided in section 246B.07.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017. The inclusion of services
while on provisional discharge applies to services received on or after July 1, 2017, regardless
of the date the civilly committed sex offender was provisionally discharged.
new text end
Sec. 4.
Minnesota Statutes 2016, section 253B.19, subdivision 1, is amended to read:
Subdivision 1.
Creation.
The Supreme Court shall establish an appeal panel composed
of three judges and four alternate judges appointed from among the acting judges of the
state. Panel members shall serve for terms of one year each. Only three judges need hear
any case. One of the regular three appointed judges shall be designated as the chief judge
of the appeal panel. The chief judge is vested with power to fix the time and place of all
hearings before the panel, issue all notices, subpoena witnesses, appoint counsel for the
patient, if necessary, and supervise and direct the operation of the appeal panel. The chief
judge shall designate one of the other judges or an alternate judge to act as chief judge in
any case where the chief judge is unable to act. No member of the appeal panel shall take
part in the consideration of any case in which that judge committed the patient. deleted text begin The chief
justice of the Supreme Court shall determine the compensation of the judges serving on the
appeal panel. The compensation shall be in addition to their regular compensation as judges.
All compensation and expenses of the appeal panel and all allowable fees and costs of the
patient's counsel shall be established and paid by the Department of Human Services.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017, and applies to all
compensation, costs, and expenses incurred on or after July 1, 2017.
new text end
Sec. 5.
Minnesota Statutes 2016, section 253B.19, is amended by adding a subdivision to
read:
new text begin Subd. 1b. new text end
new text begin Compensation, costs, and expenses. new text end
new text begin
(a) The chief justice of the Supreme
Court shall determine the compensation of the judges serving on the appeal panel. The
compensation shall be in addition to the judges' regular compensation as judges.
new text end
new text begin
(b) All compensation and expenses of the appeal panel shall be paid by the judicial
branch from judicial branch funds, including the costs of employing law clerks, court
reporters, assistant appellate court clerks, and any other staff, and the costs of courtrooms,
courtroom technology, and courtroom security.
new text end
new text begin
(c) For proceedings originating pursuant to section 253D.28, all allowable fees and costs
of the court-appointed counsel for the committed person, as defined in section 253D.02,
subdivision 4, and all allowable fees and costs of a court-appointed examiner shall be
established and paid by the judicial branch from judicial branch funds. Allowable fees and
costs include expenses associated with an appeal of a judicial appeal panel order.
new text end
new text begin
(d) For proceedings originating from subdivision 2, the Department of Human Services
shall reimburse the judicial branch for the compensation and expenses described in paragraph
(b). All allowable fees and costs of the court-appointed counsel for the patient, as defined
in section 253B.02, subdivision 15, and all allowable fees and costs of a court-appointed
examiner shall be established and paid by the Department of Human Services from
Department of Human Services funds. Allowable fees and costs include expenses associated
with an appeal of a judicial appeal panel order.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017, and applies to all
compensation, costs, and expenses incurred on or after July 1, 2017.
new text end
Sec. 6. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2016, section 246B.06,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 7
CHILDREN AND FAMILIES SERVICES
Section 1.
Minnesota Statutes 2016, section 119B.011, subdivision 6, is amended to read:
Subd. 6.
Child care fund.
"Child care fund" means a program under this chapter
providing:
(1) financial assistance for child care tonew text begin support:
new text end
new text begin (i)new text end parents engaged in employment, job search, or education and training leading to
employment, or an at-home infant child care subsidynew text begin ; and
new text end
new text begin (ii) the development and school readiness of childrennew text end ; and
(2) grants to develop, expand, and improve the access and availability of child care
services statewide.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2016, section 119B.011, is amended by adding a subdivision
to read:
new text begin Subd. 13b. new text end
new text begin Homeless. new text end
new text begin
"Homeless" means a self-declared housing status as defined in
the McKinney-Vento Act, United States Code, title 42, section 11302, paragraph (a).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 3.
Minnesota Statutes 2016, section 119B.011, is amended by adding a subdivision
to read:
new text begin Subd. 15b. new text end
new text begin Law enforcement authority. new text end
new text begin
"Law enforcement authority" means a
government agency or department within or outside Minnesota with jurisdiction to investigate
or bring a civil or criminal action against a child care provider, including a county, city, or
district attorney's office, the Attorney General's Office, a human services agency, a United
States attorney's office, or a law enforcement agency.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 4.
Minnesota Statutes 2016, section 119B.011, is amended by adding a subdivision
to read:
new text begin Subd. 16a. new text end
new text begin Legal nonlicensed related provider. new text end
new text begin
"Legal nonlicensed related provider"
means a legal nonlicensed child care provider under subdivision 16 who cares for children
related to the provider and does not care for any child receiving assistance under this chapter
who is not related to the provider. For purposes of this subdivision, "related" means the
provider is, by marriage, blood relationships, or court decrees, a sibling, grandparent, aunt,
or uncle of the child.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 25, 2017.
new text end
Sec. 5.
Minnesota Statutes 2016, section 119B.011, is amended by adding a subdivision
to read:
new text begin Subd. 16b. new text end
new text begin Legal nonlicensed unrelated provider. new text end
new text begin
"Legal nonlicensed unrelated
provider" means a legal nonlicensed child care provider under subdivision 16 who provides
care in Minnesota for at least one child receiving assistance under this chapter who is not
related to the provider. For purposes of this subdivision, "related" means the provider is,
by marriage, blood relationships, or court decrees, a sibling, grandparent, aunt, or uncle of
the child.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 25, 2017.
new text end
Sec. 6.
Minnesota Statutes 2016, section 119B.011, subdivision 19, is amended to read:
Subd. 19.
Provider.
"Provider" means:
(1) an individual or child care center or facilitydeleted text begin , either licensed or unlicensed,deleted text end providing
new text begin licensed new text end legal child care services as defined under section 245A.03; deleted text begin or
deleted text end
new text begin
(2) a license-exempt center required to be certified under chapter 245G;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end an individual or child care center or facility deleted text begin holdingdeleted text end new text begin that:
new text end
new text begin (i) holdsnew text end a valid child care license issued by another state or a tribe deleted text begin and providingdeleted text end new text begin ;
new text end
new text begin (ii) providesnew text end child care services in the licensing state or in the area under the licensing
tribe's jurisdictiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(iii) is in compliance with federal health and safety requirements as certified by the
licensing state or tribe, or as determined by receipt of Child Care Development Block Grant
funds in the licensing state; or
new text end
new text begin (4) a legal nonlicensed child care provider as defined under section 119B.011, subdivision
16, providing legal child care services. new text end A deleted text begin legally unlicensed familydeleted text end new text begin legal nonlicensednew text end child
care provider must be at least 18 years of age, and not a member of the MFIP assistance
unit or a member of the family receiving child care assistance to be authorized under this
chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 25, 2017.
new text end
Sec. 7.
Minnesota Statutes 2016, section 119B.011, is amended by adding a subdivision
to read:
new text begin Subd. 19c. new text end
new text begin Stop payment. new text end
new text begin
"Stop payment" means canceling a payment that was already
issued to a provider.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 8.
Minnesota Statutes 2016, section 119B.011, subdivision 20, is amended to read:
Subd. 20.
Transition year families.
"Transition year families" means families who have
received MFIP assistance, or who were eligible to receive MFIP assistance after choosing
to discontinue receipt of the cash portion of MFIP assistance under section 256J.31,
subdivision 12, or families who have received DWP assistance under section 256J.95 for
at least deleted text begin threedeleted text end new text begin onenew text end of the last six months before losing eligibility for MFIP or DWP.
new text begin Notwithstanding Minnesota Rules, part 3400.0040, subpart 10, and 3400.0090, subpart 2,
new text end transition year child care may be used to support employmentnew text begin , approved education or training
programs,new text end or job searchnew text begin that meets the requirements of section 119B.10new text end . Transition year
child care is not available to families who have been disqualified from MFIP or DWP due
to fraud.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 23, 2017.
new text end
Sec. 9.
Minnesota Statutes 2016, section 119B.011, subdivision 20a, is amended to read:
Subd. 20a.
Transition year extension families.
"Transition year extension families"
means families who have completed their transition year of child care assistance under this
subdivision and who are eligible for, but on a waiting list for, services under section 119B.03.
For purposes of sections 119B.03, subdivision 3, and 119B.05, subdivision 1, clause (2),
families participating in extended transition year shall not be considered transition year
families. new text begin Notwithstanding Minnesota Rules, parts 3400.0040, subpart 10, and 3400.0090,
subpart 2, new text end transition year extension child care may be used to support employmentnew text begin , approved
education or training programs,new text end or a job search that meets the requirements of section
119B.10 for the length of time necessary for families to be moved from the basic sliding
fee waiting list into the basic sliding fee program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 23, 2017.
new text end
Sec. 10.
Minnesota Statutes 2016, section 119B.02, subdivision 1, is amended to read:
Subdivision 1.
Child care services.
The commissioner shall develop standards for county
and human services boards to provide child care services to enable eligible families to
participate in employment, training, or education programs. Within the limits of available
appropriations, the commissioner shall distribute money to counties to reduce the costs of
child care for eligible families. The commissioner shall adopt rules to govern the program
in accordance with this section. The rules must establish a sliding schedule of fees for parents
receiving child care services. The rules shall provide that funds received as a lump-sum
payment of child support arrearages shall not be counted as income to a family in the month
received but shall be prorated over the 12 months following receipt and added to the family
income during those months. new text begin The commissioner may establish limits on how frequently
expedited application processing timelines are used for an applicant who declares that the
applicant is homeless. The commissioner may adopt rules to implement changes under this
subdivision. new text end The commissioner shall maximize the use of federal money under title I and
title IV of Public Law 104-193, the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, and other programs that provide federal or state reimbursement
for child care services for low-income families who are in education, training, job search,
or other activities allowed under those programs. Money appropriated under this section
must be coordinated with the programs that provide federal reimbursement for child care
services to accomplish this purpose. Federal reimbursement obtained must be allocated to
the county that spent money for child care that is federally reimbursable under programs
that provide federal reimbursement for child care services. The counties shall use the federal
money to expand child care services. The commissioner may adopt rules under chapter 14
to implement and coordinate federal program requirements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 11.
Minnesota Statutes 2016, section 119B.02, subdivision 5, is amended to read:
Subd. 5.
Program integrity.
For child care assistance programs under this chapter, the
commissioner shall enforce the requirements for program integrity and fraud prevention
investigations under sections 256.046, 256.98, and 256.983new text begin and chapter 245Enew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 12.
Minnesota Statutes 2016, section 119B.025, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Factors which must be verifieddeleted text end new text begin Applicationsnew text end .
(a) The county shall
verify the following at all initial child care applications using the universal application:
(1) identity of adults;
(2) presence of the minor child in the home, if questionable;
(3) relationship of minor child to the parent, stepparent, legal guardian, eligible relative
caretaker, or the spouses of any of the foregoing;
(4) age;
(5) immigration status, if related to eligibility;
(6) Social Security number, if given;
(7) new text begin counted new text end income;
(8) spousal support and child support payments made to persons outside the household;
(9) residence; and
(10) inconsistent information, if related to eligibility.
(b) deleted text begin If a family did not use the universal application or child care addendum to apply for
child care assistance, the family must complete the universal application or child care
addendum at its next eligibility redetermination and the county must verify the factors listed
in paragraph (a) as part of that redetermination. Once a family has completed a universal
application or child care addendum, the county shall use the redetermination form described
in paragraph (c) for that family's subsequent redeterminations. Eligibility must be
redetermined at least every six months. A family is considered to have met the eligibility
redetermination requirement if a complete redetermination form and all required verifications
are received within 30 days after the date the form was due. When the 30th day after the
date the form was due falls on a Saturday, Sunday, or legal holiday, the 30-day time period
is extended to include the next succeeding day that is not a Saturday, Sunday, or legal
holiday. Assistance shall be payable retroactively from the redetermination due date. For a
family where at least one parent is under the age of 21, does not have a high school or
general equivalency diploma, and is a student in a school district or another similar program
that provides or arranges for child care, as well as parenting, social services, career and
employment supports, and academic support to achieve high school graduation, the
redetermination of eligibility shall be deferred beyond six months, but not to exceed 12
months, to the end of the student's school year. If a family reports a change in an eligibility
factor before the family's next regularly scheduled redetermination, the county must
recalculate eligibility without requiring verification of any eligibility factor that did not
change. Changes must be reported as required by section 256P.07. A change in income
occurs on the day the participant received the first payment reflecting the change in income.deleted text end new text begin
The county must mail a notice of approval or denial of assistance to the applicant within
30 calendar days after receiving the application. The county may extend the response time
by 15 calendar days if the applicant is informed of the extension.
new text end
(c) deleted text begin The commissioner shall develop a redetermination form to redetermine eligibility
and a change report form to report changes that minimize paperwork for the county and the
participant.deleted text end new text begin The county must send a notice of approval or denial of assistance to an applicant
who declares that the applicant is homeless and who meets the definition of homeless under
section 119B.011, subdivision 13b, within five working days after receiving the application.
The county is not required to verify the factors under paragraph (a) before issuing the notice
of approval or denial. An applicant must submit proof of eligibility within three months of
the date the application was received by the county. If the applicant does not submit the
proof of eligibility within three months, the applicant's eligibility ends. The county must
send a 15-day adverse action notice to end an applicant's eligibility.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (a) and (b) are effective the day following final
enactment. Paragraph (c) is effective December 18, 2017.
new text end
Sec. 13.
Minnesota Statutes 2016, section 119B.025, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Redeterminations. new text end
new text begin
(a) Notwithstanding Minnesota Rules, part 3400.0180, item
A, the county shall conduct a redetermination according to paragraphs (b) and (c).
new text end
new text begin
(b) The county shall use the redetermination form developed by the commissioner. The
county must verify the factors listed in subdivision 1, paragraph (a), as part of the
redetermination.
new text end
new text begin
(c) An applicant's eligibility must be redetermined no more frequently than every 12
months. The following criteria apply:
new text end
new text begin
(1) a family meets the eligibility redetermination requirements if a complete
redetermination form and all required verifications are received within 30 days after the
date the form was due;
new text end
new text begin
(2) if the 30th day after the date the form was due falls on a Saturday, Sunday, or holiday,
the 30-day time period is extended to include the next day that is not a Saturday, Sunday,
or holiday. Assistance shall be payable retroactively from the redetermination due date;
new text end
new text begin
(3) for a family where at least one parent is under 21 years of age, does not have a high
school degree or general equivalency diploma, and is a student in a school district or another
similar program that provides or arranges for child care; parenting, social services, career
and employment supports; and academic support to achieve high school graduation, the
redetermination of eligibility may be deferred beyond 12 months, to the end of the student's
school year; and
new text end
new text begin
(4) a family and the family's providers must be notified that the family's redetermination
is due at least 45 days before the end of the family's 12-month eligibility period.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 23, 2017.
new text end
Sec. 14.
Minnesota Statutes 2016, section 119B.025, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Changes in eligibility. new text end
new text begin
(a) The county shall process a change in eligibility
factors according to paragraphs (b) to (g).
new text end
new text begin
(b) A family is subject to the reporting requirements in section 256P.07.
new text end
new text begin
(c) If a family reports a change or a change is known to the agency before the family's
regularly scheduled redetermination, the county must act on the change. The commissioner
shall establish standards for verifying changes.
new text end
new text begin
(d) A change in income occurs on the day the participant received the first payment
reflecting the change in income.
new text end
new text begin
(e) During a family's 12-month eligibility period, if the family's income increases and
remains at or below 85 percent of the state median income, adjusted for family size, there
is no change to the family's eligibility. The county shall not request verification of the
change. The co-payment fee shall not increase during the remaining portion of the family's
12-month eligibility period.
new text end
new text begin
(f) During a family's 12-month eligibility period, if the family's income increases and
exceeds 85 percent of the state median income, adjusted for family size, the family is not
eligible for child care assistance. The family must be given 15 calendar days to provide
verification of the change. If the required verification is not returned or confirms ineligibility,
the family's eligibility ends following a subsequent 15-day adverse action notice.
new text end
new text begin
(g) Notwithstanding Minnesota Rules, parts 3400.0040, subpart 3, and 3400.0170,
subpart 1, if an applicant or participant reports that employment ended, the agency may
accept a signed statement from the applicant or participant as verification that employment
ended.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (a) and (b) are effective the day following final
enactment. Paragraphs (c) to (g) are effective October 23, 2017.
new text end
Sec. 15.
Minnesota Statutes 2016, section 119B.03, subdivision 3, is amended to read:
Subd. 3.
Eligible participants.
Families that meet the eligibility requirements under
sections deleted text begin 119B.07,deleted text end 119B.09deleted text begin ,deleted text end and 119B.10, except MFIP participants, diversionary work
program, and transition year families are eligible for child care assistance under the basic
sliding fee program. Families enrolled in the basic sliding fee program shall be continued
until they are no longer eligible. Child care assistance provided through the child care fund
is considered assistance to the parent.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 16.
Minnesota Statutes 2016, section 119B.03, subdivision 9, is amended to read:
Subd. 9.
Portability pool.
(a) The commissioner shall establish a pool of up to five
percent of the annual appropriation for the basic sliding fee program to provide continuous
child care assistance for eligible families who move between Minnesota counties. At the
end of each allocation period, any unspent funds in the portability pool must be used for
assistance under the basic sliding fee program. If expenditures from the portability pool
exceed the amount of money available, the reallocation pool must be reduced to cover these
shortages.
(b) To be eligible for portable basic sliding fee assistance, a family that has moved from
a county in which it was receiving basic sliding fee assistance to a county with a waiting
list for the basic sliding fee program must:
(1) meet the income and eligibility guidelines for the basic sliding fee program; and
(2) notify the new county of residence within 60 days of moving and submit information
to the new county of residence to verify eligibility for the basic sliding fee program.
(c) The receiving county must:
(1) accept administrative responsibility for applicants for portable basic sliding fee
assistance at the end of the two months of assistance under the Unitary Residency Act;
(2) continue new text begin portability pool new text end basic sliding fee assistance deleted text begin for the lesser of six months ordeleted text end
until the family is able to receive assistance under the county's regular basic sliding program;
and
(3) notify the commissioner through the quarterly reporting process of any family that
meets the criteria of the portable basic sliding fee assistance pool.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 23, 2017.
new text end
Sec. 17.
Minnesota Statutes 2016, section 119B.05, subdivision 1, is amended to read:
Subdivision 1.
Eligible participants.
Families eligible for child care assistance under
the MFIP child care program are:
(1) MFIP participants who are employed or in job search and meet the requirements of
section 119B.10;
(2) persons who are members of transition year families under section 119B.011,
subdivision 20, and meet the requirements of section 119B.10;
(3) families who are participating in employment orientation or job search, or other
employment or training activities that are included in an approved employability development
plan under section 256J.95;
(4) MFIP families who are participating in work job search, job support, employment,
or training activities as required in their employment plan, or in appeals, hearings,
assessments, or orientations according to chapter 256J;
(5) MFIP families who are participating in social services activities under chapter 256J
as required in their employment plan approved according to chapter 256J;
(6) families who are participating in services or activities that are included in an approved
family stabilization plan under section 256J.575;
(7) families who are participating in programs as required in tribal contracts under section
119B.02, subdivision 2, or 256.01, subdivision 2;
(8) families who are participating in the transition year extension under section 119B.011,
subdivision 20a; deleted text begin and
deleted text end
(9) student parents as defined under section 119B.011, subdivision 19bdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(10) student parents who turn 21 years of age and who continue to meet the other
requirements under section 119B.011, subdivision 19b. A student parent continues to be
eligible until the student parent is approved for basic sliding fee child care assistance or
until the student parent's redetermination, whichever comes first. At the student parent's
redetermination, if the student parent was not approved for basic sliding fee child care
assistance, a student parent's eligibility ends following a 15-day adverse action notice.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 23, 2017.
new text end
Sec. 18.
Minnesota Statutes 2016, section 119B.09, subdivision 1, is amended to read:
Subdivision 1.
General eligibility requirements deleted text begin for all applicants for child care
assistancedeleted text end .
(a) Child care services must be available to families who need child care to find
or keep employment or to obtain the training or education necessary to find employment
and who:
(1) have household income less than or equal to 67 percent of the state median income,
adjusted for family size, new text begin at application and redetermination, new text end and meet the requirements of
section 119B.05; receive MFIP assistance; and are participating in employment and training
services under chapter 256J; or
(2) have household income less than or equal to 47 percent of the state median income,
adjusted for family size, at deleted text begin program entrydeleted text end new text begin applicationnew text end and less than or equal to 67 percent
of the state median income, adjusted for family size, at deleted text begin program exitdeleted text end new text begin redeterminationnew text end .
(b) Child care services must be made available as in-kind services.
(c) All applicants for child care assistance and families currently receiving child care
assistance must be assisted and required to cooperate in establishment of paternity and
enforcement of child support obligations for all children in the family new text begin at application and
redetermination new text end as a condition of program eligibility. For purposes of this section, a family
is considered to meet the requirement for cooperation when the family complies with the
requirements of section 256.741.
new text begin
(d) All applicants for child care assistance and families currently receiving child care
assistance must pay the co-payment fee under section 119B.12, subdivision 2, as a condition
of eligibility. The co-payment fee may include additional recoupment fees due to a child
care assistance program overpayment.
new text end
new text begin
(e) At application and redetermination, a family must self-certify that the value of the
family's assets is less than or equal to $1,000,000 as a condition of eligibility. The
commissioner shall establish procedures to determine the value of countable assets when a
family self-certifies that the value of the family's assets is greater than $1,000,000. The
value of countable assets must be less than or equal to $1,000,000 as a condition of eligibility
at application and redetermination.
new text end
new text begin
(f) If a family has one child with a child care authorization and the child turns 13 years
of age or the child has a disability and turns 15 years of age, the family remains eligible
until the redetermination.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (a) and (c) are effective October 23, 2017. Paragraph
(d) is effective the day following final enactment. Paragraph (e) is effective February 26,
2018. Paragraph (f) is effective December 18, 2017.
new text end
Sec. 19.
Minnesota Statutes 2016, section 119B.09, subdivision 4, is amended to read:
Subd. 4.
Eligibility; annual income; calculation.
new text begin (a) new text end Annual income of the applicant
family is the current monthly income of the family multiplied by 12 or the income for the
12-month period immediately preceding the date of application, or income calculated by
the method which provides the most accurate assessment of income available to the family.
new text begin (b) new text end Self-employment income must be calculated based on deleted text begin gross receipts less operating
expenses. Income must be recalculated when the family's income changes, but no less often
than every six months. For a family where at least one parent is under the age of 21, does
not have a high school or general equivalency diploma, and is a student in a school district
or another similar program that provides or arranges for child care, as well as parenting,
social services, career and employment supports, and academic support to achieve high
school graduation, income must be recalculated when the family's income changes, but
otherwise shall be deferred beyond six months, but not to exceed 12 months, to the end of
the student's school yeardeleted text end new text begin section 256P.05.
new text end
new text begin (c) Income changes are processed under section 119B.025, subdivision 4new text end . Included lump
sums counted as income under section 256P.06, subdivision 3, must be annualized over 12
months. Income must be verified with documentary evidence. If the applicant does not have
sufficient evidence of income, verification must be obtained from the source of the income.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective the day following final enactment.
Paragraph (b) is effective July 30, 2018. Paragraph (c) is effective October 23, 2017.
new text end
Sec. 20.
Minnesota Statutes 2016, section 119B.09, subdivision 9a, is amended to read:
Subd. 9a.
Child care centers; assistance.
(a) deleted text begin For the purposes of this subdivision,
"qualifying child" means a child who is not a child or dependent of an employee of the child
care provider.deleted text end new text begin A child care center may receive authorizations for 25 or fewer children who
are dependents of the center's employees. If a child care center is authorized for more than
25 children who are dependents of center employees, the county cannot authorize additional
dependents of an employee until the number of children falls below 25.
new text end
deleted text begin
(b) Funds distributed under this chapter must not be paid for child care services that are
provided for a child or dependent of an employee under paragraph (a) unless at all times at
least 50 percent of the children for whom the child care provider is providing care are
qualifying children under paragraph (a).
deleted text end
deleted text begin
(c) If a child care provider satisfies the requirements for payment under paragraph (b),
but the percentage of qualifying children under paragraph (a) for whom the provider is
providing care falls below 50 percent, the provider shall have four weeks to raise the
percentage of qualifying children for whom the provider is providing care to at least 50
percent before payments to the provider are discontinued for child care services provided
for a child who is not a qualifying child.
deleted text end
deleted text begin
(d) This subdivision shall be implemented as follows:
deleted text end
deleted text begin
(1) no later than August 1, 2014, the commissioner shall issue a notice to providers who
have been identified as ineligible for funds distributed under this chapter as described in
paragraph (b); and
deleted text end
deleted text begin
(2) no later than January 5, 2015, payments to providers who do not comply with
paragraph (c) will be discontinued for child care services provided for children who are not
qualifying children.
deleted text end
deleted text begin
(e) If a child's authorization for child care assistance is terminated under this subdivision,
the county shall send a notice of adverse action to the provider and to the child's parent or
guardian, including information on the right to appeal, under Minnesota Rules, part
3400.0185.
deleted text end
deleted text begin (f)deleted text end new text begin (b)new text end Funds paid to providers during the period of time deleted text begin between the issuance of a notice
under paragraph (d), clause (1), and discontinuation of payments under paragraph (d), clause
(2),deleted text end new text begin when a center is authorized for more than 25 children who are dependents of center
employeesnew text end must not be treated as overpayments under section 119B.11, subdivision 2a, due
to noncompliance with this subdivision.
deleted text begin (g)deleted text end new text begin (c)new text end Nothing in this subdivision precludes the commissioner from conducting fraud
investigations relating to child care assistance, imposing sanctions, and obtaining monetary
recovery as otherwise provided by law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 21.
new text begin
[119B.095] CHILD CARE AUTHORIZATIONS.
new text end
new text begin Subdivision 1. new text end
new text begin General authorization requirements. new text end
new text begin
(a) When authorizing the amount
of child care, the county agency must consider the amount of time the parent reports on the
application or redetermination form that the child attends preschool, a Head Start program,
or school while the parent is participating in an authorized activity.
new text end
new text begin
(b) Care must be authorized and scheduled with a provider based on the applicant's or
participant's verified activity schedule when:
new text end
new text begin
(1) the family requests care from more than one provider per child;
new text end
new text begin
(2) the family requests care from a legal nonlicensed provider; or
new text end
new text begin
(3) an applicant or participant is employed by any business that is licensed by the
Department of Human Services or Medicaid-enrolled as verified through the department's
Web site.
new text end
new text begin
(c) If the conditions in paragraph (b) do not apply, the county does not need to verify
the applicant's or participant's activity schedule and the amount of child care assistance
authorized may be used at times determined by the family.
new text end
new text begin
(d) If the family remains eligible at redetermination, a new authorization with fewer
hours, the same hours, or increased hours may be determined.
new text end
new text begin Subd. 2. new text end
new text begin Maintain steady child care authorizations. new text end
new text begin
(a) Notwithstanding Minnesota
Rules, chapter 3400, the amount of child care authorized under section 119B.10 for
employment, education, or an MFIP or DWP employment plan shall continue at the same
number of hours or more hours until redetermination, including:
new text end
new text begin
(1) when the other parent moves in and is employed or has an education plan under
section 119B.10, subdivision 3, or has an MFIP or DWP employment plan; or
new text end
new text begin
(2) when a participant's work hours are reduced or a participant temporarily stops working
or attending an approved education program. Temporary changes include, but are not limited
to, a medical leave, seasonal employment fluctuations, or a school break between semesters.
new text end
new text begin
(b) The county may increase the amount of child care authorized at any time if the
participant verifies the need for increased hours for authorized activities.
new text end
new text begin
(c) The county may reduce the amount of child care authorized if a parent requests a
reduction or because of a change in:
new text end
new text begin
(1) the child's school schedule;
new text end
new text begin
(2) the custody schedule; or
new text end
new text begin
(3) the provider's availability.
new text end
new text begin
(d) When a child reaches 13 years of age or a child with a disability reaches 15 years of
age, the amount of child care authorized shall continue at the same number of hours or more
hours until redetermination.
new text end
new text begin
(e) The amount of child care authorized for a family subject to subdivision 1, paragraph
(b), must change when the participant's activity schedule changes. Paragraph (a) does not
apply to a family subject to subdivision 1, paragraph (b).
new text end
new text begin Subd. 3. new text end
new text begin Assistance for persons who are homeless. new text end
new text begin
An applicant who is homeless and
is eligible for child care assistance under this chapter is eligible for 60 hours of child care
assistance per service period for three months from the date the county receives the
application. Additional hours may be authorized as needed based on the applicant's
participation in an employment, education, or MFIP or DWP employment plan. To continue
receiving child care assistance after the initial three months, the applicant must verify that
the applicant meets eligibility and activity requirements for child care assistance under this
chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 22.
new text begin
[119B.097] AUTHORIZATION WITH A SECONDARY PROVIDER.
new text end
new text begin
(a) If a child uses any combination of the following providers paid by child care
assistance, a parent must choose one primary provider and one secondary provider per child
that can be paid by child care assistance:
new text end
new text begin
(1) an individual or child care center licensed under chapter 245A;
new text end
new text begin
(2) an individual or child care center or facility holding a valid child care license issued
by another state or tribe; or
new text end
new text begin
(3) a child care center exempt from licensing under section 245A.03.
new text end
new text begin
(b) The amount of child care authorized with the secondary provider cannot exceed 20
hours per two-week service period, per child, and the amount of care paid to a child's
secondary provider is limited under section 119B.13, subdivision 1. The total amount of
child care authorized with both the primary and secondary provider cannot exceed the
amount of child care allowed based on the parents' eligible activity schedule, the child's
school schedule, and any other factors relevant to the family's child care needs.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 23.
Minnesota Statutes 2016, section 119B.10, subdivision 1, is amended to read:
Subdivision 1.
Assistance for persons seeking and retaining employment.
(a) deleted text begin Persons
who are seeking employmentdeleted text end new text begin An applicant who is job searching and who is eligible for
child care assistance under this chapter is eligible for 60 hours of child care assistance per
service period for three months from the date of eligibility. Job searching at initial application
is allowed one time per 12-month period. The applicant must meet employment requirements
under paragraph (c) or education requirements under subdivision 3, or have an MFIP or
DWP employment plan, to continue receiving child care assistance after the initial three
months.
new text end
new text begin (b) A participant who meets the employment requirements of paragraph (c) or who is
attending an approved education or training program under subdivision 3new text end and who deleted text begin are
eligible fordeleted text end new text begin is receiving child carenew text end assistance under this deleted text begin section aredeleted text end new text begin chapter isnew text end eligible to
receive deleted text begin up to 240deleted text end new text begin an additional tennew text end hours of child care assistance per deleted text begin calendar yeardeleted text end new text begin service
period for job searchnew text end .
deleted text begin (b)deleted text end new text begin (c) At application and redetermination,new text end employed persons who work at least an
average of 20 hours and full-time students who work at least an average of ten hours a week
and receive at least a minimum wage for all hours worked are eligible for deleted text begin continueddeleted text end child
care assistance for employment. For purposes of this section, work-study programs must
be counted as employment. new text begin An employed person with an MFIP or DWP employment plan
shall receive child care assistance as specified in the person's employment plan. new text end Child care
assistance during employment must be authorized as provided in paragraphs deleted text begin (c) anddeleted text end (d)new text begin and
(e)new text end .
deleted text begin (c)deleted text end new text begin (d)new text end When the person works for an hourly wage and the hourly wage is equal to or
greater than the applicable minimum wage, child care assistance shall be provided for the
deleted text begin actualdeleted text end hours of employment, break, and mealtime during the employmentnew text begin ,new text end and travel time
up to two hours per day.
deleted text begin (d)deleted text end new text begin (e)new text end When the person does not work for an hourly wage, child care assistance must
be provided for the lesser of:
(1) the amount of child care determined by dividing gross earned income new text begin or, for a
self-employed person, the self-employment income determined under section 256P.05,
subdivision 2, new text end by the applicable minimum wage, up to one hour every eight hours for meals
and break time, plus up to two hours per day for travel time; or
(2) the amount of child care equal to the actual amount of child care used during
employment, including break and mealtime during employment, and travel time up to two
hours per day.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (a) to (d) are effective December 18, 2017. Paragraph
(e) is effective July 30, 2018.
new text end
Sec. 24.
Minnesota Statutes 2016, section 119B.10, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin
Assistance for persons attending an approved education or training
program.
new text end
new text begin
(a) Money for an eligible person according to sections 119B.03, subdivision 3,
and 119B.05, subdivision 1, shall be used to reduce child care costs for a student. The county
shall not limit the duration of child care subsidies for a person in an employment or
educational program unless the person is ineligible for child care funds. Any other limitation
must be based on county policies included in the approved child care fund plan.
new text end
new text begin
(b) To be eligible, the student must be in good standing and making satisfactory progress
toward the degree. The maximum length of time a student is eligible for child care assistance
under the child care fund for education and training is no more than the time necessary to
complete the credit requirements for an associate or baccalaureate degree as determined by
the educational institution. Time limitations for child care assistance do not apply to basic
or remedial educational programs needed for postsecondary education or employment. Basic
or remedial educational programs include high school, general equivalency diploma, and
English as a second language programs. A program exempt from this time limit must not
run concurrently with a postsecondary program.
new text end
new text begin
(c) If a student meets the conditions of paragraphs (a) and (b), child care assistance must
be authorized for all hours of class time and credit hours, including independent study and
internships, and up to two hours of travel time per day. A postsecondary student shall receive
four hours of child care assistance per credit hour for study time and academic appointments
per service period.
new text end
new text begin
(d) For an MFIP or DWP participant, child care assistance must be authorized according
to the person's approved employment plan. If an MFIP or DWP participant receiving MFIP
or DWP child care assistance under this chapter moves to another county, continues to
participate in an authorized educational or training program, and remains eligible for MFIP
or DWP child care assistance, the participant must receive continued child care assistance
from the county responsible for the person's current employment plan under section 256G.07.
new text end
new text begin
(e) If a person with an approved education program under section 119B.03, subdivision
3, or 119B.05, subdivision 1, begins receiving MFIP or DWP assistance, the person continues
to receive child care assistance for the approved education program until the person's
education is included in an approved MFIP or DWP employment plan or until
redetermination, whichever occurs first.
new text end
new text begin
(f) If a person's MFIP or DWP assistance ends and the approved MFIP or DWP
employment plan included education, the person continues to be eligible for child care
assistance for education under transition year child care assistance until the person's education
is included in an approved education plan or until redetermination.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 25.
new text begin
[119B.105] EXTENDED ELIGIBILITY AND AUTHORIZATION.
new text end
new text begin Subdivision 1. new text end
new text begin Three-month extended eligibility period. new text end
new text begin
(a) A family in a situation
under paragraph (b) continues to be eligible for up to three months or until the family's
redetermination, whichever occurs first, rather than losing eligibility or having the family's
eligibility suspended. During extended eligibility, the amount of child care authorized shall
continue at the same number or more hours. The family must continue to meet all other
eligibility requirements under this chapter.
new text end
new text begin
(b) The family's three-month extended eligibility period applies when:
new text end
new text begin
(1) a participant's employment or education program ends permanently;
new text end
new text begin
(2) the other parent moves in and does not participate in an authorized activity;
new text end
new text begin
(3) a participant's MFIP assistance ends and the participant is not participating in an
authorized activity or the participant's participation in an authorized activity is unknown;
new text end
new text begin
(4) a student parent under section 119B.011, subdivision 19b, stops attending school;
or
new text end
new text begin
(5) a participant receiving basic sliding fee child care assistance or transition year child
care assistance applied for MFIP assistance and is not participating in an authorized activity
or the participant's participation in an authorized activity is unknown.
new text end
new text begin Subd. 2. new text end
new text begin Extended eligibility and redetermination. new text end
new text begin
(a) If the family received three
months of extended eligibility and redetermination is not due, to continue receiving child
care assistance the participant must be employed or have an education plan which meets
the requirements of section 119B.10, subdivision 3, or have an MFIP or DWP employment
plan. If child care assistance continues, the amount of child care authorized shall continue
at the same number or more hours until redetermination, unless a condition in section
119B.095, subdivision 2, paragraph (c), applies. A family subject to section 119B.095,
subdivision 1, paragraph (b), shall have child care authorized based on a verified activity
schedule.
new text end
new text begin
(b) If the family's redetermination occurs before the end of the three-month extended
eligibility period to continue receiving child care assistance, the participant must verify that
the participant meets eligibility and activity requirements for child care assistance under
this chapter. If child care assistance continues, the amount of child care authorized is based
on section 119B.10. A family subject to section 119B.095, subdivision 1, paragraph (b),
shall have child care authorized based on a verified activity schedule.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 26.
Minnesota Statutes 2016, section 119B.11, subdivision 2a, is amended to read:
Subd. 2a.
Recovery of overpayments.
(a) An amount of child care assistance paid to a
recipient in excess of the payment due is recoverable by the county agency under paragraphs
(b) and (c), even when the overpayment was caused by agency error or circumstances outside
the responsibility and control of the family or provider.
(b)new text begin (1) new text end An overpayment deleted text begin must be recouped or recovered from the family if the
overpaymentdeleted text end new text begin thatnew text end benefited the family by causing the family to pay less for child care
expenses than the family otherwise would have been required to pay under deleted text begin child care
assistance program requirementsdeleted text end new text begin this chapter must be established and recovered according
to clauses (1) to (5), with the following exceptions:
new text end
new text begin
(i) an overpayment estimated to be less than $500 must not be established or collected;
new text end
new text begin
(ii) the portion of an overpayment that occurred more than one year before the date of
overpayment determination must not be established or collected; or
new text end
new text begin (iii) an overpayment designated solely as agency error must not be established or
collectednew text end .
new text begin (2)new text end If the family remains eligible for child care assistancenew text begin and an overpayment is
establishednew text end , the overpayment must be recovered through recoupment as identified in
Minnesota Rules, part 3400.0187, except that the overpayments must be calculated and
collected on a service period basis. deleted text begin If the family no longer remains eligible for child care
assistance, the county may choose to initiate efforts to recover overpayments from the family
for overpayment less than $50. If the overpayment is greater than or equal to $50,
deleted text end
new text begin (3) If the family is no longer eligible for child care assistance and an overpayment is
established,new text end the county shall seek voluntary repayment of the overpayment from the family.
new text begin (4)new text end If the county is unable to recoup the overpayment through voluntary repayment, the
county shall initiate civil court proceedings to recover the overpayment unless the county's
costs to recover the overpayment will exceed the amount of the overpayment.
new text begin (5)new text end A family with an outstanding debt under this subdivision is not eligible for child care
assistance until:
deleted text begin (1)deleted text end new text begin (i)new text end the debt is paid in full; or
deleted text begin (2)deleted text end new text begin (ii) new text end satisfactory arrangements are made with the county to retire the debt consistent
with the requirements of this chapter and Minnesota Rules, chapter 3400, and the family is
in compliance with the arrangements.
(c) The county must recover an overpayment from a provider if the overpayment did
not benefit the family by causing it to receive more child care assistance or to pay less for
child care expenses than the family otherwise would have been eligible to receive or required
to pay under child care assistance program requirements, and benefited the provider by
causing the provider to receive more child care assistance than otherwise would have been
paid on the family's behalf under child care assistance program requirements. If the provider
continues to care for children receiving child care assistance, the overpayment must be
recovered through reductions in child care assistance payments for services as described in
an agreement with the county. The provider may not charge families using that provider
more to cover the cost of recouping the overpayment. If the provider no longer cares for
children receiving child care assistance, the county may choose to initiate efforts to recover
overpayments of less than $50 from the provider. If the overpayment is greater than or equal
to $50, the county shall seek voluntary repayment of the overpayment from the provider.
If the county is unable to recoup the overpayment through voluntary repayment, the county
shall initiate civil court proceedings to recover the overpayment unless the county's costs
to recover the overpayment will exceed the amount of the overpayment. A provider with
an outstanding debt under this subdivision is not eligible to care for children receiving child
care assistance until:
(1) the debt is paid in full; or
(2) satisfactory arrangements are made with the county to retire the debt consistent with
the requirements of this chapter and Minnesota Rules, chapter 3400, and the provider is in
compliance with the arrangements.
(d) When both the family and the provider acted together to intentionally cause the
overpayment, both the family and the provider are jointly liable for the overpayment
regardless of who benefited from the overpayment. The county must recover the overpayment
as provided in paragraphs (b) and (c). When the family or the provider is in compliance
with a repayment agreement, the party in compliance is eligible to receive child care
assistance or to care for children receiving child care assistance despite the other party's
noncompliance with repayment arrangements.
new text begin
(e) A provider overpayment designated as an agency error because of the application of
an incorrect maximum rate must not be established or collected. Any other provider
overpayment designated as agency error must be established and collected.
new text end
new text begin
(f) Notwithstanding any provision to the contrary in this subdivision, an overpayment
must be established and collected if the overpayment was caused in any part by wrongfully
obtaining assistance under section 256.98 or by benefits paid while an action is pending
appeal under section 119B.16, if on appeal the commissioner finds that the appellant was
ineligible for the amount of child are assistance paid.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 23, 2017.
new text end
Sec. 27.
Minnesota Statutes 2016, section 119B.12, subdivision 2, is amended to read:
Subd. 2.
Parent fee.
A family must be assessed a parent fee for each service period. A
family's parent fee must be a fixed percentage of its annual gross income. Parent fees must
apply to families eligible for child care assistance under sections 119B.03 and 119B.05.
Income must be as defined in section 119B.011, subdivision 15. The fixed deleted text begin percentdeleted text end new text begin percentagenew text end
is based on the relationship of the family's annual gross income to 100 percent of the annual
state median income. Parent fees must begin at 75 percent of the poverty level. The minimum
parent fees for families between 75 percent and 100 percent of poverty level must be $2 per
biweekly period. Parent fees must provide for graduated movement to full payment. new text begin At
initial application, the parent fee is established for the family's 12-month eligibility period.
At redetermination, if the family remains eligible, the parent fee is recalculated and is
established for the next 12-month eligibility period. A parent fee shall not increase during
the 12-month eligibility period. new text end Payment of part or all of a family's parent fee directly to
the family's child care provider on behalf of the family by a source other than the family
shall not affect the family's eligibility for child care assistance, and the amount paid shall
be excluded from the family's income. Child care providers who accept third-party payments
must maintain family specific documentation of payment source, amount, and time period
covered by the payment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 23, 2017.
new text end
Sec. 28.
Minnesota Statutes 2016, section 119B.125, subdivision 1b, is amended to read:
Subd. 1b.
Training required.
(a) deleted text begin Effective November 1, 2011, prior todeleted text end new text begin Beforenew text end initial
authorization as required in subdivision 1, a legal nonlicensed deleted text begin familydeleted text end child care provider
must complete new text begin pediatric new text end first aid and CPR training and provide the verification of new text begin the pediatric
new text end first aid and CPR training to the county. The training documentation must have valid effective
dates as of the date the registration request is submitted to the countydeleted text begin .deleted text end new text begin andnew text end the training must
have been provided by an individual approved to provide first aid and CPR instruction and
have included CPR techniques for infants and children.
(b) new text begin A new text end legal nonlicensed deleted text begin family child care providers with an authorization effective before
November 1, 2011, must be notified of the requirements before October 1, 2011, or at
authorization, and must meet the requirements upon renewal of an authorization that occurs
on or after January 1, 2012deleted text end new text begin related provider must:
new text end
new text begin
(1) complete training on abusive head trauma before being authorized for a child through
four years of age;
new text end
new text begin
(2) complete training on reducing the risk of sudden unexpected infant death before
being authorized for a child younger than 12 months old; and
new text end
new text begin (3) meet the training requirements by September 30, 2017, if authorized for a child
before July 1, 2017new text end .
(c) new text begin A legal nonlicensed unrelated provider must:
new text end
new text begin
(1) complete training on abusive head trauma before being authorized for a child through
four years of age;
new text end
new text begin
(2) complete training on reducing the risk of sudden unexpected infant death before
being authorized for a child younger than 12 months old;
new text end
new text begin
(3) complete a child care provider orientation class, or equivalent training approved by
the commissioner, within 90 days after initial authorization. The commissioner must develop
the child care provider orientation class, which must include training on maintaining health,
safety, and fire standards; and
new text end
new text begin
(4) meet the training requirements and complete a child care provider orientation class
by September 30, 2017, if authorized to care for a child before July 1, 2017.
new text end
new text begin (d) new text end Upon each reauthorization deleted text begin after the authorization period when the initial first aid
and CPR training requirements are met,deleted text end a legal nonlicensed deleted text begin family child caredeleted text end new text begin unrelatednew text end
provider must deleted text begin provide verification of at least eight hours of additional training listed in the
Minnesota Center for Professional Development Registrydeleted text end new text begin complete training on the topics
in paragraph (c), clause (3)new text end .
(deleted text begin d) This subdivision only applies to legal nonlicensed family child care providers.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 25, 2017.
new text end
Sec. 29.
Minnesota Statutes 2016, section 119B.125, subdivision 4, is amended to read:
Subd. 4.
Unsafe care.
A county may deny authorization as a child care provider to any
applicant or deleted text begin rescinddeleted text end new text begin revoke thenew text end authorization of any provider when the county knows or has
reason to believe that the provider is unsafe or that the circumstances of the chosen child
care arrangement are unsafe. The county must include the conditions under which a provider
or care arrangement will be determined to be unsafe in the county's child care fund plan
under section 119B.08, subdivision 3.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 30.
Minnesota Statutes 2016, section 119B.125, subdivision 6, is amended to read:
Subd. 6.
Record-keeping requirement.
new text begin (a) As a condition of payment, new text end all providers
receiving child care assistance payments must keep new text begin accurate and legible new text end daily attendance
records at the site where services are delivered for children receiving child care assistance
and must make those records available immediately to the county or the commissioner upon
request. The attendance records must be completed daily and include the date, the first and
last name of each child in attendance, and the times when each child is dropped off and
picked up. To the extent possible, the times that the child was dropped off to and picked up
from the child care provider must be entered by the person dropping off or picking up the
child. The daily attendance records must be retained at the site where services are delivered
for six years after the date of service.
new text begin (b) new text end A county or the commissioner may deny new text begin or revoke a provider's new text end authorization deleted text begin as a
child care provider to any applicant, rescind authorization of any provider,deleted text end new text begin to receive child
care assistance payments under section 119B.13, subdivision 6, paragraph (d), pursue a
fraud disqualification under section 256.98, take an action against the provider under chapter
245E,new text end or establish an new text begin attendance record new text end overpayment deleted text begin claim in the systemdeleted text end new text begin under paragraph
(c) new text end against a current or former provider, when the county or the commissioner knows or
has reason to believe that the provider has not complied with the record-keeping requirement
in this subdivision. deleted text begin A provider's failure to produce attendance records as requested on more
than one occasion constitutes grounds for disqualification as a provider.
deleted text end
new text begin
(c) To calculate an attendance record overpayment under this subdivision, the
commissioner or county agency subtracts the maximum daily rate from the total amount
paid to a provider for each day that a child's attendance record is missing, unavailable,
incomplete, illegible, inaccurate, or otherwise inadequate.
new text end
new text begin
(d) The commissioner shall develop criteria to direct a county when the county must
establish an attendance overpayment under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 31.
Minnesota Statutes 2016, section 119B.125, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Reporting required for child safety. new text end
new text begin
A legal nonlicensed child care provider
must report to the county agency a death, serious injury, or instance of substantiated child
abuse that occurred while a child was in the legal nonlicensed child care provider's care. A
county agency shall report to the commissioner, in a manner prescribed by the commissioner,
the number of deaths, serious injuries, and instances of substantiated child abuse that occurred
in all legal nonlicensed child care providers in the county.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 25, 2017.
new text end
Sec. 32.
Minnesota Statutes 2016, section 119B.125, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Emergency preparedness plan. new text end
new text begin
A legal nonlicensed child care provider must
have a written emergency preparedness plan for an emergency. The commissioner shall
develop a form for a provider to create a written emergency preparedness plan.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 25, 2017.
new text end
Sec. 33.
Minnesota Statutes 2016, section 119B.125, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Compliance with health and safety requirements. new text end
new text begin
(a) The commissioner
must establish health, safety, and fire standards specific to a legal nonlicensed unrelated
provider. The commissioner must develop a tool for a county agency to conduct an annual
inspection of a legal nonlicensed unrelated provider. The commissioner must develop a
process for a legal nonlicensed unrelated provider to correct violations of the health, safety,
and fire standards. The commissioner must develop a process to revoke authorization of a
legal nonlicensed unrelated provider if the provider fails to correct violations of the health,
safety, and fire standards.
new text end
new text begin
(b) A county agency must conduct at least one inspection annually of each legal
nonlicensed unrelated provider. The county agency must be given access to the physical
facility and grounds where care is provided and to children cared for by the legal nonlicensed
unrelated provider. The county agency must be given access without prior notice and as
often as the county agency considers necessary if the county agency is investigating alleged
maltreatment, conducting an inspection, or investigating an alleged violation of applicable
laws or rules. A provider's failure to give access to the county agency may result in
termination of the legal nonlicensed unrelated provider's authorization to care for a child
receiving child care assistance under this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 25, 2017.
new text end
Sec. 34.
Minnesota Statutes 2016, section 119B.13, subdivision 1, is amended to read:
Subdivision 1.
Subsidy restrictions.
(a) deleted text begin Beginning February 3, 2014, Thedeleted text end new text begin Beginning
February 26, 2018, the new text end maximum rate paid for child care assistance in any county or county
price cluster under the child care fund shall be the greater of the 25th percentile of the deleted text begin 2011deleted text end new text begin
2016new text end child care provider rate survey or the maximum rate effective deleted text begin November 28, 2011deleted text end new text begin
February 3, 2014new text end . The commissioner may: (1) assign a county with no reported provider
prices to a similar price cluster; and (2) consider county level access when determining final
price clusters.
(b) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.
(c) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.
new text begin (d) If a child uses one provider,new text end the maximum payment deleted text begin to a providerdeleted text end for one day of care
must not exceed the daily rate. The maximum payment deleted text begin to a providerdeleted text end for one week of care
must not exceed the weekly rate.
deleted text begin
(d)
deleted text end
new text begin
(e) If a child uses two providers under section 119B.097, the maximum payment
must not exceed:
new text end
new text begin
(1) the daily rate for one day of care;
new text end
new text begin
(2) the weekly rate for one week of care by a child's primary provider; and
new text end
new text begin
(3) two daily rates during two weeks of care by a child's secondary provider.
new text end
new text begin (f)new text end Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.
deleted text begin (e) Whendeleted text end new text begin (g) Ifnew text end the provider charge is greater than the maximum provider rate allowed,
the parent is responsible for payment of the difference in the rates in addition to any family
co-payment fee.
deleted text begin (f)deleted text end new text begin (h)new text end All maximum provider rates changes shall be implemented on the Monday
following the effective date of the maximum provider rate.
deleted text begin (g)deleted text end new text begin (i)new text end Notwithstanding Minnesota Rules, part 3400.0130, subpart 7, maximum
registration fees in effect on January 1, 2013, shall remain in effect.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective February 26, 2018. Paragraphs (d) to
(i) are effective April 23, 2018.
new text end
Sec. 35.
Minnesota Statutes 2016, section 119B.13, subdivision 6, is amended to read:
Subd. 6.
Provider payments.
(a) new text begin A provider must bill only for services documented
according to section 119B.125, subdivision 6. new text end The provider shall bill for services provided
within ten days of the end of the service period. deleted text begin If bills are submitted within ten days of the
end of the service period,deleted text end Payments under the child care fund shall be made within deleted text begin 30deleted text end new text begin 21
new text end days of receiving a new text begin complete new text end bill from the provider. Counties or the state may establish
policies that make payments on a more frequent basis.
(b) If a provider has received an authorization of care and been issued a billing form for
an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be
paid.
(c) If a provider provided care for a time period without receiving an authorization of
care and a billing form for an eligible family, payment of child care assistance may only be
made retroactively for a maximum of six months from the date the provider is issued an
authorization of care and billing form.
(d) A county or the commissioner may refuse to issue a child care authorization to a
licensed or legal nonlicensed provider, revoke an existing child care authorization to a
licensed or legal nonlicensed provider, stop payment issued to a licensed or legal nonlicensed
provider, or refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:
(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;
(2) a county or the commissioner finds by a preponderance of the evidence that the
provider intentionally gave the county materially false information on the provider's billing
forms, or provided false attendance records to a county or the commissioner;
(3) the provider is in violation of child care assistance program rules, until the agency
determines those violations have been corrected;
(4) the provider is operating after:
(i) an order of suspension of the provider's license issued by the commissioner;new text begin or
new text end
(ii) an order of revocation of the provider's license; deleted text begin or
deleted text end
deleted text begin
(iii) a final order of conditional license issued by the commissioner for as long as the
conditional license is in effect;
deleted text end
(5) the provider submits deleted text begin falsedeleted text end new text begin an inaccuratenew text end attendance deleted text begin reports or refuses to provide
documentation of the child's attendance upon request; ordeleted text end new text begin record;
new text end
(6) the provider gives false child care price informationdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(7) the provider fails to grant access to a county or the commissioner during regular
business hours to examine all records necessary to determine the extent of services provided
to a child care assistance recipient and the appropriateness of a claim for payment.
new text end
new text begin
(e) If a county or the commissioner finds that a provider violated paragraph (d), clause
(1) or (2), a county or the commissioner must deny or revoke the provider's authorization
and either pursue a fraud disqualification under section 256.98, subdivision 8, paragraph
(c) or refer the case to a law enforcement authority. A provider's rights related to an
authorization denial or revocation under this paragraph are established in section 119B.161.
If a provider's authorization is revoked or denied under this paragraph, the denial or
revocation lasts until either:
new text end
new text begin
(1) all criminal, civil, and administrative proceedings related to the provider's alleged
misconduct conclude and any appeal rights are exhausted; or
new text end
new text begin
(2) the commissioner decides, based on written evidence or argument submitted under
section 119B.161, to authorize the provider.
new text end
new text begin
(f) If a county or the commissioner denies or revokes a provider's authorization under
paragraph (d), clause (4), the provider shall not be authorized until the order of suspension
or order of revocation against the provider is lifted.
new text end
deleted text begin (e) For purposes ofdeleted text end new text begin (g) If a county or the commissioner finds that a provider violatednew text end
paragraph (d), clauses (3), (5), deleted text begin anddeleted text end new text begin ornew text end (6), the county or the commissioner may deleted text begin withholddeleted text end new text begin
revoke or denynew text end the provider's authorization deleted text begin or payment for a period of time not to exceed
three months beyond the time the condition has been correcteddeleted text end .new text begin If a provider's authorization
is revoked or denied under this paragraph, the denial or revocation may last up to 90 days
from the date a county or the commissioner denies or revokes the provider's authorization.
new text end
new text begin
(h) If a county or the commissioner determines a provider violated paragraph (d), clause
(7), a county or the commissioner must deny or revoke the provider's authorization until a
county or the commissioner determines whether the records sought comply with this chapter
and chapter 245E. The provider's rights related to an authorization denial or revocation
under this paragraph are established in section 119B.161.
new text end
deleted text begin (f)deleted text end new text begin (i)new text end A county's payment policies must be included in the county's child care plan under
section 119B.08, subdivision 3. If payments are made by the state, in addition to being in
compliance with this subdivision, the payments must be made in compliance with section
16A.124.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective September 25, 2017. Paragraphs (d) to
(i) are effective April 23, 2018.
new text end
Sec. 36.
Minnesota Statutes 2016, section 119B.16, subdivision 1, is amended to read:
Subdivision 1.
Fair hearing allowednew text begin for applicants and recipientsnew text end .
new text begin (a) new text end An applicant
or recipient adversely affected by new text begin an action of new text end a county agency deleted text begin actiondeleted text end new text begin or the commissionernew text end
may request new text begin and receive new text end a fair hearing in accordance with new text begin this subdivision and new text end section
256.045.
new text begin
(b) A county agency must offer an informal conference to an applicant or recipient who
is entitled to a fair hearing under this section. A county agency shall advise an adversely
affected applicant or recipient that a request for a conference is optional and does not delay
or replace the right to a fair hearing.
new text end
new text begin
(c) An applicant or recipient does not have a right to a fair hearing if a county agency
or the commissioner takes action against a provider.
new text end
new text begin
(d) If a provider's authorization is suspended, denied, or revoked, a county agency or
the commissioner must mail notice to a child care assistance program recipient receiving
care from the provider.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 37.
Minnesota Statutes 2016, section 119B.16, subdivision 1a, is amended to read:
Subd. 1a.
Fair hearing allowed for providers.
(a) This subdivision applies to providers
caring for children receiving child care assistance.
deleted text begin
(b) A provider to whom a county agency has assigned responsibility for an overpayment
may request a fair hearing in accordance with section 256.045 for the limited purpose of
challenging the assignment of responsibility for the overpayment and the amount of the
overpayment. The scope of the fair hearing does not include the issues of whether the
provider wrongfully obtained public assistance in violation of section 256.98 or was properly
disqualified under section 256.98, subdivision 8, paragraph (c), unless the fair hearing has
been combined with an administrative disqualification hearing brought against the provider
under section 256.046.
deleted text end
new text begin
(b) A provider may request a fair hearing only as specified in this subdivision.
new text end
new text begin
(c) A provider may request a fair hearing according to sections 256.045 and 256.046 if
a county agency or the commissioner:
new text end
new text begin
(1) denies or revokes a provider's authorization, unless the action entitles the provider
to a consolidated contested case hearing under section 119B.16, subdivision 3, or an
administrative review under section 119B.161;
new text end
new text begin
(2) assigns responsibility for an overpayment to a provider under section 119B.11,
subdivision 2a;
new text end
new text begin
(3) establishes an overpayment for failure to comply with section 119B.125, subdivision
6;
new text end
new text begin
(4) seeks monetary recovery or recoupment under section 245E.02, subdivision 4,
paragraph (c), item (2);
new text end
new text begin
(5) initiates an administrative fraud disqualification hearing; or
new text end
new text begin
(6) issues a payment and the provider disagrees with the amount of the payment.
new text end
new text begin
(d) A provider may request a fair hearing by submitting a written request to the
Department of Human Services, Appeals Division. A provider's request must be received
by the appeals division no later than 30 days after the date a county or the commissioner
mails the notice. The provider's appeal request must contain the following:
new text end
new text begin
(1) each disputed item, the reason for the dispute, and, if appropriate, an estimate of the
dollar amount involved for each disputed item;
new text end
new text begin
(2) the computation the provider believes to be correct, if appropriate;
new text end
new text begin
(3) the statute or rule relied on for each disputed item; and
new text end
new text begin
(4) the name, address, and telephone number of the person at the provider's place of
business with whom contact may be made regarding the appeal.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 38.
Minnesota Statutes 2016, section 119B.16, subdivision 1b, is amended to read:
Subd. 1b.
Joint fair hearings.
deleted text begin When a provider requests a fair hearing under subdivision
1a, the family in whose case the overpayment was created must be made a party to the fair
hearing. All other issues raised by the family must be resolved in the same proceeding.
When a family requests a fair hearing and claims that the county should have assigned
responsibility for an overpayment to a provider, the provider must be made a party to the
fair hearing.deleted text end The human services judge assigned to a fair hearing may join a family or a
provider as a party to the fair hearing whenever joinder of that party is necessary to fully
and fairly resolve deleted text begin overpaymentdeleted text end issues raised in the appeal.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 39.
Minnesota Statutes 2016, section 119B.16, is amended by adding a subdivision
to read:
new text begin Subd. 1c. new text end
new text begin Notice to providers. new text end
new text begin
(a) Before taking an action appealable under subdivision
1a, paragraph (c), a county agency or the commissioner must mail written notice to the
provider against whom the action is being taken.
new text end
new text begin
(b) The notice shall state:
new text end
new text begin
(1) the factual basis for the department's determination;
new text end
new text begin
(2) the action the department intends to take;
new text end
new text begin
(3) the dollar amount of the monetary recovery or recoupment, if known; and
new text end
new text begin
(4) the right to appeal the department's proposed action.
new text end
new text begin
(c) A county agency or the commissioner must mail the written notice at least 15 calendar
days before the adverse action's effective date.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 40.
Minnesota Statutes 2016, section 119B.16, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Consolidated contested case hearing. new text end
new text begin
If a county agency or the commissioner
denies or revokes a provider's authorization based on a licensing action, the provider may
only appeal the denial or revocation in the same contested case proceeding that the provider
appeals the licensing action.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 41.
Minnesota Statutes 2016, section 119B.16, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Final department action. new text end
new text begin
Unless the commissioner receives a timely and
proper request for an appeal, a county agency's or the commissioner's action shall be
considered a final department action.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 42.
new text begin
[119B.161] ADMINISTRATIVE REVIEW.
new text end
new text begin Subdivision 1. new text end
new text begin Temporary denial or revocation of authorization. new text end
new text begin
(a) A provider has
the rights listed under this section if:
new text end
new text begin
(1) the provider's authorization was denied or revoked under section 119B.13, subdivision
6, paragraph (d), clause (1), (2), or (7);
new text end
new text begin
(2) the provider's authorization was temporarily suspended under paragraph (b); or
new text end
new text begin
(3) a payment was suspended under chapter 245E.
new text end
new text begin
(b) Unless the commissioner receives a timely and proper request for an appeal, a county's
or the commissioner's action is a final department action.
new text end
new text begin
(c) The commissioner may temporarily suspend a provider's authorization without prior
notice and opportunity for hearing if the commissioner determines either that there is a
credible allegation of fraud for which an investigation is pending under the child care
assistance program, or that the suspension is necessary for public safety and the best interests
of the child care assistance program. An allegation is considered credible if the allegation
has indications of reliability. The commissioner may determine that an allegation is credible,
if the commissioner reviewed all allegations, facts, and evidence carefully and acts judiciously
on a case-by-case basis.
new text end
new text begin Subd. 2. new text end
new text begin Notice. new text end
new text begin
(a) A county or the commissioner must mail a provider notice within
five days of suspending, revoking, or denying a provider's authorization under subdivision
1.
new text end
new text begin
(b) The notice must:
new text end
new text begin
(1) state the provision under which a county or the commissioner is denying, revoking,
or suspending a provider's authorization or suspending payment to the provider;
new text end
new text begin
(2) set forth the general allegations leading to the revocation, denial, or suspension of a
provider's authorization. The notice need not disclose any specific information concerning
an ongoing investigation;
new text end
new text begin
(3) state that the suspension, revocation, or denial of a provider's authorization is for a
temporary period and explain the circumstances under which the action expires; and
new text end
new text begin
(4) inform the provider of the right to submit written evidence and argument for
consideration by the commissioner.
new text end
new text begin
(c) Notwithstanding Minnesota Rules, part 3400.0185, if a county or the commissioner
denies or revokes a provider's authorization under section 119B.13, subdivision 6, paragraph
(d), clause (1), (2), or (7); suspends a payment to a provider under chapter 245E; or
temporarily suspends a payment to a provider under section 119B.161, subdivision 1, a
county or the commissioner must send notice of termination to an affected family. The
termination sent to an affected family is effective on the date the notice is created.
new text end
new text begin Subd. 3. new text end
new text begin Duration. new text end
new text begin
If a provider's authorization is denied or revoked under section
119B.13, subdivision 6, paragraph (d), clause (1), (2), or (7); authorization is temporarily
suspended under section 119B.161; or payment is suspended under chapter 245E, the
provider's denial, revocation, temporary suspension, or payment suspension remains in
effect until:
new text end
new text begin
(1) the commissioner or a law enforcement authority determines that there is insufficient
evidence warranting the action and a county or the commissioner does not pursue an
additional administrative remedy under chapter 245E or section 256.98; or
new text end
new text begin
(2) all criminal, civil, and administrative proceedings related to the provider's alleged
misconduct conclude and any appeal rights are exhausted.
new text end
new text begin Subd. 4. new text end
new text begin Good cause exception. new text end
new text begin
A county or the commissioner may find that good cause
exists not to deny, revoke, or suspend a provider's authorization, or not to continue a denial,
revocation, or suspension of a provider's authorization if any of the following are applicable:
new text end
new text begin
(1) a law enforcement authority specifically requested that a provider's authorization
not be denied, revoked, or suspended because it may compromise an ongoing investigation;
new text end
new text begin
(2) a county or the commissioner determines that the denial, revocation, or suspension
should be removed based on the provider's written submission; or
new text end
new text begin
(3) the commissioner determines that the denial, revocation, or suspension is not in the
best interests of the program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 43.
Minnesota Statutes 2016, section 144.218, subdivision 5, is amended to read:
Subd. 5.
Replacement of vital records.
Upon deleted text begin thedeleted text end new text begin receipt of annew text end order of a court of this
statenew text begin or a certificate of adjudication formnew text end , upon the request of a court of another state, or
upon the filing of a recognition of parentage with the state registrar, a replacement birth
record must be registered consistent with the findings of the courtnew text begin , the certificate of
adjudication,new text end or the recognition of parentage.
Sec. 44.
Minnesota Statutes 2016, section 144.226, subdivision 1, is amended to read:
Subdivision 1.
Which services are for fee.
The fees for the following services shall be
the following or an amount prescribed by rule of the commissioner:
(a) The fee for the administrative review and processing of a request for a certified vital
record or a certification that the vital record cannot be found is $9. The fee is payable at the
time of application and is nonrefundable.
(b) The fee for processing a request for the replacement of a birth record for all events,
except when filing a recognition of parentage pursuant to section 257.73, subdivision 1, is
$40. The fee is payable at the time of application and is nonrefundable.new text begin To the extent funds
are available, the commissioner of human services shall pay the filing fee for the replacement
of a birth record due to a paternity adjudication.
new text end
(c) The fee for administrative review and processing of a request for the filing of a
delayed registration of birth, stillbirth, or death is $40. The fee is payable at the time of
application and is nonrefundable.
(d) The fee for administrative review and processing of a request for the amendment of
any vital record is $40. The fee is payable at the time of application and is nonrefundable.
(e) The fee for administrative review and processing of a request for the verification of
information from vital records is $9 when the applicant furnishes the specific information
to locate the vital record. When the applicant does not furnish specific information, the fee
is $20 per hour for staff time expended. Specific information includes the correct date of
the event and the correct name of the subject of the record. Fees charged shall approximate
the costs incurred in searching and copying the vital records. The fee is payable at the time
of application and is nonrefundable.
(f) The fee for administrative review and processing of a request for the issuance of a
copy of any document on file pertaining to a vital record or statement that a related document
cannot be found is $9. The fee is payable at the time of application and is nonrefundable.
Sec. 45.
Minnesota Statutes 2016, section 245.814, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Foster care parent liability insurance. new text end
new text begin
The commissioner may use federal
reimbursement money earned on an expenditure for foster care parent liability insurance
premiums to offset the costs of the premiums.
new text end
Sec. 46.
Minnesota Statutes 2016, section 245A.04, subdivision 1, is amended to read:
Subdivision 1.
Application for licensure.
(a) An individual, corporation, partnership,
voluntary association, other organization or controlling individual that is subject to licensure
under section 245A.03 must apply for a license. The application must be made on the forms
and in the manner prescribed by the commissioner. The commissioner shall provide the
applicant with instruction in completing the application and provide information about the
rules and requirements of other state agencies that affect the applicant. An applicant seeking
licensure in Minnesota with headquarters outside of Minnesota must have a program office
located within the state.
The commissioner shall act on the application within 90 working days after a complete
application and any required reports have been received from other state agencies or
departments, counties, municipalities, or other political subdivisions. The commissioner
shall not consider an application to be complete until the commissioner receives all of the
information required under section 245C.05.
When the commissioner receives an application for initial licensure that is incomplete
because the applicant failed to submit required documents or that is substantially deficient
because the documents submitted do not meet licensing requirements, the commissioner
shall provide the applicant written notice that the application is incomplete or substantially
deficient. In the written notice to the applicant the commissioner shall identify documents
that are missing or deficient and give the applicant 45 days to resubmit a second application
that is substantially complete. An applicant's failure to submit a substantially complete
application after receiving notice from the commissioner is a basis for license denial under
section 245A.05.
(b) An application for licensure must identify all controlling individuals and must specify
an agent who is responsible for dealing with the commissioner of human services on all
matters provided for in this chapter and on whom service of all notices and orders must be
made. The agent must be authorized to accept service on behalf of all of the controlling
individuals of the program. Service on the agent is service on all of the controlling individuals
of the program. It is not a defense to any action arising under this chapter that service was
not made on each controlling individual of the program. The designation of one or more
controlling individuals as agents under this paragraph does not affect the legal responsibility
of any other controlling individual under this chapter.
(c) An applicant or license holder must have a policy that prohibits license holders,
employees, subcontractors, and volunteers, when directly responsible for persons served
by the program, from abusing prescription medication or being in any manner under the
influence of a chemical that impairs the individual's ability to provide services or care. The
license holder must train employees, subcontractors, and volunteers about the program's
drug and alcohol policy.
(d) An applicant and license holder must have a program grievance procedure that permits
persons served by the program and their authorized representatives to bring a grievance to
the highest level of authority in the program.
(e) The applicant must be able to demonstrate competent knowledge of the applicable
requirements of this chapter and chapter 245C, and the requirements of other licensing
statutes and rules applicable to the program or services for which the applicant is seeking
to be licensed. Effective January 1, 2013, the commissioner may require the applicant,
except for child foster care, to demonstrate competence in the applicable licensing
requirements by successfully completing a written examination. The commissioner may
develop a prescribed written examination format.
(f) When an applicant is an individual, the individual must provide:
(1) the applicant's taxpayer identification numbers including the Social Security number,
and federal employer identification number if the applicant has employeesnew text begin unless a variance
is provided as permitted in paragraph (j)new text end ;
(2) the complete business name, if any, and if doing business under a different name,
the doing business as (DBA) name, as registered with the secretary of state; and
(3) deleted text begin adeleted text end new text begin at the commissioner's request, the new text end notarized signature of the applicant.
(g) When an applicant is a nonindividual, the applicant must provide the:
(1) applicant's taxpayer identification numbers including the Minnesota tax identification
number and federal employer identification number;
(2) complete business name, and if doing business under a different name, the doing
business as (DBA) name, as registered with the secretary of state;
(3) first, middle, and last name, and address for all individuals who will be controlling
individuals, including all officers, owners, and managerial officials as defined in section
245A.02, subdivision 5a, and the date that the background study was initiated by the applicant
for each controlling individual; and
(4) first, middle, and last name, mailing address, and notarized signature of the agent
authorized by the applicant to accept service on behalf of the controlling individuals.
(h) At the time of application for licensure or renewal of a license, the applicant or license
holdernew text begin , except as provided in paragraph (i), new text end must acknowledge on the form provided by
the commissioner if the applicant or license holder elects to receive any public funding
reimbursement from the commissioner for services provided under the license that:
(1) the applicant's or license holder's compliance with the provider enrollment agreement
or registration requirements for receipt of public funding may be monitored by the
commissioner as part of a licensing investigation or licensing inspection; and
(2) noncompliance with the provider enrollment agreement or registration requirements
for receipt of public funding that is identified through a licensing investigation or licensing
inspection, or noncompliance with a licensing requirement that is a basis of enrollment for
reimbursement for a service, may result in:
(i) a correction order or a conditional license under section 245A.06, or sanctions under
section 245A.07;
(ii) nonpayment of claims submitted by the license holder for public program
reimbursement;
(iii) recovery of payments made for the service;
(iv) disenrollment in the public payment program; or
(v) other administrative, civil, or criminal penalties as provided by law.
new text begin
(i) An applicant to provide child foster care who is an individual must attest on the form
provided by the commissioner that any public funding received for providing child foster
care services must be used for the benefit of the foster children receiving services.
new text end
new text begin
(j) The commissioner of human services may grant a variance from the requirements in
paragraph (f), clause (1), to an individual child foster care applicant who is unable to provide
a Social Security number in the application for licensure.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 47.
Minnesota Statutes 2016, section 245A.18, subdivision 2, is amended to read:
Subd. 2.
Child passenger restraint systems; training requirement.
(a) Programs
licensed by the Department of Human Services under Minnesota Rules, chapter 2960, that
serve a child or children under nine years of age must document training that fulfills the
requirements in this subdivision.
new text begin
(b) For child foster care programs, within 30 days of an emergency placement of a
relative child, and prior to licensure of a foster care home, the relative provider and applicants,
caregivers, and staff persons who will be responsible for transporting children younger than
nine years of age in a motor vehicle that have not completed the training required in paragraph
(c) within 30 days of emergency placement or prior to licensure must view a video, approved
by the Department of Public Safety, on child passenger safety. For all other programs
licensed under Minnesota Rules, chapter 2960, all staff persons who will be responsible for
transporting children younger than nine years of age in a motor vehicle that have not
completed the training required in paragraph (c) must view a video, approved by the
Department of Public Safety, on child passenger safety before transporting children.
new text end
deleted text begin (b) Before a license holder, staff person, or caregiver transports a child ordeleted text end new text begin (c) For child
foster care programs, within the first three months of licensure, license holders, caregivers,
and staff persons who transport fosternew text end children deleted text begin under age ninedeleted text end new text begin younger than nine years of
agenew text end in a motor vehicledeleted text begin , the person transporting the childdeleted text end must satisfactorily complete training
on the proper use and installation of child restraint systems in motor vehicles. Training
completed under this section may be used to meet initial or ongoing training under Minnesota
Rules, part 2960.3070, subparts 1 and 2.new text begin For all other programs licensed under Minnesota
Rules, chapter 2960, within three months of hire, all staff persons who transport children
younger than nine years of age in a motor vehicle must satisfactorily complete training on
the proper use and installation of child care restraint systems in motor vehicles.
new text end
deleted text begin
For all providers licensed prior to July 1, 2006, the training required in this subdivision
must be obtained by December 31, 2007.
deleted text end
deleted text begin (c)deleted text end new text begin (d)new text end new text begin At a minimum, new text end training required under deleted text begin this section must be at least one hour in
length, completed at orientation or initial training, and repeated at least once every five
years. At a minimum, the trainingdeleted text end new text begin paragraph (c)new text end must address the proper use of child restraint
systems based on the child's size, weight, and age, and the proper installation of a car seat
or booster seat in the motor vehicle used deleted text begin by the license holderdeleted text end to transport the child or
children.
deleted text begin (d)deleted text end new text begin (e)new text end new text begin The new text end training deleted text begin under paragraph (c) mustdeleted text end new text begin is required tonew text end be provided by individuals
who are certified and approved by the Department of Public Safety, Office of Traffic Safety.
License holders may obtain a list of certified and approved trainers through the Department
of Public Safety Web site or by contacting the agency.new text begin The training must be repeated at
least once every five years.
new text end
deleted text begin
(e) Child care providers that only transport school age children as defined in section
245A.02, subdivision 16, in school buses as defined in section 169.011, subdivision 71,
paragraphs (c) to (f), are exempt from this subdivision.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 48.
Minnesota Statutes 2016, section 245E.01, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Credible allegation of fraud. new text end
new text begin
"Credible allegation of fraud" has the meaning
given in section 256B.064, subdivision 2, paragraph (b), clause (2).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 49.
Minnesota Statutes 2016, section 245E.02, subdivision 1, is amended to read:
Subdivision 1.
Investigating provider or recipient financial misconduct.
The
department shall investigate alleged or suspected financial misconduct by providers and
errors related to payments issued by the child care assistance program under this chapter.
Recipients, employees, new text begin agents and consultants, new text end and staff may be investigated when the
evidence shows that their conduct is related to the financial misconduct of a provider, license
holder, or controlling individual. When the alleged or suspected financial misconduct relates
to acting as a recruiter offering conditional employment on behalf of a provider that has
received funds from the child care assistance program, the department may investigate the
provider, center owner, director, manager, license holder, or other controlling individual or
agent, who is alleged to have acted as a recruiter offering conditional employment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 50.
Minnesota Statutes 2016, section 245E.02, subdivision 3, is amended to read:
Subd. 3.
Determination of investigation.
After completing its investigation, the
department shall deleted text begin issue one of the following determinationsdeleted text end new text begin determine thatnew text end :
(1) no violation of child care assistance requirements occurred;
(2) there is insufficient evidence to show that a violation of child care assistance
requirements occurred;
(3) a preponderance of evidence shows a violation of child care assistance program law,
rule, or policy; or
(4) there exists a credible allegation of fraudnew text begin involving the child care assistance programnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 51.
Minnesota Statutes 2016, section 245E.02, subdivision 4, is amended to read:
Subd. 4.
deleted text begin Actionsdeleted text end new text begin Referralsnew text end or administrative deleted text begin sanctionsdeleted text end new text begin actionsnew text end .
(a) After completing
the determination under subdivision 3, the department may take one or more of the actions
or sanctions specified in this subdivision.
(b) The department may takenew text begin any ofnew text end the following actions:
(1) refer the investigation to law enforcement or a county attorney for possible criminal
prosecution;
(2) refer relevant information to the department's licensing division, new text begin the background
studies division, new text end the child care assistance program, the Department of Education, the federal
child and adult care food program, or appropriate child or adult protection agency;
(3) enter into a settlement agreement with a provider, license holder, new text begin owner, agent,
new text end controlling individual, or recipient; or
(4) refer the matter for review by a prosecutorial agency with appropriate jurisdiction
for possible civil action under the Minnesota False Claims Act, chapter 15C.
(c) In addition to section 256.98, the department may impose sanctions by:
(1) pursuing administrative disqualification through hearings or waivers;
(2) establishing and seeking monetary recovery or recoupment;
(3) issuing an order of corrective action that states the practices that are violations of
child care assistance program policies, laws, or regulations, and that they must be corrected;
deleted text begin or
deleted text end
(4) suspendingdeleted text begin , denying, or terminatingdeleted text end payments to a providerdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) taking an action under section 119B.13, subdivision 6, paragraph (d).
new text end
(d) deleted text begin Upon a finding bydeleted text end new text begin Ifnew text end the commissioner new text begin determines new text end that any child care provider, center
owner, director, manager, license holder, or other controlling individual of a child care
center has employed, used, or acted as a recruiter offering conditional employment for a
child care center that has received child care assistance program funding, the commissioner
shall:
(1) immediately suspend all program payments to all child care centers in which the
person employing, using, or acting as a recruiter offering conditional employment is an
owner, director, manager, license holder, or other controlling individual. The commissioner
shall suspend program payments under this clause even if services have already been
provided; and
(2) immediately and permanently revoke the licenses of all child care centers of which
the person employing, using, or acting as a recruiter offering conditional employment is an
owner, director, manager, license holder, or other controlling individual.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 52.
Minnesota Statutes 2016, section 245E.03, subdivision 2, is amended to read:
Subd. 2.
Failure to provide access.
deleted text begin
Failure to provide access may result in denial or
termination of authorizations for or payments to a recipient, provider, license holder, or
controlling individual in the child care assistance program.
deleted text end
new text begin
If a provider fails to grant the
department immediate access to records, the department may immediately suspend payments
under section 119B.161, or the department may deny or revoke the provider's authorization.
A provider, license holder, controlling individual, employee, or staff member must grant
the department access during any hours that the program is open to examine the provider's
program or the records listed in section 245E.05. A provider shall make records immediately
available at the provider's place of business at the time the department requests access,
unless the provider and the department both agree otherwise.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 53.
Minnesota Statutes 2016, section 245E.03, subdivision 4, is amended to read:
Subd. 4.
Continued or repeated failure to provide access.
If the provider continues
to fail to provide access at the expiration of the 15-day notice period, child care assistance
program payments to the provider must be deleted text begin denieddeleted text end new text begin suspendednew text end beginning the 16th day
following notice of the initial failure or refusal to provide access. deleted text begin The department may
rescind the denial based upon good cause if the provider submits in writing a good cause
basis for having failed or refused to provide access. The writing must be postmarked no
later than the 15th day following the provider's notice of initial failure to provide access.deleted text end new text begin A
provider's, license holder's, controlling individual's, employee's, staff member's, or recipient's
duty to provide access in this section continues after the provider's authorization is denied,
revoked, or suspended.new text end Additionally, the provider, license holder, or controlling individual
must immediately provide complete, ongoing access to the department. Repeated failures
to provide access must, after the initial failure or for any subsequent failure, result in
termination from participation in the child care assistance program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 54.
Minnesota Statutes 2016, section 245E.04, is amended to read:
245E.04 HONEST AND TRUTHFUL STATEMENTS.
It shall be unlawful for a provider, license holder, controlling individual, or recipient to:
(1) falsify, conceal, or cover up by any deleted text begin trick, scheme, or device a material factdeleted text end new text begin meansnew text end ;
(2) make any materially false, fictitious, or fraudulent statement or representation; or
(3) make or use any false writing or document knowing the same to contain any materially
false, fictitious, or fraudulent statement or entry related to any child care assistance program
services that the provider, license holder, or controlling individual supplies or in relation to
any child care assistance payments received by a provider, license holder, or controlling
individual or to any fraud investigator or law enforcement officer conducting a financial
misconduct investigation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 55.
Minnesota Statutes 2016, section 245E.05, subdivision 1, is amended to read:
Subdivision 1.
Records required to be retained.
The following records must be
maintained, controlled, and made immediately accessible to license holders, providers, and
controlling individuals. The records must be organized and labeled to correspond to categories
that make them easy to identify so that they can be made available immediately upon request
to an investigator acting on behalf of the commissioner at the provider's place of business:
(1) payroll ledgers, canceled checks, bank deposit slips, and any other accounting records;
(2) daily attendance records required by and that comply with section 119B.125,
subdivision 6;
(3) billing transmittal forms requesting payments from the child care assistance program
and billing adjustments related to child care assistance program payments;
(4) records identifying all persons, corporations, partnerships, and entities with an
ownership or controlling interest in the provider's child care business;
(5) employee new text begin or contractor new text end records identifying those persons currently employed by the
provider's child care business or who have been employed by the business at any time within
the previous five years. The records must include each employee's name, hourly and annual
salary, qualifications, position description, job title, and dates of employment. In addition,
employee records that must be made available include the employee's time sheets, current
home address of the employee or last known address of any former employee, and
documentation of background studies required under chapter 119B or 245C;
(6) records related to transportation of children in care, including but not limited to:
(i) the dates and times that transportation is provided to children for transportation to
and from the provider's business location for any purpose. For transportation related to field
trips or locations away from the provider's business location, the names and addresses of
those field trips and locations must also be provided;
(ii) the name, business address, phone number, and Web site address, if any, of the
transportation service utilized; and
(iii) all billing or transportation records related to the transportation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 56.
Minnesota Statutes 2016, section 245E.06, subdivision 1, is amended to read:
Subdivision 1.
Factors regarding imposition of administrative deleted text begin sanctionsdeleted text end new text begin actionsnew text end .
(a)
The department shall consider the following factors in determining the administrative
deleted text begin sanctionsdeleted text end new text begin actionsnew text end to be imposed:
(1) nature and extent of financial misconduct;
(2) history of financial misconduct;
(3) actions taken or recommended by other state agencies, other divisions of the
department, and court and administrative decisions;
(4) prior deleted text begin imposition of sanctionsdeleted text end new text begin actionsnew text end ;
(5) size and type of provider;
(6) information obtained through an investigation from any source;
(7) convictions or pending criminal charges; and
(8) any other information relevant to the acts or omissions related to the financial
misconduct.
(b) Any single factor under paragraph (a) may be determinative of the department's
decision of whether and what deleted text begin sanctions are imposeddeleted text end new text begin actions to takenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 57.
Minnesota Statutes 2016, section 245E.06, subdivision 2, is amended to read:
Subd. 2.
Written notice of department deleted text begin sanctiondeleted text end new text begin actionnew text end ; deleted text begin sanctiondeleted text end new text begin actionnew text end effective
datedeleted text begin ; informal meetingdeleted text end .
deleted text begin
(a) The department shall give notice in writing to a person of an
administrative sanction that is to be imposed. The notice shall be sent by mail as defined in
section 245E.01, subdivision 11.
deleted text end
deleted text begin
(b) The notice shall state:
deleted text end
deleted text begin
(1) the factual basis for the department's determination;
deleted text end
deleted text begin
(2) the sanction the department intends to take;
deleted text end
deleted text begin
(3) the dollar amount of the monetary recovery or recoupment, if any;
deleted text end
deleted text begin
(4) how the dollar amount was computed;
deleted text end
deleted text begin
(5) the right to dispute the department's determination and to provide evidence;
deleted text end
deleted text begin
(6) the right to appeal the department's proposed sanction; and
deleted text end
deleted text begin
(7) the option to meet informally with department staff, and to bring additional
documentation or information, to resolve the issues.
deleted text end
deleted text begin
(c) In cases of determinations resulting in denial or termination of payments, in addition
to the requirements of paragraph (b), the notice must state:
deleted text end
deleted text begin
(1) the length of the denial or termination;
deleted text end
deleted text begin
(2) the requirements and procedures for reinstatement; and
deleted text end
deleted text begin
(3) the provider's right to submit documents and written arguments against the denial
or termination of payments for review by the department before the effective date of denial
or termination.
deleted text end
deleted text begin
(d) The submission of documents and written argument for review by the department
under paragraph (b), clause (5) or (7), or paragraph (c), clause (3), does not stay the deadline
for filing an appeal.
deleted text end
new text begin
(a) When taking an action against a provider, the department must give notice to:
new text end
new text begin
(1) the provider as specified in section 119B.16 or 119B.161; and
new text end
new text begin
(2) a family as specified under Minnesota Rules, part 3400.0185, or section 119B.161.
new text end
deleted text begin (e)deleted text end new text begin (b)new text end Notwithstanding section 245E.03, subdivision 4, new text begin and except for a payment
suspension or action under section 119B.161, subdivision 1, new text end the effective date of the proposed
deleted text begin sanctiondeleted text end new text begin action under this chapternew text end shall be 30 days after the license holder's, provider's,
controlling individual's, or recipient's receipt of the notice, unless timely appealed. If a
timely appeal is made, the proposed deleted text begin sanctiondeleted text end new text begin actionnew text end shall be delayed pending the final
outcome of the appeal. Implementation of a proposed deleted text begin sanctiondeleted text end new text begin actionnew text end following the resolution
of a timely appeal may be postponed if, in the opinion of the department, the delay of
deleted text begin sanctiondeleted text end new text begin actionnew text end is necessary to protect the health or safety of children in care. deleted text begin The department
may consider the economic hardship of a person in implementing the proposed sanction,
but economic hardship shall not be a determinative factor in implementing the proposed
sanction.
deleted text end
deleted text begin
(f) Requests for an informal meeting to attempt to resolve issues and requests for appeals
must be sent or delivered to the department's Office of Inspector General, Financial Fraud
and Abuse Division.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 58.
Minnesota Statutes 2016, section 245E.06, subdivision 3, is amended to read:
Subd. 3.
Appeal of department deleted text begin sanctiondeleted text end new text begin actionnew text end .
deleted text begin
(a) If the department does not pursue
a criminal action against a provider, license holder, controlling individual, or recipient for
financial misconduct, but the department imposes an administrative sanction under section
245E.02, subdivision 4, paragraph (c), any individual or entity against whom the sanction
was imposed may appeal the department's administrative sanction under this section pursuant
to section 119B.16 or 256.045 with the additional requirements in clauses (1) to (4). An
appeal must specify:
deleted text end
deleted text begin
(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item, if appropriate;
deleted text end
deleted text begin
(2) the computation that is believed to be correct, if appropriate;
deleted text end
deleted text begin
(3) the authority in the statute or rule relied upon for each disputed item; and
deleted text end
deleted text begin
(4) the name, address, and phone number of the person at the provider's place of business
with whom contact may be made regarding the appeal.
deleted text end
deleted text begin
(b) Notwithstanding section 245E.03, subdivision 4, an appeal is considered timely only
if postmarked or received by the department's Appeals Division within 30 days after receiving
a notice of department sanction.
deleted text end
deleted text begin
(c) Before the appeal hearing, the department may deny or terminate authorizations or
payment to the entity or individual if the department determines that the action is necessary
to protect the public welfare or the interests of the child care assistance program.
deleted text end
new text begin
A provider's rights related to an action taken under this chapter are established in sections
119B.16 and 119B.161.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 59.
Minnesota Statutes 2016, section 245E.07, subdivision 1, is amended to read:
Subdivision 1.
Grounds for and methods of monetary recovery.
(a) The department
may obtain monetary recovery from a provider who has been improperly paid by the child
care assistance program, regardless of whether the error new text begin was on the part of the provider, the
department, or the county and regardless of whether the error new text end was intentional deleted text begin or county
errordeleted text end . The department does not need to establish a pattern deleted text begin as a precondition of monetary
recoverydeleted text end of erroneous or false billing claims, duplicate billing claims, or billing claims
based on false statements or financial misconduct.
(b) The department shall obtain monetary recovery from providers by the following
means:
(1) permitting voluntary repayment of money, either in lump-sum payment or installment
payments;
(2) using any legal collection process;
(3) deducting or withholding program payments; or
(4) utilizing the means set forth in chapter 16D.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 60.
Minnesota Statutes 2016, section 256.98, subdivision 8, is amended to read:
Subd. 8.
Disqualification from program.
(a) Any person found to be guilty of
wrongfully obtaining assistance by a federal or state court or by an administrative hearing
determination, or waiver thereof, through a disqualification consent agreement, or as part
of any approved diversion plan under section 401.065, or any court-ordered stay which
carries with it any probationary or other conditions, in the Minnesota family investment
program and any affiliated program to include the diversionary work program and the work
participation cash benefit program, the food stamp or food support program, the general
assistance program, the group residential housing program, or the Minnesota supplemental
aid program shall be disqualified from that program. In addition, any person disqualified
from the Minnesota family investment program shall also be disqualified from the food
stamp or food support program. The needs of that individual shall not be taken into
consideration in determining the grant level for that assistance unit:
(1) for one year after the first offense;
(2) for two years after the second offense; and
(3) permanently after the third or subsequent offense.
The period of program disqualification shall begin on the date stipulated on the advance
notice of disqualification without possibility of postponement for administrative stay or
administrative hearing and shall continue through completion unless and until the findings
upon which the sanctions were imposed are reversed by a court of competent jurisdiction.
The period for which sanctions are imposed is not subject to review. The sanctions provided
under this subdivision are in addition to, and not in substitution for, any other sanctions that
may be provided for by law for the offense involved. A disqualification established through
hearing or waiver shall result in the disqualification period beginning immediately unless
the person has become otherwise ineligible for assistance. If the person is ineligible for
assistance, the disqualification period begins when the person again meets the eligibility
criteria of the program from which they were disqualified and makes application for that
program.
(b) A family receiving assistance through child care assistance programs under chapter
119B with a family member who is found to be guilty of wrongfully obtaining child care
assistance by a federal court, state court, or an administrative hearing determination or
waiver, through a disqualification consent agreement, as part of an approved diversion plan
under section 401.065, or a court-ordered stay with probationary or other conditions, is
disqualified from child care assistance programs. The disqualifications must be for periods
of one year and two years for the first and second offenses, respectively. Subsequent
violations must result in permanent disqualification. During the disqualification period,
disqualification from any child care program must extend to all child care programs and
must be immediately applied.
(c) A provider caring for children receiving assistance through child care assistance
programs under chapter 119B is disqualified from receiving payment for child care services
from the child care assistance program under chapter 119B when the provider is found to
have wrongfully obtained child care assistance by a federal court, state court, or an
administrative hearing determination or waiver under section 256.046, through a
disqualification consent agreement, as part of an approved diversion plan under section
401.065, or a court-ordered stay with probationary or other conditions. The disqualification
must be for a period of deleted text begin one yeardeleted text end new text begin two yearsnew text end for the first offense deleted text begin and two years for the second
offensedeleted text end . Any subsequent violation must result in permanent disqualification. The
disqualification period must be imposed immediately after a determination is made under
this paragraph. During the disqualification period, the provider is disqualified from receiving
payment from any child care program under chapter 119B.
(d) Any person found to be guilty of wrongfully obtaining MinnesotaCare for adults
without children and upon federal approval, all categories of medical assistance and
remaining categories of MinnesotaCare, except for children through age 18, by a federal or
state court or by an administrative hearing determination, or waiver thereof, through a
disqualification consent agreement, or as part of any approved diversion plan under section
401.065, or any court-ordered stay which carries with it any probationary or other conditions,
is disqualified from that program. The period of disqualification is one year after the first
offense, two years after the second offense, and permanently after the third or subsequent
offense. The period of program disqualification shall begin on the date stipulated on the
advance notice of disqualification without possibility of postponement for administrative
stay or administrative hearing and shall continue through completion unless and until the
findings upon which the sanctions were imposed are reversed by a court of competent
jurisdiction. The period for which sanctions are imposed is not subject to review. The
sanctions provided under this subdivision are in addition to, and not in substitution for, any
other sanctions that may be provided for by law for the offense involved.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective April 23, 2018.
new text end
Sec. 61.
Minnesota Statutes 2016, section 256N.26, subdivision 5, is amended to read:
Subd. 5.
Alternate rates for preschool entry and certain transitioned children.
A
child who deleted text begin entereddeleted text end new text begin entersnew text end the Northstar kinship assistance or adoption assistance components
of Northstar Care for Children while under the age of six shall receive deleted text begin 50 percent of the
amount the child would otherwise be entitled to under subdivisions 3 and 4deleted text end new text begin the full amount
under subdivisions 3 and 4new text end . The commissioner may deleted text begin alsodeleted text end use the 50 percent rate for a child
who was transitioned into those components through declaration of the commissioner under
section 256N.28, subdivision 7.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 21, 2018.
new text end
Sec. 62.
Minnesota Statutes 2016, section 256N.27, subdivision 2, is amended to read:
Subd. 2.
State share.
The commissioner shall pay the state share of the maintenance
payments as determined under subdivision 4, and an identical share of the pre-Northstar
Care foster care program under section 260C.4411, subdivision 1, the relative custody
assistance program under section 257.85, and the pre-Northstar Care for Children adoption
assistance program under chapter 259A.new text begin The state share shall include the cost of eliminating
the alternate rate for preschool entry under section 256N.26, subdivision 5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 21, 2018.
new text end
Sec. 63.
Minnesota Statutes 2016, section 256N.27, subdivision 4, is amended to read:
Subd. 4.
Nonfederal share.
(a) The commissioner shall establish a percentage share of
the maintenance payments, reduced by federal reimbursements under title IV-E of the Social
Security Act, to be paid by the state and to be paid by the financially responsible agency.
(b) These state and local shares must initially be calculated based on the ratio of the
average appropriate expenditures made by the state and all financially responsible agencies
during calendar years 2011, 2012, 2013, and 2014. For purposes of this calculation,
appropriate expenditures for the financially responsible agencies must include basic and
difficulty of care payments for foster care reduced by federal reimbursements, but not
including any initial clothing allowance, administrative payments to child care agencies
specified in section 317A.907, child care, or other support or ancillary expenditures. For
purposes of this calculation, appropriate expenditures for the state shall include adoption
assistance and relative custody assistance, reduced by federal reimbursements.
(c) For each of the periods January 1, 2015, to June 30, 2016, and fiscal years 2017,
2018, and 2019, the commissioner shall adjust this initial percentage of state and local shares
to reflect the relative expenditure trends during calendar years 2011, 2012, 2013, and 2014,
taking into account appropriations for Northstar Care for Childrennew text begin , the cost of eliminating
the alternate rates for preschool entry under section 256N.26, subdivision 5,new text end and the turnover
rates of the components. In making these adjustments, the commissioner's goal shall be to
make these state and local expenditures other than the appropriations for Northstar Care for
Children to be the same as they would have been had Northstar Care for Children not been
implemented, or if that is not possible, proportionally higher or lower, as appropriate. Except
for adjustments so that the costs of the phase-innew text begin , the cost of eliminating the alternate rates
for preschool entry under section 256N.26, subdivision 5,new text end are borne by the state, the state
and local share percentages for fiscal year 2019 must be used for all subsequent years.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective February 21, 2018.
new text end
Sec. 64.
Minnesota Statutes 2016, section 256P.05, subdivision 1, is amended to read:
Subdivision 1.
Exempted programs.
deleted text begin Participantsdeleted text end new text begin A participantnew text end who deleted text begin qualifydeleted text end new text begin qualifiesnew text end
for deleted text begin child care assistance programs under chapter 119B,deleted text end Minnesota supplemental aid under
chapter 256Ddeleted text begin ,deleted text end and group residential housing under chapter 256I on the basis of eligibility
for Supplemental Security Income are exempt from this section.new text begin A participant who qualifies
for a child care assistance program under chapter 119B is subject to subdivision 2 of this
section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 30, 2018.
new text end
Sec. 65.
Minnesota Statutes 2016, section 256P.07, subdivision 3, is amended to read:
Subd. 3.
Changes that must be reported.
An assistance unit must report the changes
or anticipated changes specified in clauses (1) to (12) within ten days of the date they occur,
at the time of recertification of eligibility under section 256P.04, subdivisions 8 and 9, or
within eight calendar days of a reporting period, whichever occurs first. An assistance unit
must report other changes at the time of recertification of eligibility under section 256P.04,
subdivisions 8 and 9, or at the end of a reporting period, as applicable. When an agency
could have reduced or terminated assistance for one or more payment months if a delay in
reporting a change specified under clauses (1) to (12) had not occurred, the agency must
determine whether a timely notice could have been issued on the day that the change
occurred. When a timely notice could have been issued, each month's overpayment
subsequent to that notice must be considered a client error overpayment under section
119B.11, subdivision 2a, or 256P.08. Changes in circumstances that must be reported within
ten days must also be reported for the reporting period in which those changes occurred.
Within ten days, an assistance unit must report:
(1) a change in earned income of $100 per month or greaternew text begin with the exception of a
program under chapter 119Bnew text end ;
(2) a change in unearned income of $50 per month or greaternew text begin with the exception of a
program under chapter 119Bnew text end ;
(3) a change in employment status and hoursnew text begin with the exception of a program under a
chapter 119Bnew text end ;
(4) a change in address or residence;
(5) a change in household composition with the exception of programs under chapter
256I;
(6) a receipt of a lump-sum paymentnew text begin with the exception of a program under chapter
119Bnew text end ;
(7) an increase in assets if over $9,000 with the exception of programs under chapter
119B;
(8) a change in citizenship or immigration status;
(9) a change in family status with the exception of programs under chapter 256I;
(10) a change in disability status of a unit member, with the exception of programs under
chapter 119B;
(11) a new rent subsidy or a change in rent subsidynew text begin with the exception of a program
under chapter 119Bnew text end ; and
(12) a sale, purchase, or transfer of real propertynew text begin with the exception of a program under
chapter 119Bnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 66.
Minnesota Statutes 2016, section 256P.07, subdivision 6, is amended to read:
Subd. 6.
Child care assistance programs-specific reporting.
new text begin (a) new text end In addition to
subdivision 3, an assistance unit under chapter 119B, within ten days of the change, must
report:
(1) a change in a parentally responsible individual's deleted text begin visitation schedule ordeleted text end custody
deleted text begin arrangementdeleted text end new text begin schedulenew text end for any child receiving child care assistance program benefits; deleted text begin and
deleted text end
(2) a deleted text begin change indeleted text end new text begin permanent end in a parentally responsible individual'snew text end authorized activity
deleted text begin status.deleted text end new text begin ; and
new text end
new text begin
(3) if the unit's family's annual included income exceeds 85 percent of the state median
income, adjusted for family size.
new text end
new text begin
(b) An assistance unit subject to chapter 119B.095, subdivision 1, paragraph (b), must
report a change in the unit's authorized activity status.
new text end
new text begin
(c) An assistance unit must notify the county when the unit wants to reduce the number
of authorized hours for children in the unit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 18, 2017.
new text end
Sec. 67.
Minnesota Statutes 2016, section 257.73, subdivision 1, is amended to read:
Subdivision 1.
Replacement birth record.
new text begin
Upon an adjudication of paternity in a IV-D
matter, the court shall provide a certificate of adjudication form for children who were born
in Minnesota to the Office of Vital Records at the Department of Health.
new text end
Upon compliance with the provisions of section 257.55, subdivision 1, paragraph (e),new text begin
or a recognition of parentage pursuant to section new text end 257.75, or upon new text begin receipt of a certificate of
adjudication form or an new text end order of a court of this state or upon request of a court of another
state, the state registrar of vital records shall prepare a replacement record of birth consistent
with the acknowledgmentnew text begin , the certificate of adjudication form,new text end or the findings of the court
and shall substitute the replacement certificate for the original record of birthnew text begin as required
under section 144.218new text end .
Sec. 68.
Minnesota Statutes 2016, section 257.73, is amended by adding a subdivision to
read:
new text begin Subd. 1a. new text end
new text begin Certificate of adjudication forms. new text end
new text begin
The commissioner of health, in consultation
with the commissioner of human services, shall prepare a certificate of adjudication form
that includes all information necessary for the registrar of vital records to prepare a
replacement birth record that is consistent with the order or findings of the court, and
identifies whether paternity was adjudicated as part of an IV-D case.
new text end
Sec. 69.
Minnesota Statutes 2016, section 518.68, subdivision 2, is amended to read:
Subd. 2.
Contents.
The required notices must be substantially as follows:
IMPORTANT NOTICE
1. PAYMENTS TO PUBLIC AGENCY
According to Minnesota Statutes, section 518A.50, payments ordered for maintenance
and support must be paid to the public agency responsible for child support enforcement
as long as the person entitled to receive the payments is receiving or has applied for
public assistance or has applied for support and maintenance collection services. MAIL
PAYMENTS TO:
2. DEPRIVING ANOTHER OF CUSTODIAL OR PARENTAL RIGHTS -- A FELONY
A person may be charged with a felony who conceals a minor child or takes, obtains,
retains, or fails to return a minor child from or to the child's parent (or person with
custodial or visitation rights), according to Minnesota Statutes, section 609.26. A copy
of that section is available from any district court clerk.
3. NONSUPPORT OF A SPOUSE OR CHILD -- CRIMINAL PENALTIES
A person who fails to pay court-ordered child support or maintenance may be charged
with a crime, which may include misdemeanor, gross misdemeanor, or felony charges,
according to Minnesota Statutes, section 609.375. A copy of that section is available
from any district court clerk.
4. RULES OF SUPPORT, MAINTENANCE, PARENTING TIME
(a) Payment of support or spousal maintenance is to be as ordered, and the giving of
gifts or making purchases of food, clothing, and the like will not fulfill the obligation.
(b) Payment of support must be made as it becomes due, and failure to secure or denial
of parenting time is NOT an excuse for nonpayment, but the aggrieved party must seek
relief through a proper motion filed with the court.
(c) Nonpayment of support is not grounds to deny parenting time. The party entitled to
receive support may apply for support and collection services, file a contempt motion,
or obtain a judgment as provided in Minnesota Statutes, section 548.091.
(d) The payment of support or spousal maintenance takes priority over payment of debts
and other obligations.
(e) A party who accepts additional obligations of support does so with the full knowledge
of the party's prior obligation under this proceeding.
(f) Child support or maintenance is based on annual income, and it is the responsibility
of a person with seasonal employment to budget income so that payments are made
throughout the year as ordered.
(g) Reasonable parenting time guidelines are contained in Appendix B, which is available
from the court administrator.
(h) The nonpayment of support may be enforced through the denial of student grants;
interception of state and federal tax refunds; suspension of driver's, recreational, and
occupational licenses; referral to the department of revenue or private collection agencies;
seizure of assets, including bank accounts and other assets held by financial institutions;
reporting to credit bureaus; interest charging, income withholding, and contempt
proceedings; and other enforcement methods allowed by law.
(i) The public authority may suspend or resume collection of the amount allocated for
child care expenses if the conditions of section 518A.40, subdivision 4, are met.
new text begin
(j) Child care support automatically terminates when the youngest child reaches 13 years
of age unless child care assistance under chapter 119B continues on behalf of the child.
If child care support is calculated separately for each child, child care support for the
child shall automatically terminate when the child turns 13 years of age. If a child
continues to receive child care assistance under chapter 119B after 13 years of age, child
care assistance terminates on the first of the month following the termination of child
care support payments on behalf of the child. The court may order a different age or
event that terminates child care support.
new text end
deleted text begin (j)deleted text end new text begin (k)new text end The public authority may remove or resume a medical support offset if the
conditions of section 518A.41, subdivision 16, are met.
deleted text begin (k)deleted text end new text begin (l)new text end The public authority may suspend or resume interest charging on child support
judgments if the conditions of section 548.091, subdivision 1a, are met.
5. MODIFYING CHILD SUPPORT
If either the obligor or obligee is laid off from employment or receives a pay reduction,
child support may be modified, increased, or decreased. Any modification will only take
effect when it is ordered by the court, and will only relate back to the time that a motion
is filed. Either the obligor or obligee may file a motion to modify child support, and may
request the public agency for help. UNTIL A MOTION IS FILED, THE CHILD
SUPPORT OBLIGATION WILL CONTINUE AT THE CURRENT LEVEL. THE
COURT IS NOT PERMITTED TO REDUCE SUPPORT RETROACTIVELY.
6. PARENTAL RIGHTS FROM MINNESOTA STATUTES, SECTION 518.17,
SUBDIVISION 3
Unless otherwise provided by the Court:
(a) Each party has the right of access to, and to receive copies of, school, medical, dental,
religious training, and other important records and information about the minor children.
Each party has the right of access to information regarding health or dental insurance
available to the minor children. Presentation of a copy of this order to the custodian of
a record or other information about the minor children constitutes sufficient authorization
for the release of the record or information to the requesting party.
(b) Each party shall keep the other informed as to the name and address of the school
of attendance of the minor children. Each party has the right to be informed by school
officials about the children's welfare, educational progress and status, and to attend
school and parent teacher conferences. The school is not required to hold a separate
conference for each party.
(c) In case of an accident or serious illness of a minor child, each party shall notify the
other party of the accident or illness, and the name of the health care provider and the
place of treatment.
(d) Each party has the right of reasonable access and telephone contact with the minor
children.
7. WAGE AND INCOME DEDUCTION OF SUPPORT AND MAINTENANCE
Child support and/or spousal maintenance may be withheld from income, with or without
notice to the person obligated to pay, when the conditions of Minnesota Statutes, section
518A.53 have been met. A copy of those sections is available from any district court
clerk.
8. CHANGE OF ADDRESS OR RESIDENCE
Unless otherwise ordered, each party shall notify the other party, the court, and the public
authority responsible for collection, if applicable, of the following information within
ten days of any change: the residential and mailing address, telephone number, driver's
license number, Social Security number, and name, address, and telephone number of
the employer.
9. COST OF LIVING INCREASE OF SUPPORT AND MAINTENANCE
Basic support and/or spousal maintenance may be adjusted every two years based upon
a change in the cost of living (using Department of Labor Consumer Price Index ..........,
unless otherwise specified in this order) when the conditions of Minnesota Statutes,
section 518A.75, are met. Cost of living increases are compounded. A copy of Minnesota
Statutes, section 518A.75, and forms necessary to request or contest a cost of living
increase are available from any district court clerk.
10. JUDGMENTS FOR UNPAID SUPPORT
If a person fails to make a child support payment, the payment owed becomes a judgment
against the person responsible to make the payment by operation of law on or after the
date the payment is due, and the person entitled to receive the payment or the public
agency may obtain entry and docketing of the judgment WITHOUT NOTICE to the
person responsible to make the payment under Minnesota Statutes, section 548.091.
Interest begins to accrue on a payment or installment of child support whenever the
unpaid amount due is greater than the current support due, according to Minnesota
Statutes, section 548.091, subdivision 1a.
11. JUDGMENTS FOR UNPAID MAINTENANCE
A judgment for unpaid spousal maintenance may be entered when the conditions of
Minnesota Statutes, section 548.091, are met. A copy of that section is available from
any district court clerk.
12. ATTORNEY FEES AND COLLECTION COSTS FOR ENFORCEMENT OF CHILD
SUPPORT
A judgment for attorney fees and other collection costs incurred in enforcing a child
support order will be entered against the person responsible to pay support when the
conditions of section 518A.735, are met. A copy of sections 518.14 and 518A.735 and
forms necessary to request or contest these attorney fees and collection costs are available
from any district court clerk.
13. PARENTING TIME EXPEDITOR PROCESS
On request of either party or on its own motion, the court may appoint a parenting time
expeditor to resolve parenting time disputes under Minnesota Statutes, section 518.1751.
A copy of that section and a description of the expeditor process is available from any
district court clerk.
14. PARENTING TIME REMEDIES AND PENALTIES
Remedies and penalties for the wrongful denial of parenting time are available under
Minnesota Statutes, section 518.175, subdivision 6. These include compensatory parenting
time; civil penalties; bond requirements; contempt; and reversal of custody. A copy of
that subdivision and forms for requesting relief are available from any district court
clerk.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2018.
new text end
Sec. 70.
Minnesota Statutes 2016, section 518A.40, subdivision 4, is amended to read:
Subd. 4.
Change in child care.
(a) When a court order provides for child care expenses,
and child care support is not assigned under section 256.741, the public authority, if the
public authority provides child support enforcement services, may suspend collecting the
amount allocated for child care expenses when either party informs the public authority that
no child care costs are being incurred and:
(1) the public authority verifies the accuracy of the information with the obligee; or
(2) the obligee fails to respond within 30 days of the date of a written request from the
public authority for information regarding child care costs. A written or oral response from
the obligee that child care costs are being incurred is sufficient for the public authority to
continue collecting child care expenses.
The suspension is effective as of the first day of the month following the date that the public
authority either verified the information with the obligee or the obligee failed to respond.
The public authority will resume collecting child care expenses when either party provides
information that child care costs are incurred, or when a child care support assignment takes
effect under section 256.741, subdivision 4. The resumption is effective as of the first day
of the month after the date that the public authority received the information.
(b) If the parties provide conflicting information to the public authority regarding whether
child care expenses are being incurred, the public authority will continue or resume collecting
child care expenses. Either party, by motion to the court, may challenge the suspension,
continuation, or resumption of the collection of child care expenses under this subdivision.
If the public authority suspends collection activities for the amount allocated for child care
expenses, all other provisions of the court order remain in effect.
(c) In cases where there is a substantial increase or decrease in child care expenses, the
parties may modify the order under section 518A.39.
new text begin
(d) Unless otherwise ordered by the court, if the obligor has arrearages for basic, medical,
or child care support at the time a child care support obligation is suspended under this
subdivision, the public authority shall continue to collect the child care support obligation
until the arrearages are paid in full. After a child care support obligation has terminated, the
20 percent arrears payback under section 518A.53, subdivision 10, shall be calculated
without including the amount of the child care support obligation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2018.
new text end
Sec. 71.
Minnesota Statutes 2016, section 518A.40, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Automatic termination of child care support. new text end
new text begin
(a) Unless child care assistance
under chapter 119B continues to be paid on behalf of a child 13 years of age or older, or a
court orders otherwise, if a child care support obligation is ordered in a specific amount per
child, the child care support obligation for each child terminates automatically and without
any action by the obligor to reduce, modify, or terminate the order upon the first of the
month following the month in which that child reaches 13 years of age. If child care
assistance is paid on behalf of a child, the obligation to pay child care support on behalf of
that child terminates on the first of the month following the month in which the child care
assistance terminates.
new text end
new text begin
(b) Unless child care assistance under chapter 119B continues to be paid on behalf of a
child 13 years of age or older, a child care support obligation for two or more children that
is not a child care support obligation in a specific amount per child continues in the full
amount until the first of the month following the month in which the youngest child reaches
13 years of age or until further order of the court. If child care assistance is paid on behalf
of a child, the obligation to pay child care support on behalf of that child terminates on the
first of the month following the month in which the child care assistance terminates.
new text end
new text begin
(c) Either party, or the public authority if child care assistance under chapter 119B is
provided on behalf of the supported child, by motion to the court, may challenge the
termination of child care support.
new text end
new text begin
(d) The obligor may request a modification of the obligor's child care support order
when a child reaches 13 years of age if there is still a minor child under the child care support
order. The child care support obligation shall be determined based on the income of the
parties and the costs of work-related child care at the time the modification is sought.
new text end
new text begin
(e) Unless otherwise ordered by the court, if the obligor has arrearages for basic, medical,
or child care support at the time child care support is terminated under this subdivision, the
public authority shall continue to collect the child care support obligation until the arrearages
are paid in full. After a child care support obligation has terminated, the 20 percent arrears
payback under section 518A.23, subdivision 10, shall be calculated without including the
amount of the child care support obligation.
new text end
new text begin
(f) If the public authority provides child support services at the time child care support
is set to terminate under this subdivision, the public authority shall send the parties 90 days'
notice of the child care support obligation termination. The notice shall state that the child
care support obligation must continue to be collected in full until any existing arrears have
been paid in full, and that collection of the child care support obligation is in addition to
the 20 percent paid under section 518A.53.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2018.
new text end
Sec. 72.
Minnesota Statutes 2016, section 626.556, subdivision 3c, is amended to read:
Subd. 3c.
Local welfare agency, Department of Human Services or Department of
Health responsible for assessing or investigating reports of maltreatmentnew text begin or deathnew text end .
(a)
new text begin Except as provided in paragraph (b), new text end the county local welfare agency is the agency
responsible for assessing or investigating allegations of maltreatment in child foster caredeleted text begin ,deleted text end new text begin
andnew text end family child carenew text begin that do not involve the death of a childnew text end , legally unlicensed child care,
juvenile correctional facilities licensed under section 241.021 located in the local welfare
agency's county, and reports involving children served by an unlicensed personal care
provider organization under section 256B.0659. Copies of findings related to personal care
provider organizations under section 256B.0659 must be forwarded to the Department of
Human Services provider enrollment.
(b) The Department of Human Services is the agency responsible for assessing or
investigating allegations of maltreatment innew text begin :
new text end
new text begin (1) new text end facilities licensed under chapters 245A and 245D, except deleted text begin for child foster care anddeleted text end new text begin
innew text end family child caredeleted text begin .deleted text end new text begin and child foster care homes that are monitored by county agencies
according to section 245A.16, subdivision 1;
new text end
new text begin
(2) child foster care homes that are monitored by private agencies and homes are licensed
by the commissioner to perform licensing functions and activities according to section
245A.16, subdivision 1; and
new text end
new text begin
(3) child foster care and family child care homes that are monitored by county agencies
according to section 245A.16, subdivision 1, upon agreement by the county and the
Department of Human Services for a specific case, or when the commissioner identifies
cause.
new text end
new text begin
(c) The Department of Human Services is responsible for investigating the death of a
child in a child foster care program or family child care program.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The Department of Health is the agency responsible for assessing or investigating
allegations of child maltreatment in facilities licensed under sections 144.50 to 144.58 deleted text begin and
144A.43 to 144A.482deleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 73.
Minnesota Statutes 2016, section 626.556, subdivision 10b, is amended to read:
Subd. 10b.
Duties of commissioner; neglect deleted text begin ordeleted text end new text begin ,new text end abusenew text begin , or deathnew text end in new text begin a new text end facility.
(a) This
section applies to the commissioners of human services, health, and education. The
commissioner of the agency responsible for assessing or investigating the report shall
immediately assess or investigate if the report alleges that:
(1) a child who is in the care of a facility as defined in subdivision 2 is neglected,
physically abused, sexually abused, or is the victim of maltreatment in a facility by an
individual in that facility, or has been so neglected or abused, or been the victim of
maltreatment in a facility by an individual in that facility within the three years preceding
the report; or
(2) a child was neglected, physically abused, sexually abused, or is the victim of
maltreatment in a facility by an individual in a facility defined in subdivision 2, while in
the care of that facility within the three years preceding the report.
The commissioner of the agency responsible for assessing or investigating the report
shall arrange for the transmittal to the commissioner of reports received by local agencies
and may delegate to a local welfare agency the duty to investigate reports. In conducting
an investigation under this section, the commissioner has the powers and duties specified
for local welfare agencies under this section. The commissioner of the agency responsible
for assessing or investigating the report or local welfare agency may interview any children
who are or have been in the care of a facility under investigation and their parents, guardians,
or legal custodians.
(b) Prior to any interview, the commissioner of the agency responsible for assessing or
investigating the report or local welfare agency shall notify the parent, guardian, or legal
custodian of a child who will be interviewed in the manner provided for in subdivision 10d,
paragraph (a). If reasonable efforts to reach the parent, guardian, or legal custodian of a
child in an out-of-home placement have failed, the child may be interviewed if there is
reason to believe the interview is necessary to protect the child or other children in the
facility. The commissioner of the agency responsible for assessing or investigating the report
or local agency must provide the information required in this subdivision to the parent,
guardian, or legal custodian of a child interviewed without parental notification as soon as
possible after the interview. When the investigation is completed, any parent, guardian, or
legal custodian notified under this subdivision shall receive the written memorandum
provided for in subdivision 10d, paragraph (c).
(c) In conducting investigations under this subdivision the commissioner or local welfare
agency shall obtain access to information consistent with subdivision 10, paragraphs (h),
(i), and (j). In conducting assessments or investigations under this subdivision, the
commissioner of education shall obtain access to reports and investigative data that are
relevant to a report of maltreatment and are in the possession of a school facility as defined
in subdivision 2, paragraph (c), notwithstanding the classification of the data as educational
or personnel data under chapter 13. This includes, but is not limited to, school investigative
reports, information concerning the conduct of school personnel alleged to have committed
maltreatment of students, information about witnesses, and any protective or corrective
action taken by the school facility regarding the school personnel alleged to have committed
maltreatment.
(d) The commissioner may request assistance from the local social services agency.
new text begin
(e) The commissioner of human services shall investigate every incident involving the
death of a child during placement in a child foster care home licensed under chapter 245A
and Minnesota Rules, chapter 2960. The investigation, notifications, and data classifications
are governed by this section, even if abuse or neglect is not alleged in the report.
new text end
new text begin
(f) The commissioner of human services shall investigate every incident involving the
death of a child in a family child care program licensed under chapter 245A and Minnesota
Rules, chapter 9502. The investigation, notifications, and data classifications are governed
by this section, even if abuse or neglect is not alleged in the report.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 74.
Minnesota Statutes 2016, section 626.559, subdivision 1, is amended to read:
Subdivision 1.
Job classification; continuing education.
The commissioner of human
services, for employees subject to the Minnesota Merit System, and directors of county
personnel systems, for counties not subject to the Minnesota Merit System, shall establish
a job classification consisting exclusively of persons with the specialized knowledge, skills,
and experience required to satisfactorily perform child protection duties pursuant to section
626.556, subdivisions 10, 10a, and 10b.
All child protection workers or social services staff having responsibility for child
protective duties under section 626.556 shall receive deleted text begin 15deleted text end new text begin 20new text end hours of continuing education
or in-service training each year relevant to providing child protective services. new text begin At least ten
of the hours shall include advanced training in topics to be decided and developed by the
commissioner of human services. new text end The local social service agency shall maintain a record
of training completed by each employee having responsibility for performing child protective
duties.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 75. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2016, section 119B.07,
new text end
new text begin
is repealed effective December 18, 2017.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2016, section 119B.125, subdivision 5,
new text end
new text begin
is repealed effective the
day following final enactment.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Statutes 2016, sections 119B.16, subdivision 2; 245E.03, subdivision 3;
and 245E.06, subdivisions 4 and 5,
new text end
new text begin
and
new text end
new text begin
Minnesota Rules, part 3400.0185, subpart 5,
new text end
new text begin
are
repealed effective April 23, 2018.
new text end
ARTICLE 8
CHEMICAL AND MENTAL HEALTH SERVICES
Section 1.
Minnesota Statutes 2016, section 245.4661, subdivision 9, is amended to read:
Subd. 9.
Services and programs.
(a) The following deleted text begin threedeleted text end distinct grant programs are
funded under this section:
(1) mental health crisis services;
(2) housing with supports for adults with serious mental illness; deleted text begin and
deleted text end
(3) projects for assistance in transitioning from homelessness (PATH program)deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) community-based mental health infrastructure development grants.
new text end
(b) In addition, the following are eligible for grant funds:
(1) community education and prevention;
(2) client outreach;
(3) early identification and intervention;
(4) adult outpatient diagnostic assessment and psychological testing;
(5) peer support services;
(6) community support program services (CSP);
(7) adult residential crisis stabilization;
(8) supported employment;
(9) assertive community treatment (ACT);
(10) housing subsidies;
(11) basic living, social skills, and community intervention;
(12) emergency response services;
(13) adult outpatient psychotherapy;
(14) adult outpatient medication management;
(15) adult mobile crisis services;
(16) adult day treatment;
(17) partial hospitalization;
(18) adult residential treatment;
(19) adult mental health targeted case management;
(20) intensive community rehabilitative services (ICRS); and
(21) transportation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2016, section 245.4889, subdivision 1, is amended to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; or
(4) mental health service providers.
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with severe emotional disturbances who are at risk
of out-of-home placement;
(4) children's mental health crisis services;
(5) mental health services for people from cultural and ethnic minorities;
(6) children's mental health screening and follow-up diagnostic assessment and treatment;
(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(8) school-linked mental health services;
(9) building evidence-based mental health intervention capacity for children birth to age
five;
(10) suicide prevention and counseling services that use text messaging statewide;
(11) mental health first aid training;
(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
Web site to share information and strategies to promote resilience and prevent trauma;
(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(14) early childhood mental health consultation;
(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis; deleted text begin and
deleted text end
(16) psychiatric consultation for primary care practitionersdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(17) start-up funding to establish new childrens' mental health programs to support
providers to meet all program requirements and begin operations.
new text end
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under paragraph (b) must be
designed to foster independent living in the community.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2016, section 245A.03, subdivision 2, is amended to read:
Subd. 2.
Exclusion from licensure.
(a) This chapter does not apply to:
(1) residential or nonresidential programs that are provided to a person by an individual
who is related unless the residential program is a child foster care placement made by a
local social services agency or a licensed child-placing agency, except as provided in
subdivision 2a;
(2) nonresidential programs that are provided by an unrelated individual to persons from
a single related family;
(3) residential or nonresidential programs that are provided to adults who do not deleted text begin abuse
chemicals or who do not have a chemical dependencydeleted text end new text begin misuse substances or have a substance
use disordernew text end , a mental illness, a developmental disability, a functional impairment, or a
physical disability;
(4) sheltered workshops or work activity programs that are certified by the commissioner
of employment and economic development;
(5) programs operated by a public school for children 33 months or older;
(6) nonresidential programs primarily for children that provide care or supervision for
periods of less than three hours a day while the child's parent or legal guardian is in the
same building as the nonresidential program or present within another building that is
directly contiguous to the building in which the nonresidential program is located;
(7) nursing homes or hospitals licensed by the commissioner of health except as specified
under section 245A.02;
(8) board and lodge facilities licensed by the commissioner of health that do not provide
children's residential services under Minnesota Rules, chapter 2960, mental health or chemical
dependency treatment;
(9) homes providing programs for persons placed by a county or a licensed agency for
legal adoption, unless the adoption is not completed within two years;
(10) programs licensed by the commissioner of corrections;
(11) recreation programs for children or adults that are operated or approved by a park
and recreation board whose primary purpose is to provide social and recreational activities;
(12) programs operated by a school as defined in section 120A.22, subdivision 4; YMCA
as defined in section 315.44; YWCA as defined in section 315.44; or JCC as defined in
section 315.51, whose primary purpose is to provide child care or services to school-age
children;
(13) Head Start nonresidential programs which operate for less than 45 days in each
calendar year;
(14) noncertified boarding care homes unless they provide services for five or more
persons whose primary diagnosis is mental illness or a developmental disability;
(15) programs for children such as scouting, boys clubs, girls clubs, and sports and art
programs, and nonresidential programs for children provided for a cumulative total of less
than 30 days in any 12-month period;
(16) residential programs for persons with mental illness, that are located in hospitals;
(17) the religious instruction of school-age children; Sabbath or Sunday schools; or the
congregate care of children by a church, congregation, or religious society during the period
used by the church, congregation, or religious society for its regular worship;
(18) camps licensed by the commissioner of health under Minnesota Rules, chapter
4630;
(19) mental health outpatient services for adults with mental illness or children with
emotional disturbance;
(20) residential programs serving school-age children whose sole purpose is cultural or
educational exchange, until the commissioner adopts appropriate rules;
(21) community support services programs as defined in section 245.462, subdivision
6, and family community support services as defined in section 245.4871, subdivision 17;
(22) the placement of a child by a birth parent or legal guardian in a preadoptive home
for purposes of adoption as authorized by section 259.47;
(23) settings registered under chapter 144D which provide home care services licensed
by the commissioner of health to fewer than seven adults;
(24) deleted text begin chemical dependency ordeleted text end substance deleted text begin abusedeleted text end new text begin use disordernew text end treatment activities of licensed
professionals in private practice as defined in deleted text begin Minnesota Rules, part 9530.6405, subpart 15,
when the treatment activities are not paid for by the consolidated chemical dependency
treatment funddeleted text end new text begin section 245G.01, subdivision 17new text end ;
(25) consumer-directed community support service funded under the Medicaid waiver
for persons with developmental disabilities when the individual who provided the service
is:
(i) the same individual who is the direct payee of these specific waiver funds or paid by
a fiscal agent, fiscal intermediary, or employer of record; and
(ii) not otherwise under the control of a residential or nonresidential program that is
required to be licensed under this chapter when providing the service;
(26) a program serving only children who are age 33 months or older, that is operated
by a nonpublic school, for no more than four hours per day per child, with no more than 20
children at any one time, and that is accredited by:
(i) an accrediting agency that is formally recognized by the commissioner of education
as a nonpublic school accrediting organization; or
(ii) an accrediting agency that requires background studies and that receives and
investigates complaints about the services provided.
A program that asserts its exemption from licensure under item (ii) shall, upon request
from the commissioner, provide the commissioner with documentation from the accrediting
agency that verifies: that the accreditation is current; that the accrediting agency investigates
complaints about services; and that the accrediting agency's standards require background
studies on all people providing direct contact services; or
(27) a program operated by a nonprofit organization incorporated in Minnesota or another
state that serves youth in kindergarten through grade 12; provides structured, supervised
youth development activities; and has learning opportunities take place before or after
school, on weekends, or during the summer or other seasonal breaks in the school calendar.
A program exempt under this clause is not eligible for child care assistance under chapter
119B. A program exempt under this clause must:
(i) have a director or supervisor on site who is responsible for overseeing written policies
relating to the management and control of the daily activities of the program, ensuring the
health and safety of program participants, and supervising staff and volunteers;
(ii) have obtained written consent from a parent or legal guardian for each youth
participating in activities at the site; and
(iii) have provided written notice to a parent or legal guardian for each youth at the site
that the program is not licensed or supervised by the state of Minnesota and is not eligible
to receive child care assistance payments.
(b) For purposes of paragraph (a), clause (6), a building is directly contiguous to a
building in which a nonresidential program is located if it shares a common wall with the
building in which the nonresidential program is located or is attached to that building by
skyway, tunnel, atrium, or common roof.
(c) Except for the home and community-based services identified in section 245D.03,
subdivision 1, nothing in this chapter shall be construed to require licensure for any services
provided and funded according to an approved federal waiver plan where licensure is
specifically identified as not being a condition for the services and funding.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 4.
Minnesota Statutes 2016, section 245A.03, subdivision 7, is amended to read:
Subd. 7.
Licensing moratorium.
(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);
(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;
(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
or
(5) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner for the transition of people from personal care assistance to
the home and community-based services.
(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.
(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department shall decrease
the statewide licensed capacity for adult foster care settings where the physical location is
not the primary residence of the license holder, or for adult community residential settings,
if the voluntary changes described in paragraph (e) are not sufficient to meet the savings
required by reductions in licensed bed capacity under Laws 2011, First Special Session
chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide long-term care
residential services capacity within budgetary limits. Implementation of the statewide
licensed capacity reduction shall begin on July 1, 2013. The commissioner shall delicense
up to 128 beds by June 30, 2014, using the needs determination process. Prior to any
involuntary reduction of licensed capacity, the commissioner shall consult with lead agencies
and license holders to determine which adult foster care settings, where the physical location
is not the primary residence of the license holder, or community residential settings, are
licensed for up to five beds, but have operated at less than full capacity for 12 or more
months as of March 1, 2014. The settings that meet these criteria must be the first to be
considered for an involuntary decrease in statewide licensed capacity, up to a maximum of
35 beds. If more than 35 beds are identified that meet these criteria, the commissioner shall
prioritize the selection of those beds to be closed based on the length of time the beds have
been vacant. The longer a bed has been vacant, the higher priority it must be given for
closure. Under this paragraph, the commissioner has the authority to reduce unused licensed
capacity of a current foster care program, or the community residential settings, to accomplish
the consolidation or closure of settings. Under this paragraph, the commissioner has the
authority to manage statewide capacity, including adjusting the capacity available to each
county and adjusting statewide available capacity, to meet the statewide needs identified
through the process in paragraph (e). A decreased licensed capacity according to this
paragraph is not subject to appeal under this chapter.
(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.
(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity required under paragraph (c) will be implemented.
The commissioner shall consult with the stakeholders described in section 144A.351, and
employ a variety of methods to improve the state's capacity to meet long-term care service
needs within budgetary limits, including seeking proposals from service providers or lead
agencies to change service type, capacity, or location to improve services, increase the
independence of residents, and better meet needs identified by the long-term care services
reports and statewide data and information. By February 1, 2013, and August 1, 2014, and
each following year, the commissioner shall provide information and data on the overall
capacity of licensed long-term care services, actions taken under this subdivision to manage
statewide long-term care services and supports resources, and any recommendations for
change to the legislative committees with jurisdiction over health and human services budget.
(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.
(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under section 256B.0915, 256B.092, or 256B.49, must inform the human services
licensing division that the license holder provides or intends to provide these waiver-funded
services.
new text begin
(h) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 5.
Minnesota Statutes 2016, section 245A.191, is amended to read:
245A.191 PROVIDER ELIGIBILITY FOR PAYMENTS FROM THE CHEMICAL
DEPENDENCY CONSOLIDATED TREATMENT FUND.
(a) When a deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end treatment provider licensed
under new text begin chapter 245G or new text end Minnesota Rules, parts 2960.0430 to 2960.0490 deleted text begin or 9530.6405 to
9530.6505deleted text end , agrees to meet the applicable requirements under section 254B.05, subdivision
5, deleted text begin paragraphs (b), clauses (1) to (4) and (6), (c), and (e),deleted text end to be eligible for enhanced funding
from the chemical dependency consolidated treatment fund, the applicable requirements
under section 254B.05 are also licensing requirements that may be monitored for compliance
through licensing investigations and licensing inspections.
(b) Noncompliance with the requirements identified under paragraph (a) may result in:
(1) a correction order or a conditional license under section 245A.06, or sanctions under
section 245A.07;
(2) nonpayment of claims submitted by the license holder for public program
reimbursement;
(3) recovery of payments made for the service;
(4) disenrollment in the public payment program; or
(5) other administrative, civil, or criminal penalties as provided by law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 6.
new text begin
[245G.01] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
The terms used in this chapter have the meanings given them.
new text end
new text begin Subd. 2. new text end
new text begin Administration of medication. new text end
new text begin
"Administration of medication" means providing
a medication to a client, and includes the following tasks, performed in the following order:
new text end
new text begin
(1) checking the client's medication record;
new text end
new text begin
(2) preparing the medication for administration;
new text end
new text begin
(3) administering the medication to the client;
new text end
new text begin
(4) documenting the administration of the medication, or the reason for not administering
a medication as prescribed; and
new text end
new text begin
(5) reporting information to a licensed practitioner or a nurse regarding a problem with
the administration of medication or the client's refusal to take the medication, if applicable.
new text end
new text begin Subd. 3. new text end
new text begin Adolescent. new text end
new text begin
"Adolescent" means an individual under 18 years of age.
new text end
new text begin Subd. 4. new text end
new text begin Alcohol and drug counselor. new text end
new text begin
"Alcohol and drug counselor" has the meaning
given in section 148F.01, subdivision 5.
new text end
new text begin Subd. 5. new text end
new text begin Applicant. new text end
new text begin
"Applicant" means an individual, corporation, partnership, voluntary
association, controlling individual, or other organization that applied for a license under
this chapter.
new text end
new text begin Subd. 6. new text end
new text begin Capacity management system. new text end
new text begin
"Capacity management system" means a
database maintained by the department to compile and make information available to the
public about the waiting list status and current admission capability of each opioid treatment
program.
new text end
new text begin Subd. 7. new text end
new text begin Central registry. new text end
new text begin
"Central registry" means a database maintained by the
department to collect identifying information from two or more programs about an individual
applying for maintenance treatment or detoxification treatment for opioid addiction to
prevent an individual's concurrent enrollment in more than one program.
new text end
new text begin Subd. 8. new text end
new text begin Client. new text end
new text begin
"Client" means an individual accepted by a license holder for assessment
or treatment of a substance use disorder. An individual remains a client until the license
holder no longer provides or intends to provide the individual with treatment service.
new text end
new text begin Subd. 9. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of human services.
new text end
new text begin Subd. 10. new text end
new text begin Co-occurring disorders. new text end
new text begin
"Co-occurring disorders" means a diagnosis of both
a substance use disorder and a mental health disorder.
new text end
new text begin Subd. 11. new text end
new text begin Department. new text end
new text begin
"Department" means the Department of Human Services.
new text end
new text begin Subd. 12. new text end
new text begin Direct contact. new text end
new text begin
"Direct contact" has the meaning given for "direct contact"
in section 245C.02, subdivision 11.
new text end
new text begin Subd. 13. new text end
new text begin Face-to-face. new text end
new text begin
"Face-to-face" means two-way, real-time, interactive and visual
communication between a client and a treatment service provider and includes services
delivered via telemedicine.
new text end
new text begin Subd. 14. new text end
new text begin License. new text end
new text begin
"License" means a certificate issued by the commissioner authorizing
the license holder to provide a specific program for a specified period of time according to
the terms of the license and the rules of the commissioner.
new text end
new text begin Subd. 15. new text end
new text begin License holder. new text end
new text begin
"License holder" means an individual, corporation, partnership,
voluntary organization, or other organization that is legally responsible for the operation of
the program, was granted a license by the commissioner under this chapter, and is a
controlling individual.
new text end
new text begin Subd. 16. new text end
new text begin Licensed practitioner. new text end
new text begin
"Licensed practitioner" means an individual who is
authorized to prescribe medication as defined in section 151.01, subdivision 23.
new text end
new text begin Subd. 17. new text end
new text begin Licensed professional in private practice. new text end
new text begin
"Licensed professional in private
practice" means an individual who:
new text end
new text begin
(1) is licensed under chapter 148F, or is exempt from licensure under that chapter but
is otherwise licensed to provide alcohol and drug counseling services;
new text end
new text begin
(2) practices solely within the permissible scope of the individual's license as defined
in the law authorizing licensure; and
new text end
new text begin
(3) does not affiliate with other licensed or unlicensed professionals to provide alcohol
and drug counseling services. Affiliation does not include conferring with another
professional or making a client referral.
new text end
new text begin Subd. 18. new text end
new text begin Nurse. new text end
new text begin
"Nurse" means an individual licensed and currently registered to
practice professional or practical nursing as defined in section 148.171, subdivisions 14 and
15.
new text end
new text begin Subd. 19. new text end
new text begin Opioid treatment program. new text end
new text begin
"Opioid treatment program" or "OTP" means a
program or practitioner engaged in opioid treatment of an individual that provides dispensing
of an opioid agonist treatment medication, along with a comprehensive range of medical
and rehabilitative services, when clinically necessary, to an individual to alleviate the adverse
medical, psychological, or physical effects of an opioid addiction. OTP includes
detoxification treatment, short-term detoxification treatment, long-term detoxification
treatment, maintenance treatment, comprehensive maintenance treatment, and interim
maintenance treatment.
new text end
new text begin Subd. 20. new text end
new text begin Paraprofessional. new text end
new text begin
"Paraprofessional" means an employee, agent, or
independent contractor of the license holder who performs tasks to support treatment service.
A paraprofessional may be referred to by a variety of titles including but not limited to
technician, case aide, or counselor assistant. If currently a client of the license holder, the
client cannot be a paraprofessional for the license holder.
new text end
new text begin Subd. 21. new text end
new text begin Student intern. new text end
new text begin
"Student intern" means an individual who is authorized by a
licensing board to provide services under supervision of a licensed professional.
new text end
new text begin Subd. 22. new text end
new text begin Substance. new text end
new text begin
"Substance" means alcohol, solvents, controlled substances as
defined in section 152.01, subdivision 4, and other mood-altering substances.
new text end
new text begin Subd. 23. new text end
new text begin Substance use disorder. new text end
new text begin
"Substance use disorder" has the meaning given in
the current Diagnostic and Statistical Manual of Mental Disorders.
new text end
new text begin Subd. 24. new text end
new text begin Substance use disorder treatment. new text end
new text begin
"Substance use disorder treatment" means
treatment of a substance use disorder, including the process of assessment of a client's needs,
development of planned methods, including interventions or services to address a client's
needs, provision of services, facilitation of services provided by other service providers,
and ongoing reassessment by a qualified professional when indicated. The goal of substance
use disorder treatment is to assist or support the client's efforts to recover from a substance
use disorder.
new text end
new text begin Subd. 25. new text end
new text begin Target population. new text end
new text begin
"Target population" means individuals with a substance
use disorder and the specified characteristics that a license holder proposes to serve.
new text end
new text begin Subd. 26. new text end
new text begin Telemedicine. new text end
new text begin
"Telemedicine" means the delivery of a substance use disorder
treatment service while the client is at an originating site and the licensed health care provider
is at a distant site as specified in section 254B.05, subdivision 5, paragraph (f).
new text end
new text begin Subd. 27. new text end
new text begin Treatment director. new text end
new text begin
"Treatment director" means an individual who meets
the qualifications specified in section 245G.11, subdivisions 1 and 3, and is designated by
the license holder to be responsible for all aspects of the delivery of treatment service.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 7.
new text begin
[245G.02] APPLICABILITY.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
Except as provided in subdivisions 2 and 3, no person,
corporation, partnership, voluntary association, controlling individual, or other organization
may provide a substance use disorder treatment service to an individual with a substance
use disorder unless licensed by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Exemption from license requirement. new text end
new text begin
This chapter does not apply to a county
or recovery community organization that is a vendor under section 254B.05 or to an
organization whose primary functions are information, referral, diagnosis, case management,
and assessment for the purposes of client placement, education, support group services, or
self-help programs. This chapter does not apply to the activities of a licensed professional
in private practice.
new text end
new text begin Subd. 3. new text end
new text begin Excluded hospitals. new text end
new text begin
This chapter does not apply to substance use disorder
treatment provided by a hospital licensed under chapter 62J, or under sections 144.50 to
144.56, unless the hospital accepts funds for substance use disorder treatment from the
consolidated chemical dependency treatment fund under chapter 254B, medical assistance
under chapter 256B, or MinnesotaCare or health care cost containment under chapter 256L,
or general assistance medical care formerly codified in chapter 256D.
new text end
new text begin Subd. 4. new text end
new text begin Applicability of Minnesota Rules, chapter 2960. new text end
new text begin
A residential adolescent
substance use disorder treatment program serving an individual younger than 16 years of
age must be licensed according to Minnesota Rules, chapter 2960.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 8.
new text begin
[245G.03] LICENSING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin License requirements. new text end
new text begin
(a) An applicant for a license to provide substance
use disorder treatment must comply with the general requirements in chapters 245A and
245C, sections 626.556 and 626.557, and Minnesota Rules, chapter 9544.
new text end
new text begin
(b) The commissioner may grant variances to the requirements in this chapter that do
not affect the client's health or safety if the conditions in section 245A.04, subdivision 9,
are met.
new text end
new text begin Subd. 2. new text end
new text begin Application. new text end
new text begin
Before the commissioner issues a license, an applicant must
submit, on forms provided by the commissioner, any documents the commissioner requires
to demonstrate the following:
new text end
new text begin
(1) compliance with this chapter;
new text end
new text begin
(2) compliance with applicable building, fire and safety codes, health rules, zoning
ordinances, and other applicable rules and regulations or documentation that a waiver was
granted. An applicant's receipt of a waiver does not constitute modification of any
requirement in this chapter;
new text end
new text begin
(3) completion of an assessment of need for a new or expanded program according to
Minnesota Rules, part 9530.6800, subpart 1. If an application proposes a program that would
be subject to the federal Institution for Mental Diseases (IMD) exclusion, the applicant must
demonstrate the need for the proposed bed capacity and that the program would be more
cost-effective for the state than a non-IMD model; and
new text end
new text begin
(4) insurance coverage, including bonding, sufficient to cover all client funds, property,
and interests.
new text end
new text begin Subd. 3. new text end
new text begin Change in license terms. new text end
new text begin
(a) The commissioner must determine whether a
new license is needed when a change in clauses (1) to (4) occurs. A license holder must
notify the commissioner before a change in one of the following occurs:
new text end
new text begin
(1) the Department of Health's licensure of the program;
new text end
new text begin
(2) whether the license holder provides services specified in sections 245G.18 to 245G.22;
new text end
new text begin
(3) location; or
new text end
new text begin
(4) capacity if the license holder meets the requirements of section 245G.21.
new text end
new text begin
(b) A license holder must notify the commissioner and must apply for a new license if
there is a change in program ownership.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 9.
new text begin
[245G.04] INITIAL SERVICES PLAN.
new text end
new text begin
(a) The license holder must complete an initial services plan on the day of service
initiation. The plan must address the client's immediate health and safety concerns, identify
the needs to be addressed in the first treatment session, and make treatment suggestions for
the client during the time between intake and completion of the individual treatment plan.
new text end
new text begin
(b) The initial services plan must include a determination of whether a client is a
vulnerable adult as defined in section 626.5572, subdivision 21. An adult client of a
residential program is a vulnerable adult. An individual abuse prevention plan, according
to sections 245A.65, subdivision 2, paragraph (b), and 626.557, subdivision 14, paragraph
(b), is required for a client who meets the definition of vulnerable adult.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 10.
new text begin
[245G.05] COMPREHENSIVE ASSESSMENT AND ASSESSMENT
SUMMARY.
new text end
new text begin Subdivision 1. new text end
new text begin Comprehensive assessment. new text end
new text begin
(a) A comprehensive assessment of the
client's substance use disorder must be administered face-to-face by an alcohol and drug
counselor within three calendar days after service initiation for a residential program or
during the initial session for all other programs. If the comprehensive assessment is not
completed during the initial session, the client-centered reason for the delay must be
documented in the client's file and the planned completion date. If the client received a
comprehensive assessment that authorized the treatment service, an alcohol and drug
counselor must review the assessment to determine compliance with this subdivision,
including applicable timelines. If available, the alcohol and drug counselor may use current
information provided by a referring agency or other source as a supplement. Information
gathered more than 45 days before the date of admission is not considered current. If the
comprehensive assessment cannot be completed in the time specified, the treatment plan
must indicate a person-centered reason for the delay, and how and when the comprehensive
assessment will be completed. The comprehensive assessment must include sufficient
information to complete the assessment summary according to subdivision 2 and the
individual treatment plan according to section 245G.06. The comprehensive assessment
must include information about the client's needs that relate to substance use and personal
strengths that support recovery, including:
new text end
new text begin
(1) age, sex, cultural background, sexual orientation, living situation, economic status,
and level of education;
new text end
new text begin
(2) circumstances of service initiation;
new text end
new text begin
(3) previous attempts at treatment for substance misuse or substance use disorder,
compulsive gambling, or mental illness;
new text end
new text begin
(4) substance use history including amounts and types of substances used, frequency
and duration of use, periods of abstinence, and circumstances of relapse, if any. For each
substance used within the previous 30 days, the information must include the date and time
of the most recent use and previous withdrawal symptoms;
new text end
new text begin
(5) specific problem behaviors exhibited by the client when under the influence of
substances;
new text end
new text begin
(6) family status, family history, including history or presence of physical or sexual
abuse, level of family support, and substance misuse or substance use disorder of a family
member or significant other;
new text end
new text begin
(7) physical concerns or diagnoses, the severity of the concerns, and whether the concerns
are being addressed by a health care professional;
new text end
new text begin
(8) mental health history and psychiatric status, including symptoms, disability, current
treatment supports, and psychotropic medication needed to maintain stability; the assessment
must utilize screening tools approved by the commissioner pursuant to section 245.4863 to
identify whether the client screens positive for co-occurring disorders;
new text end
new text begin
(9) arrests and legal interventions related to substance use;
new text end
new text begin
(10) ability to function appropriately in work and educational settings;
new text end
new text begin
(11) ability to understand written treatment materials, including rules and the client's
rights;
new text end
new text begin
(12) risk-taking behavior, including behavior that puts the client at risk of exposure to
blood-borne or sexually transmitted diseases;
new text end
new text begin
(13) social network in relation to expected support for recovery and leisure time activities
that are associated with substance use;
new text end
new text begin
(14) whether the client is pregnant and, if so, the health of the unborn child and the
client's current involvement in prenatal care;
new text end
new text begin
(15) whether the client recognizes problems related to substance use and is willing to
follow treatment recommendations; and
new text end
new text begin
(16) collateral information. If the assessor gathered sufficient information from the
referral source or the client to apply the criteria in parts 9530.6620 and 9530.6622, a collateral
contact is not required.
new text end
new text begin
(b) If the client is identified as having opioid use disorder or seeking treatment for opioid
use disorder, the program must provide educational information to the client concerning:
new text end
new text begin
(1) risks for opioid use disorder and dependence;
new text end
new text begin
(2) treatment options, including the use of a medication for opioid use disorder;
new text end
new text begin
(3) the risk of and recognizing opioid overdose; and
new text end
new text begin
(4) the use, availability, and administration of naloxone to respond to opioid overdose.
new text end
new text begin
(c) The commissioner shall develop educational materials that are supported by research
and updated periodically. The license holder must use the educational materials that are
approved by the commissioner to comply with this requirement.
new text end
new text begin
(d) If the comprehensive assessment is completed to authorize treatment service for the
client, at the earliest opportunity during the assessment interview the assessor shall determine
if:
new text end
new text begin
(1) the client is in severe withdrawal and likely to be a danger to self or others;
new text end
new text begin
(2) the client has severe medical problems that require immediate attention; or
new text end
new text begin
(3) the client has severe emotional or behavioral symptoms that place the client or others
at risk of harm.
new text end
new text begin
If one or more of the conditions in clauses (1) to (3) are present, the assessor must end the
assessment interview and follow the procedures in the program's medical services plan
under section 245G.08, subdivision 2, to help the client obtain the appropriate services. The
assessment interview may resume when the condition is resolved.
new text end
new text begin Subd. 2. new text end
new text begin Assessment summary. new text end
new text begin
(a) An alcohol and drug counselor must complete an
assessment summary within three calendar days after service initiation for a residential
program and within three sessions for all other programs. If the comprehensive assessment
is used to authorize the treatment service, the alcohol and drug counselor must prepare an
assessment summary on the same date the comprehensive assessment is completed. If the
comprehensive assessment and assessment summary are to authorize treatment services,
the assessor must determine appropriate services for the client using the dimensions in
Minnesota Rules, part 9530.6622, and document the recommendations.
new text end
new text begin
(b) An assessment summary must include:
new text end
new text begin
(1) a risk description according to section 245G.05 for each dimension listed in paragraph
(c);
new text end
new text begin
(2) a narrative summary supporting the risk descriptions; and
new text end
new text begin
(3) a determination of whether the client has a substance use disorder.
new text end
new text begin
(c) An assessment summary must contain information relevant to treatment service
planning and recorded in the dimensions in clauses (1) to (6). The license holder must
consider:
new text end
new text begin
(1) Dimension 1, acute intoxication/withdrawal potential; the client's ability to cope with
withdrawal symptoms and current state of intoxication;
new text end
new text begin
(2) Dimension 2, biomedical conditions and complications; the degree to which any
physical disorder of the client would interfere with treatment for substance use, and the
client's ability to tolerate any related discomfort. The license holder must determine the
impact of continued chemical use on the unborn child, if the client is pregnant;
new text end
new text begin
(3) Dimension 3, emotional, behavioral, and cognitive conditions and complications;
the degree to which any condition or complication is likely to interfere with treatment for
substance use or with functioning in significant life areas and the likelihood of harm to self
or others;
new text end
new text begin
(4) Dimension 4, readiness for change; the support necessary to keep the client involved
in treatment service;
new text end
new text begin
(5) Dimension 5, relapse, continued use, and continued problem potential; the degree
to which the client recognizes relapse issues and has the skills to prevent relapse of either
substance use or mental health problems; and
new text end
new text begin
(6) Dimension 6, recovery environment; whether the areas of the client's life are
supportive of or antagonistic to treatment participation and recovery.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 11.
new text begin
[245G.06] INDIVIDUAL TREATMENT PLAN.
new text end
new text begin Subdivision 1. new text end
new text begin General. new text end
new text begin
Each client must have an individual treatment plan developed
by an alcohol and drug counselor within seven days of service initiation for a residential
program and within three sessions for all other programs. The client must have active, direct
involvement in selecting the anticipated outcomes of the treatment process and developing
the treatment plan. The individual treatment plan must be signed by the client and the alcohol
and drug counselor and document the client's involvement in the development of the plan.
The plan may be a continuation of the initial services plan required in section 245G.04.
Treatment planning must include ongoing assessment of client needs. An individual treatment
plan must be updated based on new information gathered about the client's condition and
on whether methods identified have the intended effect. A change to the plan must be signed
by the client and the alcohol and drug counselor. The plan must provide for the involvement
of the client's family and people selected by the client as important to the success of treatment
at the earliest opportunity, consistent with the client's treatment needs and written consent.
new text end
new text begin Subd. 2. new text end
new text begin Plan contents. new text end
new text begin
An individual treatment plan must be recorded in the six
dimensions listed in section 245G.05, subdivision 2, paragraph (c), must address each issue
identified in the assessment summary, prioritized according to the client's needs and focus,
and must include:
new text end
new text begin
(1) specific methods to address each identified need, including amount, frequency, and
anticipated duration of treatment service. The methods must be appropriate to the client's
language, reading skills, cultural background, and strengths;
new text end
new text begin
(2) resources to refer the client to when the client's needs are to be addressed concurrently
by another provider; and
new text end
new text begin
(3) goals the client must reach to complete treatment and terminate services.
new text end
new text begin Subd. 3. new text end
new text begin Daily documentation; residential programs. new text end
new text begin
For a client receiving residential
services licensed under section 245G.21, notes must be entered in a client's file every calendar
day. The note must include observations about the client's behavior, incidents involving the
client, absences from the program, and treatment services received that day. The note may
be entered by nontreatment staff unless the note is a clinical observation or record.
new text end
new text begin Subd. 4. new text end
new text begin Documentation of treatment services; treatment plan review. new text end
new text begin
(a) A review
of all treatment services must be documented weekly and include a review of:
new text end
new text begin
(1) care coordination activities;
new text end
new text begin
(2) medical and other appointments the client attended;
new text end
new text begin
(3) issues related to medications that are not documented in the medication administration
record; and
new text end
new text begin
(4) issues related to attendance for treatment services, including the reason for any client
absence from a treatment service.
new text end
new text begin
(b) A note must be entered immediately following any significant event. A significant
event is an event that impacts the client's relationship with other clients, staff, the client's
family, or the client's treatment plan.
new text end
new text begin
(c) A treatment plan review must be entered in a client's file weekly or after each treatment
service, whichever is less frequent, by the staff member providing the service. The review
must indicate the span of time covered by the review and each of the six dimensions listed
in section 245G.05, subdivision 2, paragraph (c). The review must:
new text end
new text begin
(1) indicate the date, type, and amount of each treatment service provided and the client's
response to each service;
new text end
new text begin
(2) address each goal in the treatment plan and whether the methods to address the goals
are effective;
new text end
new text begin
(3) include monitoring of any physical and mental health problems;
new text end
new text begin
(4) document the participation of others;
new text end
new text begin
(5) document staff recommendations for changes in the methods identified in the treatment
plan and whether the client agrees with the change; and
new text end
new text begin
(6) include a review and evaluation of the individual abuse prevention plan according
to section 245A.65.
new text end
new text begin
(d) Each entry in a client's record must be accurate, legible, signed, and dated. A late
entry must be clearly labeled "late entry." A correction to an entry must be made in a way
in which the original entry can still be read.
new text end
new text begin Subd. 5. new text end
new text begin Service discharge summary. new text end
new text begin
(a) An alcohol and drug counselor must write a
service discharge summary for each client. For a planned discharge, the service discharge
summary must be completed within 24 hours before the client's discharge and provided to
the client at discharge. For an unplanned discharge, the service discharge summary must
be completed and provided to the client at discharge or within five days following the client's
discharge, or document why providing the discharge summary was not possible.
new text end
new text begin
(b) The service discharge summary must be recorded in the six dimensions listed in
section 245G.05, subdivision 2, paragraph (c), and include the following information:
new text end
new text begin
(1) the client's issues, strengths, and needs while participating in treatment, including
services provided;
new text end
new text begin
(2) the client's progress toward achieving each goal identified in the individual treatment
plan;
new text end
new text begin
(3) a risk description according to section 245G.05; and
new text end
new text begin
(4) the reasons for and circumstances of service termination. If a program discharges a
client at staff request, the reason for discharge and the procedure followed for the decision
to discharge must be documented and comply with the program's policies on staff-initiated
client discharge. If a client is discharged at staff request, the program must give the client
crisis and other referrals appropriate for the client's needs and offer assistance to the client
to access the services.
new text end
new text begin
(c) For a client who successfully completes treatment, the summary must also include:
new text end
new text begin
(1) the client's living arrangements at service termination;
new text end
new text begin
(2) continuing care recommendations, including transitions between more or less intense
services, or more frequent to less frequent services, and referrals made with specific attention
to continuity of care for mental health, as needed;
new text end
new text begin
(3) service termination diagnosis; and
new text end
new text begin
(4) the client's prognosis.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 12.
new text begin
[245G.07] TREATMENT SERVICE.
new text end
new text begin Subdivision 1. new text end
new text begin Treatment service. new text end
new text begin
(a) A license holder must offer the following treatment
services, unless clinically inappropriate and the justifying clinical rationale is documented:
new text end
new text begin
(1) individual and group counseling to help the client identify and address needs related
to substance use and develop strategies to avoid harmful substance use after discharge and
to help the client obtain the services necessary to establish a lifestyle free of the harmful
effects of substance use disorder;
new text end
new text begin
(2) client education strategies to avoid inappropriate substance use and health problems
related to substance use and the necessary lifestyle changes to regain and maintain health.
Client education must include information on tuberculosis education on a form approved
by the commissioner, the human immunodeficiency virus according to Minnesota Statutes,
section 245A.19, other sexually transmitted diseases, drug and alcohol use during pregnancy,
and hepatitis;
new text end
new text begin
(3) a service to help the client integrate gains made during treatment into daily living
and to reduce the client's reliance on a staff member for support;
new text end
new text begin
(4) a service to address issues related to co-occurring disorders, including client education
on symptoms of mental illness, the possibility of comorbidity, and the need for continued
medication compliance while recovering from substance use disorder. A group must address
co-occurring disorders, as needed. When treatment for mental health problems is indicated,
the treatment must be integrated into the client's individual treatment plan;
new text end
new text begin
(5) on July 1, 2018, or upon federal approval, whichever is later, peer recovery support
services provided one-to-one by an individual in recovery. Peer support services include
education, advocacy, mentoring through self-disclosure of personal recovery experiences,
attending recovery and other support groups with a client, accompanying the client to
appointments that support recovery, assistance accessing resources to obtain housing,
employment, education, and advocacy services, and nonclinical recovery support to assist
the transition from treatment into the recovery community; and
new text end
new text begin
(6) on July 1, 2018, or upon federal approval, whichever is later, care coordination
provided by an individual who meets the staff qualifications in section 245G.11, subdivision
7. Care coordination services include:
new text end
new text begin
(i) assistance in coordination with significant others to help in the treatment planning
process whenever possible;
new text end
new text begin
(ii) assistance in coordination with and follow up for medical services as identified in
the treatment plan;
new text end
new text begin
(iii) facilitation of referrals to substance use disorder services as indicated by a client's
medical provider, comprehensive assessment, or treatment plan;
new text end
new text begin
(iv) facilitation of referrals to mental health services as identified by a client's
comprehensive assessment or treatment plan;
new text end
new text begin
(v) assistance with referrals to economic assistance, social services, housing resources,
and prenatal care according to the client's needs;
new text end
new text begin
(vi) life skills advocacy and support accessing treatment follow-up, disease management,
and education services, including referral and linkages to long-term services and supports
as needed; and
new text end
new text begin
(vii) documentation of the provision of care coordination services in the client's file.
new text end
new text begin
(b) A treatment service provided to a client must be provided according to the individual
treatment plan and must consider cultural differences and special needs of a client.
new text end
new text begin Subd. 2. new text end
new text begin Additional treatment service. new text end
new text begin
A license holder may provide or arrange the
following additional treatment service as a part of the client's individual treatment plan:
new text end
new text begin
(1) relationship counseling provided by a qualified professional to help the client identify
the impact of the client's substance use disorder on others and to help the client and persons
in the client's support structure identify and change behaviors that contribute to the client's
substance use disorder;
new text end
new text begin
(2) therapeutic recreation to allow the client to participate in recreational activities
without the use of mood-altering chemicals and to plan and select leisure activities that do
not involve the inappropriate use of chemicals;
new text end
new text begin
(3) stress management and physical well-being to help the client reach and maintain an
appropriate level of health, physical fitness, and well-being;
new text end
new text begin
(4) living skills development to help the client learn basic skills necessary for independent
living;
new text end
new text begin
(5) employment or educational services to help the client become financially independent;
new text end
new text begin
(6) socialization skills development to help the client live and interact with others in a
positive and productive manner; and
new text end
new text begin
(7) room, board, and supervision at the treatment site to provide the client with a safe
and appropriate environment to gain and practice new skills.
new text end
new text begin Subd. 3. new text end
new text begin Counselors. new text end
new text begin
A treatment service, including therapeutic recreation, must be
provided by an alcohol and drug counselor according to section 245G.11, unless the
individual providing the service is specifically qualified according to the accepted credential
required to provide the service. Therapeutic recreation does not include planned leisure
activities.
new text end
new text begin Subd. 4. new text end
new text begin Location of service provision. new text end
new text begin
The license holder may provide services at any
of the license holder's licensed locations or at another suitable location including a school,
government building, medical or behavioral health facility, or social service organization.
If services are provided off site from the licensed site, the reason for the provision of services
remotely must be documented.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 13.
new text begin
[245G.08] MEDICAL SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Health care services. new text end
new text begin
An applicant or license holder must maintain a
complete description of the health care services, nursing services, dietary services, and
emergency physician services offered by the applicant or license holder.
new text end
new text begin Subd. 2. new text end
new text begin Procedures. new text end
new text begin
The applicant or license holder must have written procedures for
obtaining a medical intervention for a client, that are approved in writing by a physician
who is licensed under chapter 147, unless:
new text end
new text begin
(1) the license holder does not provide a service under section 245G.21; and
new text end
new text begin
(2) a medical intervention is referred to 911, the emergency telephone number, or the
client's physician.
new text end
new text begin Subd. 3. new text end
new text begin Standing order protocol. new text end
new text begin
A license holder that maintains a supply of naloxone
available for emergency treatment of opioid overdose must have a written standing order
protocol by a physician who is licensed under chapter 147, that permits the license holder
to maintain a supply of naloxone on site, and must require staff to undergo specific training
in administration of naloxone.
new text end
new text begin Subd. 4. new text end
new text begin Consultation services. new text end
new text begin
The license holder must have access to and document
the availability of a licensed mental health professional to provide diagnostic assessment
and treatment planning assistance.
new text end
new text begin Subd. 5. new text end
new text begin Administration of medication and assistance with self-medication. new text end
new text begin
(a) A
license holder must meet the requirements in this subdivision if a service provided includes
the administration of medication.
new text end
new text begin
(b) A staff member, other than a licensed practitioner or nurse, who is delegated by a
licensed practitioner or a registered nurse the task of administration of medication or assisting
with self-medication, must:
new text end
new text begin
(1) successfully complete a medication administration training program for unlicensed
personnel through an accredited Minnesota postsecondary educational institution. A staff
member's completion of the course must be documented in writing and placed in the staff
member's personnel file;
new text end
new text begin
(2) be trained according to a formalized training program that is taught by a registered
nurse and offered by the license holder. The training must include the process for
administration of naloxone, if naloxone is kept on site. A staff member's completion of the
training must be documented in writing and placed in the staff member's personnel records;
or
new text end
new text begin
(3) demonstrate to a registered nurse competency to perform the delegated activity. A
registered nurse must be employed or contracted to develop the policies and procedures for
administration of medication or assisting with self-administration of medication, or both.
new text end
new text begin
(c) A registered nurse must provide supervision as defined in section 148.171, subdivision
23. The registered nurse's supervision must include, at a minimum, monthly on-site
supervision or more often if warranted by a client's health needs. The policies and procedures
must include:
new text end
new text begin
(1) a provision that a delegation of administration of medication is limited to the
administration of a medication that is administered orally, topically, or as a suppository, an
eye drop, an ear drop, or an inhalant;
new text end
new text begin
(2) a provision that each client's file must include documentation indicating whether
staff must conduct the administration of medication or the client must self-administer
medication, or both;
new text end
new text begin
(3) a provision that a client may carry emergency medication such as nitroglycerin as
instructed by the client's physician;
new text end
new text begin
(4) a provision for the client to self-administer medication when a client is scheduled to
be away from the facility;
new text end
new text begin
(5) a provision that if a client self-administers medication when the client is present in
the facility, the client must self-administer medication under the observation of a trained
staff member;
new text end
new text begin
(6) a provision that when a license holder serves a client who is a parent with a child,
the parent may only administer medication to the child under a staff member's supervision;
new text end
new text begin
(7) requirements for recording the client's use of medication, including staff signatures
with date and time;
new text end
new text begin
(8) guidelines for when to inform a nurse of problems with self-administration of
medication, including a client's failure to administer, refusal of a medication, adverse
reaction, or error; and
new text end
new text begin
(9) procedures for acceptance, documentation, and implementation of a prescription,
whether written, verbal, telephonic, or electronic.
new text end
new text begin Subd. 6. new text end
new text begin Control of drugs. new text end
new text begin
A license holder must have and implement written policies
and procedures developed by a registered nurse that contain:
new text end
new text begin
(1) a requirement that each drug must be stored in a locked compartment. A Schedule
II drug, as defined by section 152.02, subdivision 3, must be stored in a separately locked
compartment, permanently affixed to the physical plant or medication cart;
new text end
new text begin
(2) a system which accounts for all scheduled drugs each shift;
new text end
new text begin
(3) a procedure for recording the client's use of medication, including the signature of
the staff member who completed the administration of the medication with the time and
date;
new text end
new text begin
(4) a procedure to destroy a discontinued, outdated, or deteriorated medication;
new text end
new text begin
(5) a statement that only authorized personnel are permitted access to the keys to a locked
compartment;
new text end
new text begin
(6) a statement that no legend drug supply for one client shall be given to another client;
and
new text end
new text begin
(7) a procedure for monitoring the available supply of naloxone on site, replenishing
the naloxone supply when needed, and destroying naloxone according to clause (4).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 14.
new text begin
[245G.09] CLIENT RECORDS.
new text end
new text begin Subdivision 1. new text end
new text begin Client records required. new text end
new text begin
(a) A license holder must maintain a file of
current and accurate client records on the premises where the treatment service is provided
or coordinated. For services provided off site, client records must be available at the program
and adhere to the same clinical and administrative policies and procedures as services
provided on site. A program using an electronic health record must maintain virtual access
to client records on the premises where the treatment service is delivered. The content and
format of client records must be uniform and entries in each record must be signed and
dated by the staff member making the entry. Client records must be protected against loss,
tampering, or unauthorized disclosure according to section 254A.09, chapter 13, and Code
of Federal Regulations, title 42, chapter 1, part 2, subpart B, sections 2.1 to 2.67, and title
45, parts 160 to 164.
new text end
new text begin
(b) The program must have a policy and procedure that identifies how the program will
track and record client attendance at treatment activities, including the date, duration, and
nature of each treatment service provided to the client.
new text end
new text begin Subd. 2. new text end
new text begin Record retention. new text end
new text begin
The client records of a discharged client must be retained
by a license holder for seven years. A license holder that ceases to provide treatment service
must retain client records for seven years from the date of facility closure and must notify
the commissioner of the location of the client records and the name of the individual
responsible for maintaining the client's records.
new text end
new text begin Subd. 3. new text end
new text begin Contents. new text end
new text begin
Client records must contain the following:
new text end
new text begin
(1) documentation that the client was given information on client rights and
responsibilities, grievance procedures, tuberculosis, and HIV, and that the client was provided
an orientation to the program abuse prevention plan required under section 245A.65,
subdivision 2, paragraph (a), clause (4);
new text end
new text begin
(2) an initial services plan completed according to section 245G.04;
new text end
new text begin
(3) a comprehensive assessment completed according to section 245G.05;
new text end
new text begin
(4) an assessment summary completed according to section 245G.05, subdivision 2;
new text end
new text begin
(5) an individual abuse prevention plan according to sections 245A.65, subdivision 2,
and 626.557, subdivision 14, when applicable;
new text end
new text begin
(6) an individual treatment plan according to section 245G.06, subdivisions 1 and 2;
new text end
new text begin
(7) daily documentation, according to section 245G.06, subdivision 3;
new text end
new text begin
(8) documentation of treatment services and treatment plan review according to section
245G.06, subdivision 4; and
new text end
new text begin
(9) a summary at the time of service termination according to section 245G.06,
subdivision 5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 15.
new text begin
[245G.10] STAFF REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Treatment director. new text end
new text begin
A license holder must have a treatment director.
new text end
new text begin Subd. 2. new text end
new text begin Alcohol and drug counselor supervisor. new text end
new text begin
A license holder must employ an
alcohol and drug counselor supervisor who meets the requirements of section 245G.11,
subdivision 4. An individual may be simultaneously employed as a treatment director,
alcohol and drug counselor supervisor, and an alcohol and drug counselor if the individual
meets the qualifications for each position. If an alcohol and drug counselor is simultaneously
employed as an alcohol and drug counselor supervisor or treatment director, that individual
must be considered a 0.5 full-time equivalent alcohol and drug counselor for staff
requirements under subdivision 4.
new text end
new text begin Subd. 3. new text end
new text begin Responsible staff member. new text end
new text begin
A treatment director must designate a staff member
who, when present in the facility, is responsible for the delivery of treatment service. A
license holder must have a designated staff member during all hours of operation. A license
holder providing room and board and treatment at the same site must have a responsible
staff member on duty 24 hours a day. The designated staff member must know and understand
the implications of this chapter and sections 245A.65, 626.556, 626.557, and 626.5572.
new text end
new text begin Subd. 4. new text end
new text begin Staff requirement. new text end
new text begin
It is the responsibility of the license holder to determine
an acceptable group size based on each client's needs except that treatment services provided
in a group shall not exceed 16 clients. A counselor in an opioid treatment program must not
supervise more than 50 clients. The license holder must maintain a record that documents
compliance with this subdivision.
new text end
new text begin Subd. 5. new text end
new text begin Medical emergency. new text end
new text begin
When a client is present, a license holder must have at
least one staff member on the premises who has a current American Red Cross standard
first aid certificate or an equivalent certificate and at least one staff member on the premises
who has a current American Red Cross community, American Heart Association, or
equivalent CPR certificate. A single staff member with both certifications satisfies this
requirement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 16.
new text begin
[245G.11] STAFF QUALIFICATIONS.
new text end
new text begin Subdivision 1. new text end
new text begin General qualifications. new text end
new text begin
(a) All staff members who have direct contact
must be 18 years of age or older. At the time of employment, each staff member must meet
the qualifications in this subdivision. For purposes of this subdivision, "problematic substance
use" means a behavior or incident listed by the license holder in the personnel policies and
procedures according to section 245G.13, subdivision 1, clause (5).
new text end
new text begin
(b) A treatment director, supervisor, nurse, counselor, student intern, or other professional
must be free of problematic substance use for at least the two years immediately preceding
employment and must sign a statement attesting to that fact.
new text end
new text begin
(c) A paraprofessional, recovery peer, or any other staff member with direct contact
must be free of problematic substance use for at least one year immediately preceding
employment and must sign a statement attesting to that fact.
new text end
new text begin Subd. 2. new text end
new text begin Employment; prohibition on problematic substance use. new text end
new text begin
A staff member
with direct contact must be free from problematic substance use as a condition of
employment, but is not required to sign additional statements. A staff member with direct
contact who is not free from problematic substance use must be removed from any
responsibilities that include direct contact for the time period specified in subdivision 1.
The time period begins to run on the date of the last incident of problematic substance use
as described in the facility's policies and procedures according to section 245G.13,
subdivision 1, clause (5).
new text end
new text begin Subd. 3. new text end
new text begin Treatment directors. new text end
new text begin
A treatment director must:
new text end
new text begin
(1) have at least one year of work experience in direct service to an individual with
substance use disorder or one year of work experience in the management or administration
of direct service to an individual with substance use disorder;
new text end
new text begin
(2) have a baccalaureate degree or three years of work experience in administration or
personnel supervision in human services; and
new text end
new text begin
(3) know and understand the implications of this chapter, chapter 245A, and sections
626.556, 626.557, and 626.5572. Demonstration of the treatment director's knowledge must
be documented in the personnel record.
new text end
new text begin Subd. 4. new text end
new text begin Alcohol and drug counselor supervisors. new text end
new text begin
An alcohol and drug counselor
supervisor must:
new text end
new text begin
(1) meet the qualification requirements in subdivision 5;
new text end
new text begin
(2) have three or more years of experience providing individual and group counseling
to individuals with substance use disorder; and
new text end
new text begin
(3) know and understand the implications of this chapter and sections 245A.65, 626.556,
626.557, and 626.5572.
new text end
new text begin Subd. 5. new text end
new text begin Alcohol and drug counselor qualifications. new text end
new text begin
(a) An alcohol and drug counselor
must either be: (1) licensed under chapter 148F; or (2) exempt from licensure under chapter
148F and be a mental health professional as defined in section 245.462, subdivision 18.
new text end
new text begin
(b) An alcohol and drug counselor must document competence in screening for and
working with clients with mental health disorders through education, training, and experience,
according to section 245G.13, subdivision 2, clause (5). For the purposes of enforcing this
section, the commissioner has the authority to monitor a service provider's compliance with
the relevant standards of a service provider's profession and may issue licensing actions
according to sections 245A.05, 245A.06, and 245A.07 based on the commissioner's
determination of noncompliance.
new text end
new text begin
(c) A mental health professional identified in section 245.462, subdivision 18, must meet
one of the following criteria:
new text end
new text begin
(1) completion of 270 hours of alcohol and drug counselor training that covers each of
the core functions listed in section 148F.01, subdivision 10, and successful completion of
880 hours of supervised experience as an alcohol and drug counselor, either as a student or
as a staff member; or
new text end
new text begin
(2) current certification as an alcohol and drug counselor or alcohol and drug counselor
reciprocal, through the evaluation process established by the International Certification and
Reciprocity Consortium Alcohol and Other Drug Abuse, Inc.
new text end
new text begin
(d) An individual who is currently certified as an alcohol and drug counselor by the
Upper Midwest Indian Council on Addictive Disorders meets the qualifications of an alcohol
and drug counselor when providing services to Native American people.
new text end
new text begin Subd. 6. new text end
new text begin Paraprofessionals. new text end
new text begin
A paraprofessional must have knowledge of client rights,
according to section 148F.165, and staff member responsibilities. A paraprofessional may
not admit, transfer, or discharge a client but may be responsible for the delivery of treatment
service according to section 245G.10, subdivision 3.
new text end
new text begin Subd. 7. new text end
new text begin Care coordination provider qualifications. new text end
new text begin
(a) Care coordination must be
provided by qualified staff. An individual is qualified to provide care coordination if the
individual:
new text end
new text begin
(1) is skilled in the process of identifying and assessing a wide range of client needs;
new text end
new text begin
(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;
new text end
new text begin
(3) has successfully completed 30 hours of classroom instruction on care coordination
for an individual with substance use disorder;
new text end
new text begin
(4) has either:
new text end
new text begin
(i) a bachelor's degree in one of the behavioral sciences or related fields; or
new text end
new text begin
(ii) current certification as an alcohol and drug counselor, level I, by the Upper Midwest
Indian Council on Addictive Disorders; and
new text end
new text begin
(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.
new text end
new text begin
(b) A care coordinator must receive at least one hour of supervision regarding individual
service delivery from an alcohol and drug counselor weekly.
new text end
new text begin Subd. 8. new text end
new text begin Recovery peer qualifications. new text end
new text begin
A recovery peer must:
new text end
new text begin
(1) be at least 21 years of age and have a high school diploma or its equivalent;
new text end
new text begin
(2) have a minimum of one year in recovery from substance use disorder;
new text end
new text begin
(3) hold a current credential from a certification body approved by the commissioner
that demonstrates skills and training in the domains of ethics and boundaries, advocacy,
mentoring and education, and recovery and wellness support; and
new text end
new text begin
(4) receive ongoing supervision in areas specific to the domains of the recovery peer's
role by an alcohol and drug counselor or an individual with a certification approved by the
commissioner.
new text end
new text begin Subd. 9. new text end
new text begin Volunteers. new text end
new text begin
A volunteer may provide treatment service when the volunteer is
supervised and can be seen or heard by a staff member meeting the criteria in subdivision
4 or 5, but may not practice alcohol and drug counseling unless qualified under subdivision
5.
new text end
new text begin Subd. 10. new text end
new text begin Student interns. new text end
new text begin
A qualified staff member must supervise and be responsible
for a treatment service performed by a student intern and must review and sign each
assessment, progress note, and individual treatment plan prepared by a student intern. A
student intern must receive the orientation and training required in section 245G.13,
subdivisions 1, clause (7), and 2. No more than 50 percent of the treatment staff may be
students or licensing candidates with time documented to be directly related to the provision
of treatment services for which the staff are authorized.
new text end
new text begin Subd. 11. new text end
new text begin Individuals with temporary permit. new text end
new text begin
(a) An individual with a temporary
permit from the Board of Behavioral Health and Therapy may provide chemical dependency
treatment service according to this subdivision.
new text end
new text begin
(b) An individual with a temporary permit must be supervised by a licensed alcohol and
drug counselor assigned by the license holder. The supervising licensed alcohol and drug
counselor must document the amount and type of supervision provided at least on a weekly
basis. The supervision must relate to the clinical practice.
new text end
new text begin
(c) An individual with a temporary permit must be supervised by a clinical supervisor
approved by the Board of Behavioral Health and Therapy. The supervision must be
documented and meet the requirements of section 148F.04, subdivision 4.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 17.
new text begin
[245G.12] PROVIDER POLICIES AND PROCEDURES.
new text end
new text begin
A license holder must develop a written policies and procedures manual, indexed
according to section 245A.04, subdivision 14, paragraph (c), that provides staff members
immediate access to all policies and procedures and provides a client and other authorized
parties access to all policies and procedures. The manual must contain the following
materials:
new text end
new text begin
(1) assessment and treatment planning policies, including screening for mental health
concerns and treatment objectives related to the client's identified mental health concerns
in the client's treatment plan;
new text end
new text begin
(2) policies and procedures regarding HIV according to section 245A.19;
new text end
new text begin
(3) the license holder's methods and resources to provide information on tuberculosis
and tuberculosis screening to each client and to report a known tuberculosis infection
according to section 144.4804;
new text end
new text begin
(4) personnel policies according to section 245G.13;
new text end
new text begin
(5) policies and procedures that protect a client's rights according to section 245G.15;
new text end
new text begin
(6) a medical services plan according to section 245G.08;
new text end
new text begin
(7) emergency procedures according to section 245G.16;
new text end
new text begin
(8) policies and procedures for maintaining client records according to section 245G.09;
new text end
new text begin
(9) procedures for reporting the maltreatment of minors according to section 626.556,
and vulnerable adults according to sections 245A.65, 626.557, and 626.5572;
new text end
new text begin
(10) a description of treatment services, including the amount and type of services
provided;
new text end
new text begin
(11) the methods used to achieve desired client outcomes;
new text end
new text begin
(12) the hours of operation; and
new text end
new text begin
(13) the target population served.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 18.
new text begin
[245G.13] PROVIDER PERSONNEL POLICIES.
new text end
new text begin Subdivision 1. new text end
new text begin Personnel policy requirements. new text end
new text begin
A license holder must have written
personnel policies that are available to each staff member. The personnel policies must:
new text end
new text begin
(1) ensure that staff member retention, promotion, job assignment, or pay are not affected
by a good faith communication between a staff member and the department, the Department
of Health, the ombudsman for mental health and developmental disabilities, law enforcement,
or a local agency for the investigation of a complaint regarding a client's rights, health, or
safety;
new text end
new text begin
(2) contain a job description for each staff member position specifying responsibilities,
degree of authority to execute job responsibilities, and qualification requirements;
new text end
new text begin
(3) provide for a job performance evaluation based on standards of job performance
conducted on a regular and continuing basis, including a written annual review;
new text end
new text begin
(4) describe behavior that constitutes grounds for disciplinary action, suspension, or
dismissal, including policies that address staff member problematic substance use and the
requirements of section 245G.11, subdivision 1, policies prohibiting personal involvement
with a client in violation of chapter 604, and policies prohibiting client abuse described in
sections 245A.65, 626.556, 626.557, and 626.5572;
new text end
new text begin
(5) identify how the program will identify whether behaviors or incidents are problematic
substance use, including a description of how the facility must address:
new text end
new text begin
(i) receiving treatment for substance use within the period specified for the position in
the staff qualification requirements, including medication-assisted treatment;
new text end
new text begin
(ii) substance use that negatively impacts the staff member's job performance;
new text end
new text begin
(iii) chemical use that affects the credibility of treatment services with a client, referral
source, or other member of the community;
new text end
new text begin
(iv) symptoms of intoxication or withdrawal on the job; and
new text end
new text begin
(v) the circumstances under which an individual who participates in monitoring by the
health professional services program for a substance use or mental health disorder is able
to provide services to the program's clients;
new text end
new text begin
(6) include a chart or description of the organizational structure indicating lines of
authority and responsibilities;
new text end
new text begin
(7) include orientation within 24 working hours of starting for each new staff member
based on a written plan that, at a minimum, must provide training related to the staff member's
specific job responsibilities, policies and procedures, client confidentiality, HIV minimum
standards, and client needs; and
new text end
new text begin
(8) include policies outlining the license holder's response to a staff member with a
behavior problem that interferes with the provision of treatment service.
new text end
new text begin Subd. 2. new text end
new text begin Staff development. new text end
new text begin
(a) A license holder must ensure that each staff member
has the training described in this subdivision.
new text end
new text begin
(b) Each staff member must be trained every two years in:
new text end
new text begin
(1) client confidentiality rules and regulations and client ethical boundaries; and
new text end
new text begin
(2) emergency procedures and client rights as specified in sections 144.651, 148F.165,
and 253B.03.
new text end
new text begin
(c) Annually each staff member with direct contact must be trained on mandatory
reporting as specified in sections 245A.65, 626.556, 626.5561, 626.557, and 626.5572,
including specific training covering the license holder's policies for obtaining a release of
client information.
new text end
new text begin
(d) Upon employment and annually thereafter, each staff member with direct contact
must receive training on HIV minimum standards according to section 245A.19.
new text end
new text begin
(e) A treatment director, supervisor, nurse, or counselor must have a minimum of 12
hours of training in co-occurring disorders that includes competencies related to philosophy,
trauma-informed care, screening, assessment, diagnosis and person-centered treatment
planning, documentation, programming, medication, collaboration, mental health
consultation, and discharge planning. A new staff member who has not obtained the training
must complete the training within six months of employment. A staff member may request,
and the license holder may grant, credit for relevant training obtained before employment,
which must be documented in the staff member's personnel file.
new text end
new text begin Subd. 3. new text end
new text begin Personnel files. new text end
new text begin
The license holder must maintain a separate personnel file for
each staff member. At a minimum, the personnel file must conform to the requirements of
this chapter. A personnel file must contain the following:
new text end
new text begin
(1) a completed application for employment signed by the staff member and containing
the staff member's qualifications for employment;
new text end
new text begin
(2) documentation related to the staff member's background study data, according to
chapter 245C;
new text end
new text begin
(3) for a staff member who provides psychotherapy services, employer names and
addresses for the past five years for which the staff member provided psychotherapy services,
and documentation of an inquiry required by sections 604.20 to 604.205 made to the staff
member's former employer regarding substantiated sexual contact with a client;
new text end
new text begin
(4) documentation that the staff member completed orientation and training;
new text end
new text begin
(5) documentation that the staff member meets the requirements in section 245G.11;
new text end
new text begin
(6) documentation demonstrating the staff member's compliance with section 245G.08,
subdivision 3, for a staff member who conducts administration of medication; and
new text end
new text begin
(7) documentation demonstrating the staff member's compliance with section 245G.18,
subdivision 2, for a staff member that treats an adolescent client.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 19.
new text begin
[245G.14] SERVICE INITIATION AND TERMINATION POLICIES.
new text end
new text begin Subdivision 1. new text end
new text begin Service initiation policy. new text end
new text begin
A license holder must have a written service
initiation policy containing service initiation preferences that comply with this section and
Code of Federal Regulations, title 45, part 96.131, and specific service initiation criteria.
The license holder must not initiate services for an individual who does not meet the service
initiation criteria. The service initiation criteria must be either posted in the area of the
facility where services for a client are initiated, or given to each interested person upon
request. Titles of each staff member authorized to initiate services for a client must be listed
in the services initiation and termination policies.
new text end
new text begin Subd. 2. new text end
new text begin License holder responsibilities. new text end
new text begin
(a) The license holder must have and comply
with a written protocol for (1) assisting a client in need of care not provided by the license
holder, and (2) a client who poses a substantial likelihood of harm to the client or others, if
the behavior is beyond the behavior management capabilities of the staff members.
new text end
new text begin
(b) A service termination and denial of service initiation that poses an immediate threat
to the health of any individual or requires immediate medical intervention must be referred
to a medical facility capable of admitting the client.
new text end
new text begin
(c) A service termination policy and a denial of service initiation that involves the
commission of a crime against a license holder's staff member or on a license holder's
premises, as provided under Code of Federal Regulations, title 42, section 2.12(c)(5), and
title 45, parts 160 to 164, must be reported to a law enforcement agency with jurisdiction.
new text end
new text begin Subd. 3. new text end
new text begin Service termination policies. new text end
new text begin
A license holder must have a written policy
specifying the conditions when a client must be terminated from service. The service
termination policy must include:
new text end
new text begin
(1) procedures for a client whose services were terminated under subdivision 2;
new text end
new text begin
(2) a description of client behavior that constitutes reason for a staff-requested service
termination and a process for providing this information to a client;
new text end
new text begin
(3) a requirement that before discharging a client from a residential setting, for not
reaching treatment plan goals, the license holder must confer with other interested persons
to review the issues involved in the decision. The documentation requirements for a
staff-requested service termination must describe why the decision to discharge is warranted,
the reasons for the discharge, and the alternatives considered or attempted before discharging
the client;
new text end
new text begin
(4) procedures consistent with section 253B.16, subdivision 2, that staff members must
follow when a client admitted under chapter 253B is to have services terminated;
new text end
new text begin
(5) procedures a staff member must follow when a client leaves against staff or medical
advice and when the client may be dangerous to the client or others, including a policy that
requires a staff member to assist the client with assessing needs of care or other resources;
new text end
new text begin
(6) procedures for communicating staff-approved service termination criteria to a client,
including the expectations in the client's individual treatment plan according to section
245G.06; and
new text end
new text begin
(7) titles of each staff member authorized to terminate a client's service must be listed
in the service initiation and service termination policies.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 20.
new text begin
[245G.15] CLIENT RIGHTS PROTECTION.
new text end
new text begin Subdivision 1. new text end
new text begin Explanation. new text end
new text begin
A client has the rights identified in sections 144.651,
148F.165, 253B.03, and 254B.02, subdivision 2, as applicable. The license holder must
give each client at service initiation a written statement of the client's rights and
responsibilities. A staff member must review the statement with a client at that time.
new text end
new text begin Subd. 2. new text end
new text begin Grievance procedure. new text end
new text begin
At service initiation, the license holder must explain
the grievance procedure to the client or the client's representative. The grievance procedure
must be posted in a place visible to clients, and made available upon a client's or former
client's request. The grievance procedure must require that:
new text end
new text begin
(1) a staff member helps the client develop and process a grievance;
new text end
new text begin
(2) current telephone numbers and addresses of the Department of Human Services,
Licensing Division; the Office of Ombudsman for Mental Health and Developmental
Disabilities; the Department of Health Office of Health Facilities Complaints; and the Board
of Behavioral Health and Therapy, when applicable, be made available to a client; and
new text end
new text begin
(3) a license holder responds to the client's grievance within three days of a staff member's
receipt of the grievance, and the client may bring the grievance to the highest level of
authority in the program if not resolved by another staff member.
new text end
new text begin Subd. 3. new text end
new text begin Photographs of client. new text end
new text begin
(a) A photograph, video, or motion picture of a client
taken in the provision of treatment service is considered client records. A photograph for
identification and a recording by video or audio technology to enhance either therapy or
staff member supervision may be required of a client, but may only be available for use as
communications within a program. A client must be informed when the client's actions are
being recorded by camera or other technology, and the client must have the right to refuse
any recording or photography, except as authorized by this subdivision.
new text end
new text begin
(b) A license holder must have a written policy regarding the use of any personal
electronic device that can record, transmit, or make images of another client. A license
holder must inform each client of this policy and the client's right to refuse being
photographed or recorded.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 21.
new text begin
[245G.16] BEHAVIORAL EMERGENCY PROCEDURES.
new text end
new text begin
(a) A license holder or applicant must have written behavioral emergency procedures
that staff must follow when responding to a client who exhibits behavior that is threatening
to the safety of the client or others. Programs must incorporate person-centered planning
and trauma-informed care in the program's behavioral emergency procedure policies. The
procedures must include:
new text end
new text begin
(1) a plan designed to prevent a client from hurting themselves or others;
new text end
new text begin
(2) contact information for emergency resources that staff must consult when a client's
behavior cannot be controlled by the behavioral emergency procedures;
new text end
new text begin
(3) types of procedures that may be used;
new text end
new text begin
(4) circumstances under which behavioral emergency procedures may be used; and
new text end
new text begin
(5) staff members authorized to implement behavioral emergency procedures.
new text end
new text begin
(b) Behavioral emergency procedures must not be used to enforce facility rules or for
the convenience of staff. Behavioral emergency procedures must not be part of any client's
treatment plan, or used at any time for any reason except in response to specific current
behavior that threatens the safety of the client or others. Behavioral emergency procedures
may not include the use of seclusion or restraint.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 22.
new text begin
[245G.17] EVALUATION.
new text end
new text begin
A license holder must participate in the drug and alcohol abuse normative evaluation
system by submitting information about each client to the commissioner in a manner
prescribed by the commissioner. A license holder must submit additional information
requested by the commissioner that is necessary to meet statutory or federal funding
requirements.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 23.
new text begin
[245G.18] LICENSE HOLDERS SERVING ADOLESCENTS.
new text end
new text begin Subdivision 1. new text end
new text begin License. new text end
new text begin
A residential treatment program that serves an adolescent younger
than 16 years of age must be licensed as a residential program for a child in out-of-home
placement by the department unless the license holder is exempt under section 245A.03,
subdivision 2.
new text end
new text begin Subd. 2. new text end
new text begin Alcohol and drug counselor qualifications. new text end
new text begin
In addition to the requirements
specified in section 245G.11, subdivisions 1 and 5, an alcohol and drug counselor providing
treatment service to an adolescent must have:
new text end
new text begin
(1) an additional 30 hours of classroom instruction or one three-credit semester college
course in adolescent development. This training need only be completed one time; and
new text end
new text begin
(2) at least 150 hours of supervised experience as an adolescent counselor, either as a
student or as a staff member.
new text end
new text begin Subd. 3. new text end
new text begin Staff ratios. new text end
new text begin
At least 25 percent of a counselor's scheduled work hours must
be allocated to indirect services, including documentation of client services, coordination
of services with others, treatment team meetings, and other duties. A counseling group
consisting entirely of adolescents must not exceed 16 adolescents. It is the responsibility of
the license holder to determine an acceptable group size based on the needs of the clients.
new text end
new text begin Subd. 4. new text end
new text begin Academic program requirements. new text end
new text begin
A client who is required to attend school
must be enrolled and attending an educational program that was approved by the Department
of Education.
new text end
new text begin Subd. 5. new text end
new text begin Program requirements. new text end
new text begin
In addition to the requirements specified in the client's
treatment plan under section 245G.06, programs serving an adolescent must include:
new text end
new text begin
(1) coordination with the school system to address the client's academic needs;
new text end
new text begin
(2) when appropriate, a plan that addresses the client's leisure activities without chemical
use; and
new text end
new text begin
(3) a plan that addresses family involvement in the adolescent's treatment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 24.
new text begin
[245G.19] LICENSE HOLDERS SERVING CLIENTS WITH CHILDREN.
new text end
new text begin Subdivision 1. new text end
new text begin Health license requirements. new text end
new text begin
In addition to the requirements of sections
245G.01 to 245G.17, a license holder that offers supervision of a child of a client is subject
to the requirements of this section. A license holder providing room and board for a client
and the client's child must have an appropriate facility license from the Department of
Health.
new text end
new text begin Subd. 2. new text end
new text begin Supervision of a child. new text end
new text begin
"Supervision of a child" means a caregiver is within
sight or hearing of an infant, toddler, or preschooler at all times so that the caregiver can
intervene to protect the child's health and safety. For a school-age child it means a caregiver
is available to help and care for the child to protect the child's health and safety.
new text end
new text begin Subd. 3. new text end
new text begin Policy and schedule required. new text end
new text begin
A license holder must meet the following
requirements:
new text end
new text begin
(1) have a policy and schedule delineating the times and circumstances when the license
holder is responsible for supervision of a child in the program and when the child's parents
are responsible for supervision of a child. The policy must explain how the program will
communicate its policy about supervision of a child responsibility to the parent; and
new text end
new text begin
(2) have written procedures addressing the actions a staff member must take if a child
is neglected or abused, including while the child is under the supervision of the child's
parent.
new text end
new text begin Subd. 4. new text end
new text begin Additional licensing requirements. new text end
new text begin
During the times the license holder is
responsible for the supervision of a child, the license holder must meet the following
standards:
new text end
new text begin
(1) child and adult ratios in Minnesota Rules, part 9502.0367;
new text end
new text begin
(2) day care training in section 245A.50;
new text end
new text begin
(3) behavior guidance in Minnesota Rules, part 9502.0395;
new text end
new text begin
(4) activities and equipment in Minnesota Rules, part 9502.0415;
new text end
new text begin
(5) physical environment in Minnesota Rules, part 9502.0425; and
new text end
new text begin
(6) water, food, and nutrition in Minnesota Rules, part 9502.0445, unless the license
holder has a license from the Department of Health.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 25.
new text begin
[245G.20] LICENSE HOLDERS SERVING PERSONS WITH
CO-OCCURRING DISORDERS.
new text end
new text begin
A license holder specializing in the treatment of a person with co-occurring disorders
must:
new text end
new text begin
(1) demonstrate that staff levels are appropriate for treating a client with a co-occurring
disorder, and that there are adequate staff members with mental health training;
new text end
new text begin
(2) have continuing access to a medical provider with appropriate expertise in prescribing
psychotropic medication;
new text end
new text begin
(3) have a mental health professional available for staff member supervision and
consultation;
new text end
new text begin
(4) determine group size, structure, and content considering the special needs of a client
with a co-occurring disorder;
new text end
new text begin
(5) have documentation of active interventions to stabilize mental health symptoms
present in the individual treatment plans and progress notes;
new text end
new text begin
(6) have continuing documentation of collaboration with continuing care mental health
providers, and involvement of the providers in treatment planning meetings;
new text end
new text begin
(7) have available program materials adapted to a client with a mental health problem;
new text end
new text begin
(8) have policies that provide flexibility for a client who may lapse in treatment or may
have difficulty adhering to established treatment rules as a result of a mental illness, with
the goal of helping a client successfully complete treatment; and
new text end
new text begin
(9) have individual psychotherapy and case management available during treatment
service.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 26.
new text begin
[245G.21] REQUIREMENTS FOR LICENSED RESIDENTIAL
TREATMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
A license holder who provides supervised room and board
at the licensed program site as a treatment component is defined as a residential program
according to section 245A.02, subdivision 14, and is subject to this section.
new text end
new text begin Subd. 2. new text end
new text begin Visitors. new text end
new text begin
A client must be allowed to receive visitors at times prescribed by
the license holder. The license holder must set and post a notice of visiting rules and hours,
including both day and evening times. A client's right to receive visitors other than a personal
physician, religious adviser, county case manager, parole or probation officer, or attorney
may be subject to visiting hours established by the license holder for all clients. The treatment
director or designee may impose limitations as necessary for the welfare of a client provided
the limitation and the reasons for the limitation are documented in the client's file. A client
must be allowed to receive visits at all reasonable times from the client's personal physician,
religious adviser, county case manager, parole or probation officer, and attorney.
new text end
new text begin Subd. 3. new text end
new text begin Client property management. new text end
new text begin
A license holder who provides room and board
and treatment services to a client in the same facility, and any license holder that accepts
client property must meet the requirements for handling client funds and property in section
245A.04, subdivision 13. License holders:
new text end
new text begin
(1) may establish policies regarding the use of personal property to ensure that treatment
activities and the rights of other clients are not infringed upon;
new text end
new text begin
(2) may take temporary custody of a client's property for violation of a facility policy;
new text end
new text begin
(3) must retain the client's property for a minimum of seven days after the client's service
termination if the client does not reclaim property upon service termination, or for a minimum
of 30 days if the client does not reclaim property upon service termination and has received
room and board services from the license holder; and
new text end
new text begin
(4) must return all property held in trust to the client at service termination regardless
of the client's service termination status, except that:
new text end
new text begin
(i) a drug, drug paraphernalia, or drug container that is subject to forfeiture under section
609.5316, must be given to the custody of a local law enforcement agency. If giving the
property to the custody of a local law enforcement agency violates Code of Federal
Regulations, title 42, sections 2.1 to 2.67, or title 45, parts 160 to 164, a drug, drug
paraphernalia, or drug container must be destroyed by a staff member designated by the
program director; and
new text end
new text begin
(ii) a weapon, explosive, and other property that can cause serious harm to the client or
others must be given to the custody of a local law enforcement agency, and the client must
be notified of the transfer and of the client's right to reclaim any lawful property transferred;
and
new text end
new text begin
(iii) a medication that was determined by a physician to be harmful after examining the
client must be destroyed, except when the client's personal physician approves the medication
for continued use.
new text end
new text begin Subd. 4. new text end
new text begin Health facility license. new text end
new text begin
A license holder who provides room and board and
treatment services in the same facility must have the appropriate license from the Department
of Health.
new text end
new text begin Subd. 5. new text end
new text begin Facility abuse prevention plan. new text end
new text begin
A license holder must establish and enforce
an ongoing facility abuse prevention plan consistent with sections 245A.65 and 626.557,
subdivision 14.
new text end
new text begin Subd. 6. new text end
new text begin Individual abuse prevention plan. new text end
new text begin
A license holder must prepare an individual
abuse prevention plan for each client as specified under sections 245A.65, subdivision 2,
and 626.557, subdivision 14.
new text end
new text begin Subd. 7. new text end
new text begin Health services. new text end
new text begin
A license holder must have written procedures for assessing
and monitoring a client's health, including a standardized data collection tool for collecting
health-related information about each client. The policies and procedures must be approved
and signed by a registered nurse.
new text end
new text begin Subd. 8. new text end
new text begin Administration of medication. new text end
new text begin
A license holder must meet the administration
of medications requirements of section 245G.08, subdivision 5, if services include medication
administration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 27.
new text begin
[245G.22] OPIOID TREATMENT PROGRAMS.
new text end
new text begin Subdivision 1. new text end
new text begin Additional requirements. new text end
new text begin
(a) An opioid treatment program licensed
under this chapter must also comply with the requirements of this section and Code of
Federal Regulations, title 42, part 8. When federal guidance or interpretations are issued on
federal standards or requirements also required under this section, the federal guidance or
interpretations shall apply.
new text end
new text begin
(b) Where a standard in this section differs from a standard in an otherwise applicable
administrative rule or statute, the standard of this section applies.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given them.
new text end
new text begin
(b) "Diversion" means the use of a medication for the treatment of opioid addiction being
diverted from intended use of the medication.
new text end
new text begin
(c) "Guest dose" means administration of a medication used for the treatment of opioid
addiction to a person who is not a client of the program that is administering or dispensing
the medication.
new text end
new text begin
(d) "Medical director" means a physician licensed to practice medicine in the jurisdiction
that the opioid treatment program is located who assumes responsibility for administering
all medical services performed by the program, either by performing the services directly
or by delegating specific responsibility to authorized program physicians and health care
professionals functioning under the medical director's direct supervision.
new text end
new text begin
(e) "Medication used for the treatment of opioid use disorder" means a medication
approved by the Food and Drug Administration for the treatment of opioid use disorder.
new text end
new text begin
(f) "Minnesota health care programs" has the meaning given in section 256B.0636.
new text end
new text begin
(g) "Opioid treatment program" has the meaning given in Code of Federal Regulations,
title 42, section 8.12, and includes programs licensed under this chapter.
new text end
new text begin
(h) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605,
subpart 21a.
new text end
new text begin
(i) "Unsupervised use" means the use of a medication for the treatment of opioid use
disorder dispensed for use by a client outside of the program setting.
new text end
new text begin Subd. 3. new text end
new text begin Medication orders. new text end
new text begin
Before the program may administer or dispense a medication
used for the treatment of opioid use disorder:
new text end
new text begin
(1) a client-specific order must be received from an appropriately credentialed physician
who is enrolled as a Minnesota health care programs provider and meets all applicable
provider standards;
new text end
new text begin
(2) the signed order must be documented in the client's record; and
new text end
new text begin
(3) if the physician that issued the order is not able to sign the order when issued, the
unsigned order must be entered in the client record at the time it was received, and the
physician must review the documentation and sign the order in the client's record within 72
hours of the medication being ordered. The license holder must report to the commissioner
any medication error that endangers a client's health, as determined by the medical director.
new text end
new text begin Subd. 4. new text end
new text begin High dose requirements. new text end
new text begin
A client being administered or dispensed a dose
beyond that set forth in subdivision 6, paragraph (a), clause (1), that exceeds 150 milligrams
of methadone or 24 milligrams of buprenorphine daily, and for each subsequent increase,
must meet face-to-face with a prescribing physician. The meeting must occur before the
administration or dispensing of the increased medication dose.
new text end
new text begin Subd. 5. new text end
new text begin Drug testing. new text end
new text begin
Each client enrolled in the program must receive a minimum of
eight random drug abuse tests per 12 months of treatment. Drug abuse tests must be
reasonably disbursed over the 12-month period. A license holder may elect to conduct more
drug abuse tests.
new text end
new text begin Subd. 6. new text end
new text begin Criteria for unsupervised use. new text end
new text begin
(a) To limit the potential for diversion of
medication used for the treatment of opioid use disorder to the illicit market, medication
dispensed to a client for unsupervised use shall be subject to the following requirements:
new text end
new text begin
(1) any client in an opioid treatment program may receive a single unsupervised use
dose for a day that the clinic is closed for business, including Sundays and state and federal
holidays; and
new text end
new text begin
(2) other treatment program decisions on dispensing medications used for the treatment
of opioid use disorder to a client for unsupervised use shall be determined by the medical
director.
new text end
new text begin
(b) In determining whether a client may be permitted unsupervised use of medications,
a physician with authority to prescribe must consider the criteria in this paragraph. The
criteria in this paragraph must also be considered when determining whether dispensing
medication for a client's unsupervised use is appropriate to increase or to extend the amount
of time between visits to the program. The criteria are:
new text end
new text begin
(1) absence of recent abuse of drugs including but not limited to opioids, nonnarcotics,
and alcohol;
new text end
new text begin
(2) regularity of program attendance;
new text end
new text begin
(3) absence of serious behavioral problems at the program;
new text end
new text begin
(4) absence of known recent criminal activity such as drug dealing;
new text end
new text begin
(5) stability of the client's home environment and social relationships;
new text end
new text begin
(6) length of time in comprehensive maintenance treatment;
new text end
new text begin
(7) reasonable assurance that unsupervised use medication will be safely stored within
the client's home; and
new text end
new text begin
(8) whether the rehabilitative benefit the client derived from decreasing the frequency
of program attendance outweighs the potential risks of diversion or unsupervised use.
new text end
new text begin
(c) The determination, including the basis of the determination must be documented in
the client's medical record.
new text end
new text begin Subd. 7. new text end
new text begin Restrictions for unsupervised use of methadone hydrochloride. new text end
new text begin
(a) If a
physician with authority to prescribe determines that a client meets the criteria in subdivision
6 and may be dispensed a medication used for the treatment of opioid addiction, the
restrictions in this subdivision must be followed when the medication to be dispensed is
methadone hydrochloride.
new text end
new text begin
(b) During the first 90 days of treatment, the unsupervised use medication supply must
be limited to a maximum of a single dose each week and the client shall ingest all other
doses under direct supervision.
new text end
new text begin
(c) In the second 90 days of treatment, the unsupervised use medication supply must be
limited to two doses per week.
new text end
new text begin
(d) In the third 90 days of treatment, the unsupervised use medication supply must not
exceed three doses per week.
new text end
new text begin
(e) In the remaining months of the first year, a client may be given a maximum six-day
unsupervised use medication supply.
new text end
new text begin
(f) After one year of continuous treatment, a client may be given a maximum two-week
unsupervised use medication supply.
new text end
new text begin
(g) After two years of continuous treatment, a client may be given a maximum one-month
unsupervised use medication supply, but must make monthly visits to the program.
new text end
new text begin Subd. 8. new text end
new text begin Restriction exceptions. new text end
new text begin
When a license holder has reason to accelerate the
number of unsupervised use doses of methadone hydrochloride, the license holder must
comply with the requirements of Code of Federal Regulations, title 42, section 8.12, the
criteria for unsupervised use and must use the exception process provided by the federal
Center for Substance Abuse Treatment Division of Pharmacologic Therapies. For the
purposes of enforcement of this subdivision, the commissioner has the authority to monitor
a program for compliance with federal regulations and may issue licensing actions according
to sections 245A.05, 245A.06, and 245A.07 based on the commissioner's determination of
noncompliance.
new text end
new text begin Subd. 9. new text end
new text begin Guest dose. new text end
new text begin
To receive a guest dose, the client must be enrolled in an opioid
treatment program elsewhere in the state or country and be receiving the medication on a
temporary basis because the client is not able to receive the medication at the program in
which the client is enrolled. Such arrangements shall not exceed 30 consecutive days in any
one program and must not be for the convenience or benefit of either program. A guest dose
may also occur when the client's primary clinic is not open and the client is not receiving
unsupervised use doses.
new text end
new text begin Subd. 10. new text end
new text begin Capacity management and waiting list system compliance. new text end
new text begin
An opioid
treatment program must notify the department within seven days of the program reaching
both 90 and 100 percent of the program's capacity to care for clients. Each week, the program
must report its capacity, currently enrolled dosing clients, and any waiting list. A program
reporting 90 percent of capacity must also notify the department when the program's census
increases or decreases from the 90 percent level.
new text end
new text begin Subd. 11. new text end
new text begin Waiting list. new text end
new text begin
An opioid treatment program must have a waiting list system.
If the person seeking admission cannot be admitted within 14 days of the date of application,
each person seeking admission must be placed on the waiting list, unless the person seeking
admission is assessed by the program and found ineligible for admission according to this
chapter and Code of Federal Regulations, title 42, part 1, subchapter A, section 8.12(e), and
title 45, parts 160 to 164. The waiting list must assign a unique client identifier for each
person seeking treatment while awaiting admission. A person seeking admission on a waiting
list who receives no services under section 245G.07, subdivision 1, must not be considered
a "client" as defined in section 245G.01, subdivision 9.
new text end
new text begin Subd. 12. new text end
new text begin Client referral. new text end
new text begin
An opioid treatment program must consult the capacity
management system to ensure that a person on a waiting list is admitted at the earliest time
to a program providing appropriate treatment within a reasonable geographic area. If the
client was referred through a public payment system and if the program is not able to serve
the client within 14 days of the date of application for admission, the program must contact
and inform the referring agency of any available treatment capacity listed in the state capacity
management system.
new text end
new text begin Subd. 13. new text end
new text begin Outreach. new text end
new text begin
An opioid treatment program must carry out activities to encourage
an individual in need of treatment to undergo treatment. The program's outreach model
must:
new text end
new text begin
(1) select, train, and supervise outreach workers;
new text end
new text begin
(2) contact, communicate, and follow up with individuals with high-risk substance
misuse, individuals with high-risk substance misuse associates, and neighborhood residents
within the constraints of federal and state confidentiality requirements;
new text end
new text begin
(3) promote awareness among individuals who engage in substance misuse by injection
about the relationship between injecting substances and communicable diseases such as
HIV; and
new text end
new text begin
(4) recommend steps to prevent HIV transmission.
new text end
new text begin Subd. 14. new text end
new text begin Central registry. new text end
new text begin
(a) A license holder must comply with requirements to
submit information and necessary consents to the state central registry for each client
admitted, as specified by the commissioner. The license holder must submit data concerning
medication used for the treatment of opioid use disorder. The data must be submitted in a
method determined by the commissioner and the original information must be kept in the
client's record. The information must be submitted for each client at admission and discharge.
The program must document the date the information was submitted. The client's failure to
provide the information shall prohibit participation in an opioid treatment program. The
information submitted must include the client's:
new text end
new text begin
(1) full name and all aliases;
new text end
new text begin
(2) date of admission;
new text end
new text begin
(3) date of birth;
new text end
new text begin
(4) Social Security number or Alien Registration Number, if any;
new text end
new text begin
(5) current or previous enrollment status in another opioid treatment program;
new text end
new text begin
(6) government-issued photo identification card number; and
new text end
new text begin
(7) driver's license number, if any.
new text end
new text begin
(b) The requirements in paragraph (a) are effective upon the commissioner's
implementation of changes to the drug and alcohol abuse normative evaluation system or
development of an electronic system by which to submit the data.
new text end
new text begin Subd. 15. new text end
new text begin Nonmedication treatment services; documentation. new text end
new text begin
(a) The program must
offer at least 50 consecutive minutes of individual or group therapy treatment services as
defined in section 245G.07, subdivision 1, paragraph (a), clause (1), per week, for the first
ten weeks following admission, and at least 50 consecutive minutes per month thereafter.
As clinically appropriate, the program may offer these services cumulatively and not
consecutively in increments of no less than 15 minutes over the required time period, and
for a total of 60 minutes of treatment services over the time period, and must document the
reason for providing services cumulatively in the client's record. The program may offer
additional levels of service when deemed clinically necessary.
new text end
new text begin
(b) Notwithstanding the requirements of comprehensive assessments in section 245G.05,
the assessment must be completed within 21 days of service initiation.
new text end
new text begin
(c) Notwithstanding the requirements of individual treatment plans set forth in section
245G.06:
new text end
new text begin
(1) treatment plan contents for a maintenance client are not required to include goals
the client must reach to complete treatment and have services terminated;
new text end
new text begin
(2) treatment plans for a client in a taper or detox status must include goals the client
must reach to complete treatment and have services terminated;
new text end
new text begin
(3) for the initial ten weeks after admission for all new admissions, readmissions, and
transfers, progress notes must be entered in a client's file at least weekly and be recorded
in each of the six dimensions upon the development of the treatment plan and thereafter.
Subsequently, the counselor must document progress in the six dimensions at least once
monthly or, when clinical need warrants, more frequently; and
new text end
new text begin
(4) upon the development of the treatment plan and thereafter, treatment plan reviews
must occur weekly, or after each treatment service, whichever is less frequent, for the first
ten weeks after the treatment plan is developed. Following the first ten weeks of treatment
plan reviews, reviews may occur monthly, unless the client's needs warrant more frequent
revisions or documentation.
new text end
new text begin Subd. 16. new text end
new text begin Prescription monitoring program. new text end
new text begin
(a) The program must develop and
maintain a policy and procedure that requires the ongoing monitoring of the data from the
prescription monitoring program (PMP) for each client. The policy and procedure must
include how the program meets the requirements in paragraph (b).
new text end
new text begin
(b) If a medication used for the treatment of substance use disorder is administered or
dispensed to a client, the license holder shall be subject to the following requirements:
new text end
new text begin
(1) upon admission to a methadone clinic outpatient treatment program, a client must
be notified in writing that the commissioner of human services and the medical director
must monitor the PMP to review the prescribed controlled drugs a client received;
new text end
new text begin
(2) the medical director or the medical director's delegate must review the data from the
PMP described in section 152.126 before the client is ordered any controlled substance, as
defined under section 152.126, subdivision 1, paragraph (c), including medications used
for the treatment of opioid addiction, and the medical director's or the medical director's
delegate's subsequent reviews of the PMP data must occur at least every 90 days;
new text end
new text begin
(3) a copy of the PMP data reviewed must be maintained in the client's file;
new text end
new text begin
(4) when the PMP data contains a recent history of multiple prescribers or multiple
prescriptions for controlled substances, the physician's review of the data and subsequent
actions must be documented in the client's file within 72 hours and must contain the medical
director's determination of whether or not the prescriptions place the client at risk of harm
and the actions to be taken in response to the PMP findings. The provider must conduct
subsequent reviews of the PMP on a monthly basis; and
new text end
new text begin
(5) if at any time the medical director believes the use of the controlled substances places
the client at risk of harm, the program must seek the client's consent to discuss the client's
opioid treatment with other prescribers and must seek the client's consent for the other
prescriber to disclose to the opioid treatment program's medical director the client's condition
that formed the basis of the other prescriptions. If the information is not obtained within
seven days, the medical director must document whether or not changes to the client's
medication dose or number of unsupervised use doses are necessary until the information
is obtained.
new text end
new text begin
(c) The commissioner shall collaborate with the Minnesota Board of Pharmacy to develop
and implement an electronic system for the commissioner to routinely access the PMP data
to determine whether any client enrolled in an opioid addiction treatment program licensed
according to this section was prescribed or dispensed a controlled substance in addition to
that administered or dispensed by the opioid addiction treatment program. When the
commissioner determines there have been multiple prescribers or multiple prescriptions of
controlled substances for a client, the commissioner shall:
new text end
new text begin
(1) inform the medical director of the opioid treatment program only that the
commissioner determined the existence of multiple prescribers or multiple prescriptions of
controlled substances; and
new text end
new text begin
(2) direct the medical director of the opioid treatment program to access the data directly,
review the effect of the multiple prescribers or multiple prescriptions, and document the
review.
new text end
new text begin
(d) If determined necessary, the commissioner shall seek a federal waiver of, or exception
to, any applicable provision of Code of Federal Regulations, title 42, section 2.34(c), before
implementing this subdivision.
new text end
new text begin Subd. 17. new text end
new text begin Policies and procedures. new text end
new text begin
(a) A license holder must develop and maintain the
policies and procedures required in this subdivision.
new text end
new text begin
(b) For a program that is not open every day of the year, the license holder must maintain
a policy and procedure that permits a client to receive a single unsupervised use of medication
used for the treatment of opioid use disorder for days that the program is closed for business,
including, but not limited to, Sundays and state and federal holidays as required under
subdivision 6, paragraph (a), clause (1).
new text end
new text begin
(c) The license holder must maintain a policy and procedure that includes specific
measures to reduce the possibility of diversion. The policy and procedure must:
new text end
new text begin
(1) specifically identify and define the responsibilities of the medical and administrative
staff for performing diversion control measures; and
new text end
new text begin
(2) include a process for contacting no less than five percent of clients who have
unsupervised use of medication, excluding clients approved solely under subdivision 6,
paragraph (a), clause (1), to require clients to physically return to the program each month.
The system must require clients to return to the program within a stipulated time frame and
turn in all unused medication containers related to opioid use disorder treatment. The license
holder must document all related contacts on a central log and the outcome of the contact
for each client in the client's record.
new text end
new text begin
(d) Medication used for the treatment of opioid use disorder must be ordered,
administered, and dispensed according to applicable state and federal regulations and the
standards set by applicable accreditation entities. If a medication order requires assessment
by the person administering or dispensing the medication to determine the amount to be
administered or dispensed, the assessment must be completed by an individual whose
professional scope of practice permits an assessment. For the purposes of enforcement of
this paragraph, the commissioner has the authority to monitor the person administering or
dispensing the medication for compliance with state and federal regulations and the relevant
standards of the license holder's accreditation agency and may issue licensing actions
according to sections 245A.05, 245A.06, and 245A.07, based on the commissioner's
determination of noncompliance.
new text end
new text begin Subd. 18. new text end
new text begin Quality improvement plan. new text end
new text begin
The license holder must develop and maintain
a quality improvement plan that:
new text end
new text begin
(1) includes evaluation of the services provided to clients to identify issues that may
improve service delivery and client outcomes;
new text end
new text begin
(2) includes goals for the program to accomplish based on the evaluation;
new text end
new text begin
(3) is reviewed annually by the management of the program to determine whether the
goals were met and, if not, whether additional action is required;
new text end
new text begin
(4) is updated at least annually to include new or continued goals based on an updated
evaluation of services; and
new text end
new text begin
(5) identifies two specific goal areas, in addition to others identified by the program,
including:
new text end
new text begin
(i) a goal concerning oversight and monitoring of the premises around and near the
exterior of the program to reduce the possibility of medication used for the treatment of
opioid use disorder being inappropriately used by a client, including but not limited to the
sale or transfer of the medication to others; and
new text end
new text begin
(ii) a goal concerning community outreach, including but not limited to communications
with local law enforcement and county human services agencies, to increase coordination
of services and identification of areas of concern to be addressed in the plan.
new text end
new text begin Subd. 19. new text end
new text begin Placing authorities. new text end
new text begin
A program must provide certain notification and
client-specific updates to placing authorities for a client who is enrolled in Minnesota health
care programs. At the request of the placing authority, the program must provide
client-specific updates, including but not limited to informing the placing authority of
positive drug screenings and changes in medications used for the treatment of opioid use
disorder ordered for the client.
new text end
new text begin Subd. 20. new text end
new text begin Duty to report suspected drug diversion. new text end
new text begin
(a) To the fullest extent permitted
under Code of Federal Regulations, title 42, sections 2.1 to 2.67, a program shall report to
law enforcement any credible evidence that the program or its personnel knows, or reasonably
should know, that is directly related to a diversion crime on the premises of the program,
or a threat to commit a diversion crime.
new text end
new text begin
(b) "Diversion crime," for the purposes of this section, means diverting, attempting to
divert, or conspiring to divert Schedule I, II, III, or IV drugs, as defined in section 152.02,
on the program's premises.
new text end
new text begin
(c) The program must document the program's compliance with the requirement in
paragraph (a) in either a client's record or an incident report. A program's failure to comply
with paragraph (a) may result in sanctions as provided in sections 245A.06 and 245A.07.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 28.
Minnesota Statutes 2016, section 254A.01, is amended to read:
254A.01 PUBLIC POLICY.
It is hereby declared to be the public policy of this state that new text begin scientific evidence shows
that addiction to alcohol or other drugs is a chronic brain disorder with potential for
recurrence, and as with many other chronic conditions, people with substance use disorders
can be effectively treated and can enter recovery. new text end The interests of society are best served
by new text begin reducing the stigma of substance use disorder and new text end providing persons who are dependent
upon alcohol or other drugs with a comprehensive range of rehabilitative and social servicesnew text begin
that span intensity levels and are not restricted to a particular point in timenew text end . Further, it is
declared that treatment under these services shall be voluntary when possible: treatment
shall not be denied on the basis of prior treatment; treatment shall be based on an individual
treatment plan for each person undergoing treatment; treatment shall include a continuum
of services available for a person leaving a program of treatment; treatment shall include
all family members at the earliest possible phase of the treatment process.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 29.
Minnesota Statutes 2016, section 254A.02, subdivision 2, is amended to read:
Subd. 2.
Approved treatment program.
"Approved treatment program" means care
and treatment services provided by any individual, organization or association to deleted text begin drug
dependentdeleted text end personsnew text begin with a substance use disordernew text end , which meets the standards established by
the commissioner of human services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 30.
Minnesota Statutes 2016, section 254A.02, subdivision 3, is amended to read:
Subd. 3.
Comprehensive program.
"Comprehensive program" means the range of
services which are to be made available for the purpose of prevention, care and treatment
of deleted text begin alcohol and drug abusedeleted text end new text begin substance misuse and substance use disordernew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 31.
Minnesota Statutes 2016, section 254A.02, subdivision 5, is amended to read:
Subd. 5.
Drug dependent person.
"Drug dependent person" means any deleted text begin inebriate person
or anydeleted text end person incapable of self-management or management of personal affairs or unable
to function physically or mentally in an effective manner because of the abuse of a drug,
including alcohol.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 32.
Minnesota Statutes 2016, section 254A.02, subdivision 6, is amended to read:
Subd. 6.
Facility.
"Facility" means any treatment facility administered under an approved
treatment program deleted text begin established under Laws 1973, chapter 572deleted text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 33.
Minnesota Statutes 2016, section 254A.02, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Substance misuse. new text end
new text begin
"Substance misuse" means the use of any psychoactive
or mood-altering substance, without compelling medical reason, in a manner that results in
mental, emotional, or physical impairment and causes socially dysfunctional or socially
disordering behavior and that results in psychological dependence or physiological addiction
as a function of continued use. Substance misuse has the same meaning as "drug abuse" or
"abuse of drugs."
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 34.
Minnesota Statutes 2016, section 254A.02, subdivision 8, is amended to read:
Subd. 8.
Other drugs.
"Other drugs" means any psychoactive deleted text begin chemicaldeleted text end new text begin substancenew text end other
than alcohol.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 35.
Minnesota Statutes 2016, section 254A.02, subdivision 10, is amended to read:
Subd. 10.
State authority.
"State authority" is a division established within the
Department of Human Services for the purpose of relating the authority of state government
in the area of deleted text begin alcohol and drug abusedeleted text end new text begin substance misuse and substance use disordernew text end to the
deleted text begin alcohol and drug abusedeleted text end new text begin substance misuse and substance use disorder-relatednew text end activities within
the state.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 36.
Minnesota Statutes 2016, section 254A.02, is amended by adding a subdivision
to read:
new text begin Subd. 10a. new text end
new text begin Substance use disorder. new text end
new text begin
"Substance use disorder" has the meaning given
in the current Diagnostic and Statistical Manual of Mental Disorders.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 37.
Minnesota Statutes 2016, section 254A.03, is amended to read:
254A.03 STATE AUTHORITY ON ALCOHOL AND DRUG ABUSE.
Subdivision 1.
Alcohol and Other Drug Abuse Section.
There is hereby created an
Alcohol and Other Drug Abuse Section in the Department of Human Services. This section
shall be headed by a director. The commissioner may place the director's position in the
unclassified service if the position meets the criteria established in section 43A.08,
subdivision 1a. The section shall:
(1) conduct and foster basic research relating to the cause, prevention and methods of
diagnosis, treatment and rehabilitation of deleted text begin alcoholic and other drug dependentdeleted text end personsnew text begin with
substance misuse and substance use disordernew text end ;
(2) coordinate and review all activities and programs of all the various state departments
as they relate to deleted text begin alcohol and other drug dependency and abusedeleted text end problemsnew text begin associated with
substance misuse and substance use disordernew text end ;
(3) develop, demonstrate, and disseminate new methods and techniques for deleted text begin thedeleted text end prevention,
new text begin early intervention, new text end treatment and deleted text begin rehabilitation of alcohol and other drug abuse and
dependency problemsdeleted text end new text begin recovery support for substance misuse and substance use disordernew text end ;
(4) gather facts and information about deleted text begin alcoholism and other drug dependency and abusedeleted text end new text begin
substance misuse and substance use disordernew text end , and about the efficiency and effectiveness of
prevention, treatment, and deleted text begin rehabilitationdeleted text end new text begin recovery support servicesnew text end from all comprehensive
programs, including programs approved or licensed by the commissioner of human services
or the commissioner of health or accredited by the Joint Commission on Accreditation of
Hospitals. The state authority is authorized to require information from comprehensive
programs which is reasonable and necessary to fulfill these duties. When required information
has been previously furnished to a state or local governmental agency, the state authority
shall collect the information from the governmental agency. The state authority shall
disseminate facts and summary information about deleted text begin alcohol and other drug abuse dependencydeleted text end
problemsnew text begin associated with substance misuse and substance use disordernew text end to public and private
agencies, local governments, local and regional planning agencies, and the courts for guidance
to and assistance in prevention, treatment and deleted text begin rehabilitationdeleted text end new text begin recovery supportnew text end ;
(5) inform and educate the general public on deleted text begin alcohol and other drug dependency and
abuse problemsdeleted text end new text begin substance misuse and substance use disordernew text end ;
(6) serve as the state authority concerning deleted text begin alcohol and other drug dependency and abusedeleted text end new text begin
substance misuse and substance use disordernew text end by monitoring the conduct of diagnosis and
referral services, research and comprehensive programs. The state authority shall submit a
biennial report to the governor and the legislature containing a description of public services
delivery and recommendations concerning increase of coordination and quality of services,
and decrease of service duplication and cost;
(7) establish a state plan which shall set forth goals and priorities for a comprehensive
deleted text begin alcohol and other drug dependency and abuse programdeleted text end new text begin continuum of care for substance
misuse and substance use disordernew text end for Minnesota. All state agencies operating deleted text begin alcohol and
other drug abuse or dependencydeleted text end new text begin substance misuse or substance use disordernew text end programs or
administering state or federal funds for such programs shall annually set their program goals
and priorities in accordance with the state plan. Each state agency shall annually submit its
plans and budgets to the state authority for review. The state authority shall certify whether
proposed services comply with the comprehensive state plan and advise each state agency
of review findings;
(8) make contracts with and grants to public and private agencies and organizations,
both profit and nonprofit, and individuals, using federal funds, and state funds as authorized
to pay for costs of state administration, including evaluation, statewide programs and services,
research and demonstration projects, and American Indian programs;
(9) receive and administer deleted text begin moniesdeleted text end new text begin moneynew text end available for deleted text begin alcohol and drug abusedeleted text end new text begin substance
misuse and substance use disordernew text end programs under the alcohol, drug abuse, and mental
health services block grant, United States Code, title 42, sections 300X to 300X-9;
(10) solicit and accept any gift of money or property for purposes of Laws 1973, chapter
572, and any grant of money, services, or property from the federal government, the state,
any political subdivision thereof, or any private source;
(11) with respect to deleted text begin alcohol and other drug abusedeleted text end new text begin substance misuse and substance use
disordernew text end programs serving the American Indian community, establish guidelines for the
employment of personnel with considerable practical experience in deleted text begin alcohol and other drug
abuse problemsdeleted text end new text begin substance misuse and substance use disordernew text end , and understanding of social
and cultural problems related to deleted text begin alcohol and other drug abusedeleted text end new text begin substance misuse and substance
use disordernew text end , in the American Indian community.
Subd. 2.
American Indian programs.
There is hereby created a section of American
Indian programs, within the Alcohol and Drug Abuse Section of the Department of Human
Services, to be headed by a special assistant for American Indian programs on deleted text begin alcoholism
and drug abusedeleted text end new text begin substance misuse and substance use disordernew text end and two assistants to that
position. The section shall be staffed with all personnel necessary to fully administer
programming for deleted text begin alcohol and drug abusedeleted text end new text begin substance misuse and substance use disorder
servicesnew text end for American Indians in the state. The special assistant position shall be filled by
a person with considerable practical experience in and understanding of deleted text begin alcohol and other
drug abuse problemsdeleted text end new text begin substance misuse and substance use disordernew text end in the American Indian
community, who shall be responsible to the director of the Alcohol and Drug Abuse Section
created in subdivision 1 and shall be in the unclassified service. The special assistant shall
meet and consult with the American Indian Advisory Council as described in section
254A.035 and serve as a liaison to the Minnesota Indian Affairs Council and tribes to report
on the status of deleted text begin alcohol and other drug abusedeleted text end new text begin substance misuse and substance use disordernew text end
among American Indians in the state of Minnesota. The special assistant with the approval
of the director shall:
(1) administer funds appropriated for American Indian groups, organizations and
reservations within the state for American Indian deleted text begin alcoholism and drug abusedeleted text end new text begin substance
misuse and substance use disordernew text end programs;
(2) establish policies and procedures for such American Indian programs with the
assistance of the American Indian Advisory Board; and
(3) hire and supervise staff to assist in the administration of the American Indian program
section within the Alcohol and Drug Abuse Section of the Department of Human Services.
Subd. 3.
Rules for deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end care.
new text begin (a) new text end The
commissioner of human services shall establish by rule criteria to be used in determining
the appropriate level of chemical dependency care for each recipient of public assistance
seeking treatment for deleted text begin alcohol or other drug dependency and abuse problems.deleted text end new text begin substance
misuse or substance use disorder. On July 1, 2018, or upon federal approval, whichever is
later, of comprehensive assessment as a Medicaid benefit and notwithstanding the criteria
in Minnesota Rules, parts 9530 6600 to 9530.6655, an eligible vendor of comprehensive
assessments under section 254B.05 may determine and approve the appropriate level of
substance use disorder treatment for a recipient of public assistance. The process for
determining an individual's financial eligibility for the consolidated chemical dependency
treatment fund or determining an individual's enrollment in or eligibility for a publicly
subsidized health plan is not affected by the individual's choice to access a comprehensive
assessment for placement.
new text end
new text begin
(b) The commissioner shall develop and implement a utilization review process for
publicly funded treatment placements to monitor and review the clinical appropriateness
and timeliness of all publicly funded placements in treatment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 38.
Minnesota Statutes 2016, section 254A.035, subdivision 1, is amended to read:
Subdivision 1.
Establishment.
There is created an American Indian Advisory Council
to assist the state authority on deleted text begin alcohol and drug abusedeleted text end new text begin substance misuse and substance use
disordernew text end in proposal review and formulating policies and procedures relating to deleted text begin chemical
dependency and the abuse of alcohol and other drugsdeleted text end new text begin substance misuse and substance use
disordernew text end by American Indians.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 39.
Minnesota Statutes 2016, section 254A.04, is amended to read:
254A.04 CITIZENS ADVISORY COUNCIL.
There is hereby created an Alcohol and Other Drug Abuse Advisory Council to advise
the Department of Human Services concerning the problems of deleted text begin alcohol and other drug
dependency and abusedeleted text end new text begin substance misuse and substance use disordernew text end , composed of ten
members. Five members shall be individuals whose interests or training are in the field of
deleted text begin alcohol dependencydeleted text end new text begin alcohol-specific substance use disordernew text end and deleted text begin abusedeleted text end new text begin alcohol misusenew text end ; and
five members whose interests or training are in the field of deleted text begin dependencydeleted text end new text begin substance use
disordernew text end and deleted text begin abuse of drugsdeleted text end new text begin misuse of substancesnew text end other than alcohol. The terms, compensation
and removal of members shall be as provided in section 15.059. The council expires June
30, 2018. The commissioner of human services shall appoint members whose terms end in
even-numbered years. The commissioner of health shall appoint members whose terms end
in odd-numbered years.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 40.
Minnesota Statutes 2016, section 254A.08, is amended to read:
254A.08 DETOXIFICATION CENTERS.
Subdivision 1.
Detoxification services.
Every county board shall provide detoxification
services for deleted text begin drug dependent personsdeleted text end new text begin any person incapable of self-management or management
of personal affairs or unable to function physically or mentally in an effective manner
because of the use of a drug, including alcoholnew text end . The board may utilize existing treatment
programs and other agencies to meet this responsibility.
Subd. 2.
Program requirements.
For the purpose of this section, a detoxification
program means a social rehabilitation program new text begin licensed by the Department of Human
Services under Minnesota Rules, parts 9530.6510 to 9530.6590, and new text end established for the
purpose of facilitating access into care and treatment by detoxifying and evaluating the
person and providing entrance into a comprehensive program. Evaluation of the person
shall include verification by a professional, after preliminary examination, that the person
is intoxicated or has symptoms of deleted text begin chemical dependencydeleted text end new text begin substance misuse or substance use
disordernew text end and appears to be in imminent danger of harming self or others. A detoxification
program shall have available the services of a licensed physician for medical emergencies
and routine medical surveillance. A detoxification program licensed by the Department of
Human Services to serve both adults and minors at the same site must provide for separate
sleeping areas for adults and minors.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 41.
Minnesota Statutes 2016, section 254A.09, is amended to read:
254A.09 CONFIDENTIALITY OF RECORDS.
The Department of Human Services shall assure confidentiality to individuals who are
the subject of research by the state authority or are recipients of deleted text begin alcohol or drug abusedeleted text end new text begin
substance misuse or substance use disordernew text end information, assessment, or treatment from a
licensed or approved program. The commissioner shall withhold from all persons not
connected with the conduct of the research the names or other identifying characteristics
of a subject of research unless the individual gives written permission that information
relative to treatment and recovery may be released. Persons authorized to protect the privacy
of subjects of research may not be compelled in any federal, state or local, civil, criminal,
administrative or other proceeding to identify or disclose other confidential information
about the individuals. Identifying information and other confidential information related to
deleted text begin alcohol or drug abusedeleted text end new text begin substance misuse or substance use disordernew text end information, assessment,
treatment, or aftercare services may be ordered to be released by the court for the purpose
of civil or criminal investigations or proceedings if, after review of the records considered
for disclosure, the court determines that the information is relevant to the purpose for which
disclosure is requested. The court shall order disclosure of only that information which is
determined relevant. In determining whether to compel disclosure, the court shall weigh
the public interest and the need for disclosure against the injury to the patient, to the treatment
relationship in the program affected and in other programs similarly situated, and the actual
or potential harm to the ability of programs to attract and retain patients if disclosure occurs.
This section does not exempt any person from the reporting obligations under section
626.556, nor limit the use of information reported in any proceeding arising out of the abuse
or neglect of a child. Identifying information and other confidential information related to
deleted text begin alcohol or drug abuse informationdeleted text end new text begin substance misuse or substance use disordernew text end , assessment,
treatment, or aftercare services may be ordered to be released by the court for the purpose
of civil or criminal investigations or proceedings. No information may be released pursuant
to this section that would not be released pursuant to section 595.02, subdivision 2.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 42.
Minnesota Statutes 2016, section 254A.19, subdivision 3, is amended to read:
Subd. 3.
Financial conflicts of interest.
(a) Except as provided in paragraph (b) or (c),
an assessor conducting a chemical use assessment under Minnesota Rules, parts 9530.6600
to 9530.6655, may not have any direct or shared financial interest or referral relationship
resulting in shared financial gain with a treatment provider.
(b) A county may contract with an assessor having a conflict described in paragraph (a)
if the county documents that:
(1) the assessor is employed by a culturally specific service provider or a service provider
with a program designed to treat individuals of a specific age, sex, or sexual preference;
(2) the county does not employ a sufficient number of qualified assessors and the only
qualified assessors available in the county have a direct or shared financial interest or a
referral relationship resulting in shared financial gain with a treatment provider; or
(3) the county social service agency has an existing relationship with an assessor or
service provider and elects to enter into a contract with that assessor to provide both
assessment and treatment under circumstances specified in the county's contract, provided
the county retains responsibility for making placement decisions.
(c) The county may contract with a hospital to conduct chemical assessments if the
requirements in subdivision 1a are met.
An assessor under this paragraph may not place clients in treatment. The assessor shall
gather required information and provide it to the county along with any required
documentation. The county shall make all placement decisions for clients assessed by
assessors under this paragraph.
new text begin
(d) An eligible vendor under section 254B.05 conducting a comprehensive assessment
for an individual seeking treatment shall approve the nature, intensity level, and duration
of treatment service if a need for services is indicated, but the individual assessed can access
any enrolled provider that is licensed to provide the level of service authorized, including
the provider or program that completed the assessment. If an individual is enrolled in a
prepaid health plan, the individual must comply with any provider network requirements
or limitations.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 43.
Minnesota Statutes 2016, section 254B.01, subdivision 3, is amended to read:
Subd. 3.
deleted text begin Chemical dependencydeleted text end new text begin Substance use disorder treatmentnew text end services.
"deleted text begin Chemical
dependencydeleted text end new text begin Substance use disorder treatmentnew text end services" means a planned program of care
for the treatment of deleted text begin chemical dependencydeleted text end new text begin substance misusenew text end or deleted text begin chemical abusedeleted text end new text begin substance
use disordernew text end to minimize or prevent further deleted text begin chemical abusedeleted text end new text begin substance misusenew text end by the person.
Diagnostic, evaluation, prevention, referral, detoxification, and aftercare services that are
not part of a program of care licensable as a residential or nonresidential deleted text begin chemical dependencydeleted text end new text begin
substance use disordernew text end treatment program are not deleted text begin chemical dependencydeleted text end new text begin substance use
disordernew text end services for purposes of this section. For pregnant and postpartum women, deleted text begin chemical
dependencydeleted text end new text begin substance use disordernew text end services include halfway house services, aftercare
services, psychological services, and case management.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 44.
Minnesota Statutes 2016, section 254B.01, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Recovery community organization. new text end
new text begin
"Recovery community organization"
means a community-based organization that promotes a recovery-orientation as an underlying
concept of healthy communities. A key role of a recovery community organization is the
training of recovery peers, who provide mentorship and ongoing support to persons dealing
with a substance use disorder, connecting them with the resources that can support that
person's recovery.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 45.
Minnesota Statutes 2016, section 254B.03, subdivision 2, is amended to read:
Subd. 2.
Chemical dependency fund payment.
(a) Payment from the chemical
dependency fund is limited to payments for services other than detoxification new text begin licensed under
Minnesota Rules, parts 9530.6510 to 9530.6590, new text end that, if located outside of federally
recognized tribal lands, would be required to be licensed by the commissioner as a chemical
dependency treatment or rehabilitation program under sections 245A.01 to 245A.16, and
services other than detoxification provided in another state that would be required to be
licensed as a chemical dependency program if the program were in the state. Out of state
vendors must also provide the commissioner with assurances that the program complies
substantially with state licensing requirements and possesses all licenses and certifications
required by the host state to provide chemical dependency treatment. deleted text begin Except for chemical
dependency transitional rehabilitation programs,deleted text end Vendors receiving payments from the
chemical dependency fund must not require co-payment from a recipient of benefits for
services provided under this subdivision. new text begin This includes but is not limited to cash or SNAP
benefits. Retention of SNAP benefits is a right of a client receiving services through the
consolidated chemical dependency treatment fund or through state contracted managed care
entities. new text end Payment from the chemical dependency fund shall be made for necessary room
and board costs provided by vendors certified according to section 254B.05, or in a
community hospital licensed by the commissioner of health according to sections 144.50
to 144.56 to a client who is:
(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and
(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the chemical dependency fund.
(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.
(c) The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 46.
Minnesota Statutes 2016, section 254B.04, subdivision 1, is amended to read:
Subdivision 1.
Eligibility.
deleted text begin (a)deleted text end Persons eligible for benefits under Code of Federal
Regulations, title 25, part 20, and persons eligible for medical assistance benefits under
sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 5, and 6, or who meet the
income standards of section 256B.056, subdivision 4, are entitled to chemical dependency
fund services. State money appropriated for this paragraph must be placed in a separate
account established for this purpose.
Persons with dependent children who are determined to be in need of chemical
dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
local agency to access needed treatment services. Treatment services must be appropriate
for the individual or family, which may include long-term care treatment or treatment in a
facility that allows the dependent children to stay in the treatment facility. The county shall
pay for out-of-home placement costs, if applicable.
deleted text begin
(b) A person not entitled to services under paragraph (a), but with family income that
is less than 215 percent of the federal poverty guidelines for the applicable family size, shall
be eligible to receive chemical dependency fund services within the limit of funds
appropriated for this group for the fiscal year. If notified by the state agency of limited
funds, a county must give preferential treatment to persons with dependent children who
are in need of chemical dependency treatment pursuant to an assessment under section
626.556, subdivision 10, or a case plan under section 260C.201, subdivision 6, or 260C.212.
A county may spend money from its own sources to serve persons under this paragraph.
State money appropriated for this paragraph must be placed in a separate account established
for this purpose.
deleted text end
deleted text begin
(c) Persons whose income is between 215 percent and 412 percent of the federal poverty
guidelines for the applicable family size shall be eligible for chemical dependency services
on a sliding fee basis, within the limit of funds appropriated for this group for the fiscal
year. Persons eligible under this paragraph must contribute to the cost of services according
to the sliding fee scale established under subdivision 3. A county may spend money from
its own sources to provide services to persons under this paragraph. State money appropriated
for this paragraph must be placed in a separate account established for this purpose.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 47.
Minnesota Statutes 2016, section 254B.04, subdivision 2b, is amended to read:
Subd. 2b.
Eligibility for placement in opioid treatment programs.
deleted text begin
(a) Notwithstanding
provisions of Minnesota Rules, part 9530.6622, subpart 5, related to a placement authority's
requirement to authorize services or service coordination in a program that complies with
Minnesota Rules, part 9530.6500, or Code of Federal Regulations, title 42, part 8, and after
taking into account an individual's preference for placement in an opioid
deleted text end
deleted text begin
treatment program,
a placement authority may, but is not required to, authorize services or service coordination
or otherwise place an individual in an opioid treatment program. Prior to making a
determination of placement for an individual, the placing authority must consult with the
current treatment provider, if any.
deleted text end
deleted text begin (b)deleted text end Prior to placement of an individual who is determined by the assessor to require
treatment for opioid addiction, the assessor must provide educational information concerning
treatment options for opioid addiction, including the use of a medication for the use of
opioid addiction. The commissioner shall develop educational materials supported by
research and updated periodically that must be used by assessors to comply with this
requirement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 48.
Minnesota Statutes 2016, section 254B.05, subdivision 1, is amended to read:
Subdivision 1.
Licensure required.
new text begin (a) new text end Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
deleted text begin chemical dependency primarydeleted text end new text begin substance use disordernew text end treatment, extended care, transitional
residence, or outpatient treatment services, and are licensed by tribal government are eligible
vendors.
new text begin
(b) On July 1, 2018, or upon federal approval, whichever is later, a licensed professional
in private practice who meets the requirements of section 245G.11, subdivisions 1 and 4,
is an eligible vendor of a comprehensive assessment and assessment summary provided
according to section 245G.05, and treatment services provided according to sections 245G.06
and 245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2.
new text end
new text begin
(c) On July 1, 2018, or upon federal approval, whichever is later, a county is an eligible
vendor for a comprehensive assessment and assessment summary when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 4, and
completed according to the requirements of section 245G.05. A county is an eligible vendor
of care coordination services when provided by an individual who meets the staffing
credentials of section 245G.11, subdivisions 1 and 7, and provided according to the
requirements of section 245G.07, subdivision 1, clause (7).
new text end
new text begin
(d) On July 1, 2018, or upon federal approval, whichever is later, a recovery community
organization that meets certification requirements identified by the commissioner is an
eligible vendor of peer support services.
new text end
new text begin (e) new text end Detoxification programs new text begin licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, new text end are not eligible vendors. Programs that are not licensed as a deleted text begin chemical dependencydeleted text end
residential or nonresidential new text begin substance use disorder new text end treatment new text begin or withdrawal management
new text end program by the commissioner or by tribal government or do not meet the requirements of
subdivisions 1a and 1b are not eligible vendors.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 49.
Minnesota Statutes 2016, section 254B.05, subdivision 1a, is amended to read:
Subd. 1a.
Room and board provider requirements.
(a) Effective January 1, 2000,
vendors of room and board are eligible for chemical dependency fund payment if the vendor:
(1) has rules prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of those rules;
(2) is determined to meet applicable health and safety requirements;
(3) is not a jail or prison;
(4) is not concurrently receiving funds under chapter 256I for the recipient;
(5) admits individuals who are 18 years of age or older;
(6) is registered as a board and lodging or lodging establishment according to section
157.17;
(7) has awake staff on site 24 hours per day;
(8) has staff who are at least 18 years of age and meet the requirements of deleted text begin Minnesota
Rules, part 9530.6450, subpart 1, item Adeleted text end new text begin section 245G.11, subdivision 1, paragraph (a)new text end ;
(9) has emergency behavioral procedures that meet the requirements of deleted text begin Minnesota Rules,
part 9530.6475deleted text end new text begin section 245G.16new text end ;
(10) meets the requirements of deleted text begin Minnesota Rules, part 9530.6435, subparts 3 and 4, items
A and Bdeleted text end new text begin section 245G.08, subdivision 5new text end , if administering medications to clients;
(11) meets the abuse prevention requirements of section 245A.65, including a policy on
fraternization and the mandatory reporting requirements of section 626.557;
(12) documents coordination with the treatment provider to ensure compliance with
section 254B.03, subdivision 2;
(13) protects client funds and ensures freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;
(14) has a grievance procedure that meets the requirements of deleted text begin Minnesota Rules, part
9530.6470, subpart 2deleted text end new text begin section 245G.15, subdivision 2new text end ; and
(15) has sleeping and bathroom facilities for men and women separated by a door that
is locked, has an alarm, or is supervised by awake staff.
(b) Programs licensed according to Minnesota Rules, chapter 2960, are exempt from
paragraph (a), clauses (5) to (15).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 50.
Minnesota Statutes 2016, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for deleted text begin chemical
dependencydeleted text end new text begin substance use disorder new text end services and service enhancements funded under this
chapter.
(b) Eligible deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end treatment services include:
(1) outpatient treatment services that are licensed according to deleted text begin Minnesota Rules, parts
9530.6405 to 9530.6480deleted text end new text begin sections 245G.01 to 245G.17new text end , or applicable tribal license;
new text begin
(2) on July 1, 2018, or upon federal approval, whichever is later, comprehensive
assessments provided according to sections 245.4863, paragraph (a), and 245G.05, and
Minnesota Rules, part 9530.6422;
new text end
new text begin
(3) on July 1, 2018, or upon federal approval, whichever is later, care coordination
services provided according to section 245G.07, subdivision 1, paragraph (a), clause (6);
new text end
new text begin
(4) on July 1, 2018, or upon federal approval, whichever is later, peer recovery support
services provided according to section 245G.07, subdivision 1, paragraph (a), clause (5);
new text end
new text begin
(5) on July 1, 2018, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
new text end
deleted text begin (2)deleted text end new text begin (6)new text end medication-assisted therapy services that are licensed according to deleted text begin Minnesota
Rules, parts 9530.6405 to 9530.6480 and 9530.6500deleted text end new text begin section 245G.07, subdivision 1new text end , or
applicable tribal license;
deleted text begin (3)deleted text end new text begin (7)new text end medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause deleted text begin (2)deleted text end new text begin (6)new text end and provide nine hours of clinical services each week;
deleted text begin (4)deleted text end new text begin (8)new text end high, medium, and low intensity residential treatment services that are licensed
according to deleted text begin Minnesota Rules, parts 9530.6405 to 9530.6480 and 9530.6505,deleted text end new text begin sections
245G.01 to 245G.17 and 245G.22new text end or applicable tribal license which provide, respectively,
30, 15, and five hours of clinical services each week;
deleted text begin (5)deleted text end new text begin (9)new text end hospital-based treatment services that are licensed according to deleted text begin Minnesota Rules,
parts 9530.6405 to 9530.6480,deleted text end new text begin sections 245G.01 to 245G.17 new text end or applicable tribal license and
licensed as a hospital under sections 144.50 to 144.56;
deleted text begin (6)deleted text end new text begin (10)new text end adolescent treatment programs that are licensed as outpatient treatment programs
according to deleted text begin Minnesota Rules, parts 9530.6405 to 9530.6485,deleted text end new text begin sections 245G.01 to 245G.18new text end
or as residential treatment programs according to Minnesota Rules, parts 2960.0010 to
2960.0220, and 2960.0430 to 2960.0490, or applicable tribal license;
deleted text begin (7)deleted text end new text begin (11)new text end high-intensity residential treatment services that are licensed according to
deleted text begin Minnesota Rules, parts 9530.6405 to 9530.6480 and 9530.6505,deleted text end new text begin sections 245G.01 to 245G.17
and 245G.21new text end or applicable tribal license, which provide 30 hours of clinical services each
week provided by a state-operated vendor or to clients who have been civilly committed to
the commissioner, present the most complex and difficult care needs, and are a potential
threat to the community; and
deleted text begin (8)deleted text end new text begin (12)new text end room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under deleted text begin Minnesota Rules, part 9530.6490, subpart
4deleted text end new text begin section 245G.19, subdivision 4new text end ; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in deleted text begin Minnesota Rules, part 9530.6495deleted text end new text begin
section 245G.20new text end ;
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in deleted text begin Minnesota Rules, part
9530.6490deleted text end new text begin section 245G.19new text end .
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. The use of
two-way interactive video must be medically appropriate to the condition and needs of the
person being served. Reimbursement shall be at the same rates and under the same conditions
that would otherwise apply to direct face-to-face services. The interactive video equipment
and connection must comply with Medicare standards in effect at the time the service is
provided.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 51.
Minnesota Statutes 2016, section 254B.051, is amended to read:
254B.051 SUBSTANCE deleted text begin ABUSEdeleted text end new text begin USE DISORDERnew text end TREATMENT
EFFECTIVENESS.
In addition to the substance deleted text begin abusedeleted text end new text begin use disordernew text end treatment program performance outcome
measures that the commissioner of human services collects annually from treatment providers,
the commissioner shall request additional data from programs that receive appropriations
from the consolidated chemical dependency treatment fund. This data shall include number
of client readmissions six months after release from inpatient treatment, and the cost of
treatment per person for each program receiving consolidated chemical dependency treatment
funds. The commissioner may post this data on the department Web site.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 52.
Minnesota Statutes 2016, section 254B.07, is amended to read:
254B.07 THIRD-PARTY LIABILITY.
The state agency provision and payment of, or liability for, deleted text begin chemical dependencydeleted text end new text begin
substance use disordernew text end medical care is the same as in section 256B.042.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 53.
Minnesota Statutes 2016, section 254B.08, is amended to read:
254B.08 FEDERAL WAIVERS.
The commissioner shall apply for any federal waivers necessary to secure, to the extent
allowed by law, federal financial participation for the provision of services to persons who
need deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end services. The commissioner may seek
amendments to the waivers or apply for additional waivers to contain costs. The
commissioner shall ensure that payment for the cost of providing deleted text begin chemical dependencydeleted text end new text begin
substance use disordernew text end services under the federal waiver plan does not exceed the cost of
deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end services that would have been provided without
the waivered services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 54.
Minnesota Statutes 2016, section 254B.09, is amended to read:
254B.09 INDIAN RESERVATION ALLOCATION OF CHEMICAL
DEPENDENCY FUND.
Subdivision 1.
Vendor payments.
The commissioner shall pay eligible vendors for
deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end services to American Indians on the same
basis as other payments, except that no local match is required when an invoice is submitted
by the governing authority of a federally recognized American Indian tribal body or a county
if the tribal governing body has not entered into an agreement under subdivision 2 on behalf
of a current resident of the reservation under this section.
Subd. 2.
American Indian agreements.
The commissioner may enter into agreements
with federally recognized tribal units to pay for deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end
treatment services provided under Laws 1986, chapter 394, sections 8 to 20. The agreements
must clarify how the governing body of the tribal unit fulfills local agency responsibilities
regarding:
(1) the form and manner of invoicing; and
(2) provide that only invoices for eligible vendors according to section 254B.05 will be
included in invoices sent to the commissioner for payment, to the extent that money allocated
under subdivisions 4 and 5 is used.
Subd. 6.
American Indian tribal placements.
After entering into an agreement under
subdivision 2, the governing authority of each reservation may submit invoices to the state
for the cost of providing deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end services to residents
of the reservation according to the placement rules governing county placements, except
that local match requirements are waived. The governing body may designate an agency to
act on its behalf to provide placement services and manage invoices by written notice to
the commissioner and evidence of agreement by the agency designated.
Subd. 8.
Payments to improve services to American Indians.
The commissioner may
set rates for deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end services to American Indians
according to the American Indian Health Improvement Act, Public Law 94-437, for eligible
vendors. These rates shall supersede rates set in county purchase of service agreements
when payments are made on behalf of clients eligible according to Public Law 94-437.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 55.
Minnesota Statutes 2016, section 254B.12, subdivision 2, is amended to read:
Subd. 2.
Payment methodology for highly specialized vendors.
Notwithstanding
subdivision 1, the commissioner shall seek federal authority to develop separate payment
methodologies for deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end treatment services provided
under the consolidated chemical dependency treatment fund: (1) by a state-operated vendor;
or (2) for persons who have been civilly committed to the commissioner, present the most
complex and difficult care needs, and are a potential threat to the community. A payment
methodology under this subdivision is effective for services provided on or after October
1, 2015, or on or after the receipt of federal approval, whichever is later.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 56.
Minnesota Statutes 2016, section 254B.13, subdivision 2a, is amended to read:
Subd. 2a.
Eligibility for navigator pilot program.
(a) To be considered for participation
in a navigator pilot program, an individual must:
(1) be a resident of a county with an approved navigator program;
(2) be eligible for consolidated chemical dependency treatment fund services;
(3) be a voluntary participant in the navigator program;
(4) satisfy one of the following items:
(i) have at least one severity rating of three or above in dimension four, five, or six in a
comprehensive assessment under deleted text begin Minnesota Rules, part 9530.6422deleted text end new text begin section 245G.05,
paragraph (c), clauses (4) to (6)new text end ; or
(ii) have at least one severity rating of two or above in dimension four, five, or six in a
comprehensive assessment under deleted text begin Minnesota Rules, part 9530.6422,deleted text end new text begin section 245G.05,
paragraph (c), clauses (4) to (6),new text end and be currently participating in a Rule 31 treatment program
under deleted text begin Minnesota Rules, parts 9530.6405 to 9530.6505,deleted text end new text begin chapter 245Gnew text end or be within 60 days
following discharge after participation in a Rule 31 treatment program; and
(5) have had at least two treatment episodes in the past two years, not limited to episodes
reimbursed by the consolidated chemical dependency treatment funds. An admission to an
emergency room, a detoxification program, or a hospital may be substituted for one treatment
episode if it resulted from the individual's substance use disorder.
(b) New eligibility criteria may be added as mutually agreed upon by the commissioner
and participating navigator programs.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 57.
Minnesota Statutes 2016, section 256B.0945, subdivision 2, is amended to read:
Subd. 2.
Covered services.
All services must be included in a child's individualized
treatment or multiagency plan of care as defined in chapter 245.
For facilities that are not institutions for mental diseases according to federal statute and
regulation, medical assistance covers mental health-related services that are required to be
provided by a residential facility under section 245.4882 and administrative rules promulgated
thereunder, except for room and board.new text begin For residential facilities determined by the federal
Centers for Medicare and Medicaid Services to be an institution for mental diseases, medical
assistance covers medically necessary mental health services provided by the facility
according to section 256B.055, subdivision 13, except for room and board.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for services provided on July 1, 2017,
through June 30, 2020, and expires effective July 1, 2020.
new text end
Sec. 58.
Minnesota Statutes 2016, section 256B.0945, subdivision 4, is amended to read:
Subd. 4.
Payment rates.
(a) Notwithstanding sections 256B.19 and 256B.041, payments
to counties for residential services providednew text begin under this sectionnew text end by a residential facility shallnew text begin :
new text end
new text begin (1) for services provided by a residential facility that is not an institution for mental
diseases,new text end only be made of federal earnings for services provided deleted text begin under this section,deleted text end and the
nonfederal share of costs for services provided under this section shall be paid by the county
from sources other than federal funds or funds used to match other federal funds. Payment
to counties for services provided according to this section shall be a proportion of the per
day contract rate that relates to rehabilitative mental health services and shall not include
payment for costs or services that are billed to the IV-E program as room and boarddeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(2) for services provided by a residential facility that is determined to be an institution
for mental diseases, be equivalent to the federal share of the payment that would have been
made if the residential facility were not an institution for mental diseases. The portion of
the payment representing what would be the nonfederal share shall be paid by the county.
Payment to counties for services provided according to this section shall be a proportion of
the per-day contract rate that relates to rehabilitative mental health services and shall not
include payment for costs or services that are billed to the IV-E program as room and board.
new text end
(b) Per diem rates paid to providers under this section by prepaid plans shall be the
proportion of the per-day contract rate that relates to rehabilitative mental health services
and shall not include payment for group foster care costs or services that are billed to the
county of financial responsibility. Services provided in facilities located in bordering states
are eligible for reimbursement on a fee-for-service basis only as described in paragraph (a)
and are not covered under prepaid health plans.
(c) Payment for mental health rehabilitative services provided under this section by or
under contract with an American Indian tribe or tribal organization or by agencies operated
by or under contract with an American Indian tribe or tribal organization must be made
according to section 256B.0625, subdivision 34, or other relevant federally approved
rate-setting methodology.
(d) The commissioner shall set aside a portion not to exceed five percent of the federal
funds earned for county expenditures under this section to cover the state costs of
administering this section. Any unexpended funds from the set-aside shall be distributed to
the counties in proportion to their earnings under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for services provided on July 1, 2017,
through June 30, 2020, and expires effective July 1, 2020.
new text end
Sec. 59. new text begin RESIDENTIAL TREATMENT AND PAYMENT RATE REFORM.
new text end
new text begin
The commissioner shall contract with an outside expert to identify recommendations
for the development of a substance use disorder residential treatment program model and
payment structure that is not subject to the federal institutions for mental diseases exclusion
and that is financially sustainable for providers, while incentivizing best practices and
improved treatment outcomes. The analysis and report must include recommendations and
a timeline for supporting providers to transition to the new models of care delivery. No later
than December 15, 2018, a report with recommendations must be delivered to members of
the legislative committees in the house of representatives and senate with jurisdiction over
health and human services policy and finance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 60. new text begin CHILDREN'S MENTAL HEALTH REPORT AND RECOMMENDATIONS.
new text end
new text begin
The commissioner of human services shall conduct a comprehensive analysis of
Minnesota's continuum of intensive mental health services and shall develop
recommendations for a sustainable and community-driven continuum of care for children
with serious mental health needs, including children currently being served in residential
treatment. The commissioner's analysis shall include, but not be limited to:
new text end
new text begin
(1) data related to access, utilization, efficacy, and outcomes for Minnesota's current
system of residential mental health treatment for a child with a severe emotional disturbance;
new text end
new text begin
(2) potential expansion of the state's psychiatric residential treatment facility (PRTF)
capacity, including increasing the number of PRTF beds and conversion of existing children's
mental health residential treatment programs into PRTFs;
new text end
new text begin
(3) the capacity need for PRTF and other group settings within the state if adequate
community-based alternatives are accessible, equitable, and effective statewide;
new text end
new text begin
(4) recommendations for expanding alternative community-based service models to
meet the needs of a child with a serious mental health disorder who would otherwise require
residential treatment and potential service models that could be utilized, including data
related to access, utilization, efficacy, and outcomes;
new text end
new text begin
(5) models of care used in other states; and
new text end
new text begin
(6) analysis and specific recommendations for the design and implementation of new
service models, including analysis to inform rate setting as necessary.
new text end
new text begin
The analysis shall be supported and informed by extensive stakeholder engagement.
Stakeholders include individuals who receive services, family members of individuals who
receive services, providers, counties, health plans, advocates and others. Stakeholder
engagement shall include interviews with key stakeholders, intentional outreach to individuals
who receive services and the individual's family members, and regional listening sessions.
new text end
new text begin
The commissioner shall provide a report with specific recommendations and timelines
for implementation to the legislative committees with jurisdiction over children's mental
health policy and finance by November 15, 2018.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
Sec. 61. new text begin REVISOR'S INSTRUCTION.
new text end
new text begin
In Minnesota Statutes and Minnesota Rules, the revisor of statutes, in consultation with
the with the Department of Human Services, shall make necessary cross-reference changes
that are needed as a result of the enactment of sections 5 to 26 and 56. The revisor shall
make any necessary technical and grammatical changes to preserve the meaning of the text.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 62. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2016, sections 245A.1915; 245A.192; and 254A.02, subdivision
4,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 9530.6405, subparts 1, 1a, 2, 3, 4, 5, 6, 7, 7a, 8, 9, 10, 11,
12, 13, 14, 14a, 15, 15a, 16, 17, 17a, 17b, 17c, 18, 20, and 21; 9530.6410; 9530.6415;
9530.6420; 9530.6422; 9530.6425; 9530.6430; 9530.6435; 9530.6440; 9530.6445;
9530.6450; 9530.6455; 9530.6460; 9530.6465; 9530.6470; 9530.6475; 9530.6480;
9530.6485; 9530.6490; 9530.6495; 9530.6500; and 9530.6505,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2017.
new text end
ARTICLE 9
OPERATIONS
Section 1.
Minnesota Statutes 2016, section 245A.04, subdivision 4, is amended to read:
Subd. 4.
Inspections; waiver.
(a) Before issuing an initial license, the commissioner
shall conduct an inspection of the program. The inspection must include but is not limited
to:
(1) an inspection of the physical plant;
(2) an inspection of records and documents;
(3) an evaluation of the program by consumers of the program; deleted text begin and
deleted text end
(4) observation of the program in operationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) an inspection for the health, safety, and fire standards in licensing requirements for
a child care license holder.
new text end
For the purposes of this subdivision, "consumer" means a person who receives the
services of a licensed program, the person's legal guardian, or the parent or individual having
legal custody of a child who receives the services of a licensed program.
(b) The evaluation required in paragraph (a), clause (3) or the observation in paragraph
(a), clause (4) is not required prior to issuing an initial license under subdivision 7. If the
commissioner issues an initial license under subdivision 7, these requirements must be
completed within one year after the issuance of an initial license.
new text begin
(c) The commissioner or the county shall inspect at least annually a child care provider
licensed under this chapter and Minnesota Rules, chapter 9502 or 9503, for compliance
with applicable licensing standards.
new text end
new text begin
(d) No later than November 19, 2017, the commissioner shall make publicly available
on the department's Web site the results of inspection reports of all child care providers
licensed under this chapter and under Minnesota Rules, chapter 9502 or 9503, and the
number of deaths, serious injuries, and instances of substantiated child maltreatment that
occurred in licensed child care settings each year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 2.
Minnesota Statutes 2016, section 245A.07, subdivision 3, is amended to read:
Subd. 3.
License suspension, revocation, or fine.
(a) The commissioner may suspend
or revoke a license, or impose a fine if:
(1) a license holder fails to comply fully with applicable laws or rules;
(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
a disqualification which has not been set aside under section 245C.22;
(3) a license holder knowingly withholds relevant information from or gives false or
misleading information to the commissioner in connection with an application for a license,
in connection with the background study status of an individual, during an investigation,
or regarding compliance with applicable laws or rules; or
(4) after July 1, 2012, and upon request by the commissioner, a license holder fails to
submit the information required of an applicant under section 245A.04, subdivision 1,
paragraph (f) or (g).
A license holder who has had a license suspended, revoked, or has been ordered to pay
a fine must be given notice of the action by certified mail or personal service. If mailed, the
notice must be mailed to the address shown on the application or the last known address of
the license holder. The notice must state the reasons the license was suspended, revoked,
or a fine was ordered.
(b) If the license was suspended or revoked, the notice must inform the license holder
of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
the commissioner within ten calendar days after the license holder receives notice that the
license has been suspended or revoked. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received the
order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits a
timely appeal of an order suspending or revoking a license, the license holder may continue
to operate the program as provided in section 245A.04, subdivision 7, paragraphs (g) and
(h), until the commissioner issues a final order on the suspension or revocation.
(c)(1) If the license holder was ordered to pay a fine, the notice must inform the license
holder of the responsibility for payment of fines and the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal of an
order to pay a fine must be made in writing by certified mail or personal service. If mailed,
the appeal must be postmarked and sent to the commissioner within ten calendar days after
the license holder receives notice that the fine has been ordered. If a request is made by
personal service, it must be received by the commissioner within ten calendar days after
the license holder received the order.
(2) The license holder shall pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies. If the license holder
receives state funds, the state, county, or municipal agencies or departments responsible for
administering the funds shall withhold payments and recover any payments made while the
license is suspended for failure to pay a fine. A timely appeal shall stay payment of the fine
until the commissioner issues a final order.
(3) A license holder shall promptly notify the commissioner of human services, in writing,
when a violation specified in the order to forfeit a fine is corrected. If upon reinspection the
commissioner determines that a violation has not been corrected as indicated by the order
to forfeit a fine, the commissioner may issue a second fine. The commissioner shall notify
the license holder by certified mail or personal service that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.
(4) Fines shall be assessed as follows:
new text begin (i)new text end the license holder shall forfeit $1,000 for each determination of maltreatment of a
child under section 626.556 or the maltreatment of a vulnerable adult under section 626.557
for which the license holder is determined responsible for the maltreatment under section
626.556, subdivision 10e, paragraph (i), or 626.557, subdivision 9c, paragraph (c);
new text begin
(ii) if the commissioner determines that a license holder is responsible for more than
one determination of maltreatment at the same site within a 12-month period, the license
holder shall forfeit $2,000 for each additional determination of maltreatment for which the
license holder is responsible;
new text end
new text begin
(iii) if the commissioner determines that a determination of maltreatment for which the
license holder is responsible is the result of systemic failure and the underlying facts that
constitute maltreatment meet the definition of "serious maltreatment" in section 245C.02,
subdivision 18, the license holder shall forfeit $5,000;
new text end
new text begin
(iv) for a program that operates out of the license holder's home and a program licensed
under Minnesota Rules, parts 9502.0300 to 9502.0455, the fine assessed against the license
holder shall not exceed $1,000 for each determination of maltreatment;
new text end
new text begin (v)new text end the license holder shall forfeit $200 for each occurrence of a violation of law or rule
governing matters of health, safety, or supervision, including but not limited to the provision
of adequate staff-to-child or adult ratios, and failure to comply with background study
requirements under chapter 245C; and
new text begin (vi)new text end the license holder shall forfeit $100 for each occurrence of a violation of law or rule
other than those subject to a new text begin $200, new text end $1,000new text begin , $2,000,new text end or deleted text begin $200deleted text end new text begin $5,000new text end fine deleted text begin abovedeleted text end new text begin in items (i)
to (v)new text end .
For purposes of this section, "occurrence" means each violation identified in the
commissioner's fine order. Fines assessed against a license holder that holds a license to
provide home and community-based services, as identified in section 245D.03, subdivision
1, and a community residential setting or day services facility license under chapter 245D
where the services are provided, may be assessed against both licenses for the same
occurrence, but the combined amount of the fines shall not exceed the amount specified in
this clause for that occurrence.
(5) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder will be personally liable for payment. In the case of a corporation, each
controlling individual is personally and jointly liable for payment.
(d) Except for background study violations involving the failure to comply with an order
to immediately remove an individual or an order to provide continuous, direct supervision,
the commissioner shall not issue a fine under paragraph (c) relating to a background study
violation to a license holder who self-corrects a background study violation before the
commissioner discovers the violation. A license holder who has previously exercised the
provisions of this paragraph to avoid a fine for a background study violation may not avoid
a fine for a subsequent background study violation unless at least 365 days have passed
since the license holder self-corrected the earlier background study violation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 3.
Minnesota Statutes 2016, section 245A.09, subdivision 7, is amended to read:
Subd. 7.
Regulatory methods.
(a) Where appropriate and feasible the commissioner
shall identify and implement alternative methods of regulation and enforcement to the extent
authorized in this subdivision. These methods shall include:
(1) expansion of the types and categories of licenses that may be granted;
(2) when the standards of another state or federal governmental agency or an independent
accreditation body have been shown to require the same standards, methods, or alternative
methods to achieve substantially the same intended outcomes as the licensing standards,
the commissioner shall consider compliance with the governmental or accreditation standards
to be equivalent to partial compliance with the licensing standards; and
(3) use of an abbreviated inspection that employs key standards that have been shown
to predict full compliance with the rules.
(b) If the commissioner accepts accreditation as documentation of compliance with a
licensing standard under paragraph (a), the commissioner shall continue to investigate
complaints related to noncompliance with all licensing standards. The commissioner may
take a licensing action for noncompliance under this chapter and shall recognize all existing
appeal rights regarding any licensing actions taken under this chapter.
(c) The commissioner shall work with the commissioners of health, public safety,
administration, and education in consolidating duplicative licensing and certification rules
and standards if the commissioner determines that consolidation is administratively feasible,
would significantly reduce the cost of licensing, and would not reduce the protection given
to persons receiving services in licensed programs. Where administratively feasible and
appropriate, the commissioner shall work with the commissioners of health, public safety,
administration, and education in conducting joint agency inspections of programs.
(d) The commissioner shall work with the commissioners of health, public safety,
administration, and education in establishing a single point of application for applicants
who are required to obtain concurrent licensure from more than one of the commissioners
listed in this clause.
(e) Unless otherwise specified in statute, the commissioner may conduct routine
inspections biennially.
new text begin
(f) For a licensed child care center, the commissioner shall conduct one unannounced
licensing inspection at least annually.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 4.
Minnesota Statutes 2016, section 245A.10, subdivision 2, is amended to read:
Subd. 2.
County fees for background studies and licensing inspections.
(a) new text begin Before
the implementation of NETStudy 2.0, new text end for purposes of family and group family child care
licensing under this chapter, a county agency may charge a fee to an applicant or license
holder to recover the actual cost of background studies, but in any case not to exceed $100
annually. A county agency may also charge a license fee to an applicant or license holder
not to exceed $50 for a one-year license or $100 for a two-year license.
(b) new text begin Before the implementation of NETStudy 2.0, new text end a county agency may charge a fee to
a legal nonlicensed child care provider or applicant for authorization to recover the actual
cost of background studies completed under section 119B.125, but in any case not to exceed
$100 annually.
(c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
(1) in cases of financial hardship;
(2) if the county has a shortage of providers in the county's area;
(3) for new providers; or
(4) for providers who have attained at least 16 hours of training before seeking initial
licensure.
(d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on an
installment basis for up to one year. If the provider is receiving child care assistance payments
from the state, the provider may have the fees under paragraph (a) or (b) deducted from the
child care assistance payments for up to one year and the state shall reimburse the county
for the county fees collected in this manner.
(e) For purposes of adult foster care and child foster care licensing, and licensing the
physical plant of a community residential setting, under this chapter, a county agency may
charge a fee to a corporate applicant or corporate license holder to recover the actual cost
of licensing inspections, not to exceed $500 annually.
(f) Counties may elect to reduce or waive the fees in paragraph (e) under the following
circumstances:
(1) in cases of financial hardship;
(2) if the county has a shortage of providers in the county's area; or
(3) for new providers.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 5.
Minnesota Statutes 2016, section 245A.10, subdivision 4, is amended to read:
Subd. 4.
License or certification fee for certain programs.
(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
Child Care Center License Fee |
|
| 1 to 24 persons |
$200 |
|
| 25 to 49 persons |
$300 |
|
| 50 to 74 persons |
$400 |
|
| 75 to 99 persons |
$500 |
|
| 100 to 124 persons |
$600 |
|
| 125 to 149 persons |
$700 |
|
| 150 to 174 persons |
$800 |
|
| 175 to 199 persons |
$900 |
|
| 200 to 224 persons |
$1,000 |
|
| 225 or more persons |
$1,100 |
(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee deleted text begin based ondeleted text end new text begin that is the greater of either
$400 or 0.34 percent ofnew text end revenues derived from the provision of services that would require
licensure undernew text begin thisnew text end chapter deleted text begin 245Ddeleted text end new text begin and that are specified under section 245D.03, subdivision
1,new text end during the calendar year immediately preceding the year in which the license fee is paiddeleted text begin ,
according to the following schedule:deleted text end new text begin .
new text end
|
deleted text begin
License Holder Annual Revenue deleted text end |
deleted text begin
License Fee deleted text end |
|
|
deleted text begin
less than or equal to $10,000 deleted text end |
deleted text begin
$200 deleted text end |
|
|
deleted text begin
greater than $10,000 but less than or equal to $25,000 deleted text end |
deleted text begin
$300 deleted text end |
|
|
deleted text begin
greater than $25,000 but less than or equal to $50,000 deleted text end |
deleted text begin
$400 deleted text end |
|
|
deleted text begin
greater than $50,000 but less than or equal to $100,000 deleted text end |
deleted text begin
$500 deleted text end |
|
|
deleted text begin
greater than $100,000 but less than or equal to $150,000 deleted text end |
deleted text begin
$600 deleted text end |
|
|
deleted text begin
greater than $150,000 but less than or equal to $200,000 deleted text end |
deleted text begin
$800 deleted text end |
|
|
deleted text begin
greater than $200,000 but less than or equal to $250,000 deleted text end |
deleted text begin
$1,000 deleted text end |
|
|
deleted text begin
greater than $250,000 but less than or equal to $300,000 deleted text end |
deleted text begin
$1,200 deleted text end |
|
|
deleted text begin
greater than $300,000 but less than or equal to $350,000 deleted text end |
deleted text begin
$1,400 deleted text end |
|
|
deleted text begin
greater than $350,000 but less than or equal to $400,000 deleted text end |
deleted text begin
$1,600 deleted text end |
|
|
deleted text begin
greater than $400,000 but less than or equal to $450,000 deleted text end |
deleted text begin
$1,800 deleted text end |
|
|
deleted text begin
greater than $450,000 but less than or equal to $500,000 deleted text end |
deleted text begin
$2,000 deleted text end |
|
|
deleted text begin
greater than $500,000 but less than or equal to $600,000 deleted text end |
deleted text begin
$2,250 deleted text end |
|
|
deleted text begin
greater than $600,000 but less than or equal to $700,000 deleted text end |
deleted text begin
$2,500 deleted text end |
|
|
deleted text begin
greater than $700,000 but less than or equal to $800,000 deleted text end |
deleted text begin
$2,750 deleted text end |
|
|
deleted text begin
greater than $800,000 but less than or equal to $900,000 deleted text end |
deleted text begin
$3,000 deleted text end |
|
|
deleted text begin
greater than $900,000 but less than or equal to $1,000,000 deleted text end |
deleted text begin
$3,250 deleted text end |
|
|
deleted text begin
greater than $1,000,000 but less than or equal to $1,250,000 deleted text end |
deleted text begin
$3,500 deleted text end |
|
|
deleted text begin
greater than $1,250,000 but less than or equal to $1,500,000 deleted text end |
deleted text begin
$3,750 deleted text end |
|
|
deleted text begin
greater than $1,500,000 but less than or equal to $1,750,000 deleted text end |
deleted text begin
$4,000 deleted text end |
|
|
deleted text begin
greater than $1,750,000 but less than or equal to $2,000,000 deleted text end |
deleted text begin
$4,250 deleted text end |
|
|
deleted text begin
greater than $2,000,000 but less than or equal to $2,500,000 deleted text end |
deleted text begin
$4,500 deleted text end |
|
|
deleted text begin
greater than $2,500,000 but less than or equal to $3,000,000 deleted text end |
deleted text begin
$4,750 deleted text end |
|
|
deleted text begin
greater than $3,000,000 but less than or equal to $3,500,000 deleted text end |
deleted text begin
$5,000 deleted text end |
|
|
deleted text begin
greater than $3,500,000 but less than or equal to $4,000,000 deleted text end |
deleted text begin
$5,500 deleted text end |
|
|
deleted text begin
greater than $4,000,000 but less than or equal to $4,500,000 deleted text end |
deleted text begin
$6,000 deleted text end |
|
|
deleted text begin
greater than $4,500,000 but less than or equal to $5,000,000 deleted text end |
deleted text begin
$6,500 deleted text end |
|
|
deleted text begin
greater than $5,000,000 but less than or equal to $7,500,000 deleted text end |
deleted text begin
$7,000 deleted text end |
|
|
deleted text begin
greater than $7,500,000 but less than or equal to $10,000,000 deleted text end |
deleted text begin
$8,500 deleted text end |
|
|
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greater than $10,000,000 but less than or equal to $12,500,000 deleted text end |
deleted text begin
$10,000 deleted text end |
|
|
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greater than $12,500,000 but less than or equal to $15,000,000 deleted text end |
deleted text begin
$14,000 deleted text end |
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|
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greater than $15,000,000 deleted text end |
deleted text begin
$18,000 deleted text end |
(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.
deleted text begin
(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end A license holder that knowingly provides the commissioner incorrect revenue
amounts for the purpose of paying a lower license fee shall be subject to a civil penalty in
the amount of double the fee the provider should have paid.
deleted text begin
(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).
deleted text end
new text begin
(4) The commissioner shall calculate the licensing fee for a provider of home and
community-based services and supports under this paragraph and invoice the license holder
annually. If the license holder challenges the fee amount invoiced, the commissioner shall
provide the license holder with a report identifying the medical assistance claims paid by
the commissioner to the license holder that formed the basis for the licensing fee calculation.
new text end
(c) A chemical dependency treatment program licensed under Minnesota Rules, parts
9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an annual
nonrefundable license fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$600 |
|
| 25 to 49 persons |
$800 |
|
| 50 to 74 persons |
$1,000 |
|
| 75 to 99 persons |
$1,200 |
|
| 100 or more persons |
$1,400 |
(d) A chemical dependency program licensed under Minnesota Rules, parts 9530.6510
to 9530.6590, to provide detoxification services shall pay an annual nonrefundable license
fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$760 |
|
| 25 to 49 persons |
$960 |
|
| 50 or more persons |
$1,160 |
(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$1,000 |
|
| 25 to 49 persons |
$1,100 |
|
| 50 to 74 persons |
$1,200 |
|
| 75 to 99 persons |
$1,300 |
|
| 100 or more persons |
$1,400 |
(f) A residential facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670,
to serve persons with mental illness shall pay an annual nonrefundable license fee based on
the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$2,525 |
|
| 25 or more persons |
$2,725 |
(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$450 |
|
| 25 to 49 persons |
$650 |
|
| 50 to 74 persons |
$850 |
|
| 75 to 99 persons |
$1,050 |
|
| 100 or more persons |
$1,250 |
(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.
(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.
(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$500 |
|
| 25 to 49 persons |
$700 |
|
| 50 to 74 persons |
$900 |
|
| 75 to 99 persons |
$1,100 |
|
| 100 or more persons |
$1,300 |
(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.
(l) A mental health center or mental health clinic requesting certification for purposes
of insurance and subscriber contract reimbursement under Minnesota Rules, parts 9520.0750
to 9520.0870, shall pay a certification fee of $1,550 per year. If the mental health center or
mental health clinic provides services at a primary location with satellite facilities, the
satellite facilities shall be certified with the primary location without an additional charge.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 6.
Minnesota Statutes 2016, section 245A.14, is amended by adding a subdivision to
read:
new text begin Subd. 15. new text end
new text begin Parental access in child care programs. new text end
new text begin
An enrolled child's parent or legal
guardian must be allowed access to the parent's or legal guardian's child any time while the
child is in care.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 7.
Minnesota Statutes 2016, section 245A.151, is amended to read:
245A.151 FIRE MARSHAL INSPECTION.
When licensure under this chapter requires an inspection by a fire marshal to determine
compliance with the State Fire Code under section 299F.011, a local fire code inspector
deleted text begin approveddeleted text end new text begin trainednew text end by the state fire marshal may conduct the inspection. If a community does
not have a local fire code inspector or if the local fire code inspector does not perform the
inspection, the state fire marshal must conduct the inspection. A local fire code inspector
or the state fire marshal may recover the cost of these inspections through a fee of no more
than $50 per inspection charged to the applicant or license holder. The fees collected by the
state fire marshal under this section are appropriated to the commissioner of public safety
for the purpose of conducting the inspections.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 8.
Minnesota Statutes 2016, section 245A.16, subdivision 1, is amended to read:
Subdivision 1.
Delegation of authority to agencies.
(a) County agencies and private
agencies that have been designated or licensed by the commissioner to perform licensing
functions and activities under section 245A.04 and background studies for family child care
under chapter 245C; to recommend denial of applicants under section 245A.05; to issue
correction orders, to issue variances, and recommend a conditional license under section
245A.06; or to recommend suspending or revoking a license or issuing a fine under section
245A.07, shall comply with rules and directives of the commissioner governing those
functions and with this section. The following variances are excluded from the delegation
of variance authority and may be issued only by the commissioner:
(1) dual licensure of family child care and child foster care, dual licensure of child and
adult foster care, and adult foster care and family child care;
(2) adult foster care maximum capacity;
(3) adult foster care minimum age requirement;
(4) child foster care maximum age requirement;
(5) variances regarding disqualified individuals except thatnew text begin , before the implementation
of NETStudy 2.0,new text end county agencies may issue variances under section 245C.30 regarding
disqualified individuals when the county is responsible for conducting a consolidated
reconsideration according to sections 245C.25 and 245C.27, subdivision 2, clauses (a) and
(b), of a county maltreatment determination and a disqualification based on serious or
recurring maltreatment;
(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours; and
(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holder.
Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency must
not grant a license holder a variance to exceed the maximum allowable family child care
license capacity of 14 children.
(b) new text begin Before the implementation of NETStudy 2.0, new text end county agencies must report information
about disqualification reconsiderations under sections 245C.25 and 245C.27, subdivision
2, paragraphs (a) and (b), and variances granted under paragraph (a), clause (5), to the
commissioner at least monthly in a format prescribed by the commissioner.
(c) For family deleted text begin daydeleted text end new text begin childnew text end care programs, the commissioner deleted text begin may authorizedeleted text end new text begin shall require
a county agency to conduct one unannouncednew text end licensing deleted text begin reviews every two years after a
licensee has had at least one annualdeleted text end reviewnew text begin at least annuallynew text end .
(d) For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.
(e) A license issued under this section may be issued for up to two years.
(f) During implementation of chapter 245D, the commissioner shall consider:
(1) the role of counties in quality assurance;
(2) the duties of county licensing staff; and
(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.
Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.
(g) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county and
private agencies.
new text begin
(h) A county agency shall report to the commissioner, in a manner prescribed by the
commissioner, the following information for a licensed family child care program:
new text end
new text begin
(1) the results of each licensing review completed, including the date of the review, any
licensing correction order issued; and
new text end
new text begin
(2) any death, serious injury, or determination of substantiated maltreatment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 9.
Minnesota Statutes 2016, section 245A.16, is amended by adding a subdivision to
read:
new text begin Subd. 7. new text end
new text begin Family child care licensing oversight. new text end
new text begin
(a) Only county staff trained by the
commissioner on the family child care licensing standards in this chapter and Minnesota
Rules, chapter 9502, shall perform family child care licensing functions under subdivision
1. Training must occur within 90 days of a staff person's employment.
new text end
new text begin
(b) The commissioner shall consult with county agencies to develop a formula to allocate
county family child care licensing grant funding.
new text end
new text begin
(c) If a county fails to perform the family child care licensing functions of this section,
the commissioner may reduce or delay the county's licensing grant payment until compliance
is achieved.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 10.
Minnesota Statutes 2016, section 245A.40, subdivision 1, is amended to read:
Subdivision 1.
Orientation.
The child care center license holder must ensure that every
staff person and volunteer is given orientation training and successfully completes the
training before starting assigned duties. The orientation training in this subdivision applies
to volunteers who will have direct contact with or access to children and who are not under
the direct supervision of a staff person. Completion of the orientation must be documented
in the individual's personnel record. The orientation training must include information about:
(1) the center's philosophy, child care program, and procedures for maintaining health
and safetynew text begin according to section 245A.41 and Minnesota Rules, part 9503.0140,new text end and handling
emergencies and accidentsnew text begin according to Minnesota Rules, part 9503.0110new text end ;
(2) specific job responsibilities;
(3) the behavior guidance standards in Minnesota Rules, part 9503.0055; and
(4) the reporting responsibilities in section 626.556, and Minnesota Rules, part 9503.0130.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 11.
Minnesota Statutes 2016, section 245A.40, subdivision 2, is amended to read:
Subd. 2.
Child deleted text begin growth anddeleted text end developmentnew text begin and learningnew text end training.
(a) For purposes of
child care centers, the director and all staff hired after July 1, 2006, shall complete and
document at least two hours of child deleted text begin growth anddeleted text end developmentnew text begin and learningnew text end training within
the first year of employment. For purposes of this subdivision, "child deleted text begin growth anddeleted text end developmentnew text begin
and learningnew text end training" means training in understanding how children deleted text begin acquire language anddeleted text end
develop physically, cognitively, emotionally, and sociallynew text begin and learn as part of the children's
family, culture, and communitynew text end . Training completed under this subdivision may be used to
meet deleted text begin the orientation training requirements under subdivision 1 anddeleted text end the in-service training
requirements under subdivision 7.
(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if they:
(1) have taken a three-credit college course on early childhood development within the
past five years;
(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;
(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or
(4) have received a baccalaureate degree with a Montessori certificate within the past
five years.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 12.
Minnesota Statutes 2016, section 245A.40, subdivision 3, is amended to read:
Subd. 3.
First aid.
(a) All teachers and assistant teachers in a child care center governed
by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least one staff person during
field trips and when transporting children in care, must satisfactorily complete first aid
training within 90 days of the start of work, unless the training has been completed within
the previous deleted text begin threedeleted text end new text begin twonew text end years.
(b) Notwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed first aid training must be present at all
times in the center, during field trips, and when transporting children in care.
(c) The first aid training must be repeated at least every deleted text begin threedeleted text end new text begin twonew text end years, documented in
the person's personnel record and indicated on the center's staffing chart, and provided by
an individual approved as a first aid instructor. This training may be less than eight hours.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 13.
Minnesota Statutes 2016, section 245A.40, subdivision 4, is amended to read:
Subd. 4.
Cardiopulmonary resuscitation.
(a) All teachers and assistant teachers in a
child care center governed by Minnesota Rules, parts 9503.0005 to 9503.0170, and at least
one staff person during field trips and when transporting children in care, must satisfactorily
complete training in cardiopulmonary resuscitation (CPR) that includes CPR techniques
for infants and children and in the treatment of obstructed airways. The CPR training must
be completed within 90 days of the start of work, unless the training has been completed
within the previous deleted text begin threedeleted text end new text begin twonew text end years. The CPR training must have been provided by an
individual approved to provide CPR instruction, must be repeated at least once every deleted text begin threedeleted text end new text begin
twonew text end years, and must be documented in the staff person's records.
(b) Notwithstanding paragraph (a), which allows 90 days to complete training, at least
one staff person who has satisfactorily completed cardiopulmonary resuscitation training
must be present at all times in the center, during field trips, and when transporting children
in care.
(c) CPR training may be provided for less than four hours.
(d) Persons providing CPR training must use CPR training that has been developed:
(1) by the American Heart Association or the American Red Cross and incorporates
psychomotor skills to support the instruction; or
(2) using nationally recognized, evidence-based guidelines for CPR and incorporates
psychomotor skills to support the instruction.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 14.
Minnesota Statutes 2016, section 245A.40, subdivision 7, is amended to read:
Subd. 7.
In-service.
(a) A license holder must ensure that deleted text begin an annual in-service training
plan is developed and carried out and that it meets the requirements in clauses (1) to (7).
The in-service training plan must:deleted text end new text begin the center director and all staff who have direct contact
with a child complete annual in-service training. In-service training requirements must be
met by a staff person's participation in the following training areas:
new text end
deleted text begin
(1) be consistent with the center's child care program plan;
deleted text end
deleted text begin
(2) meet the training needs of individual staff persons as specified in each staff person's
annual evaluation report;
deleted text end
deleted text begin
(3) provide training, at least one-fourth of which is by a resource not affiliated with the
license holder;
deleted text end
deleted text begin
(4) include Minnesota Rules, parts 9503.0005 to 9503.0170, relevant to the staff person's
position and must occur within two weeks of initial employment;
deleted text end
deleted text begin
(5) provide that at least one-half of the annual in-service training completed by a staff
person each year pertains to the age of children for which the person is providing care;
deleted text end
deleted text begin
(6) provide that no more than four hours of each annual in-service training requirement
relate to administration, finances, and records training for a teacher, assistant teacher, or
aide; and
deleted text end
deleted text begin
(7) provide that the remainder of the in-service training requirement be met by
participation in training in child growth and development; learning environment and
curriculum; assessment and planning for individual needs; interactions with children; families
and communities; health, safety, and nutrition; and program planning and evaluation.
deleted text end
new text begin
(1) child development and learning;
new text end
new text begin
(2) developmentally appropriate learning experiences;
new text end
new text begin
(3) relationships with families;
new text end
new text begin
(4) assessment, evaluation, and individualization;
new text end
new text begin
(5) historical and contemporary development of early childhood education;
new text end
new text begin
(6) professionalism; and
new text end
new text begin
(7) health, safety, and nutrition.
new text end
(b) For purposes of this subdivision, the following terms have the meanings given them.
(1) "Child deleted text begin growth anddeleted text end developmentnew text begin and learningnew text end training" has the meaning given it in
subdivision 2, paragraph (a).
deleted text begin
(2) "Learning environment and curriculum" means training in establishing an environment
that provides learning experiences to meet each child's needs, capabilities, and interests,
including early childhood education methods or theory, recreation, sports, promoting
creativity in the arts, arts and crafts methods or theory, and early childhood special education
methods or theory.
deleted text end
deleted text begin
(3) "Assessment and planning for individual needs" means training in observing and
assessing what children know and can do in order to provide curriculum and instruction
that addresses their developmental and learning needs, including children with special needs.
deleted text end
deleted text begin
(4) "Interactions with children" means training in establishing supportive relationships
with children and guiding them as individuals and as part of a group, including child study
techniques and behavior guidance.
deleted text end
deleted text begin
(5) "Families and communities" means training in working collaboratively with families,
agencies, and organizations to meet children's needs and to encourage the community's
involvement, including family studies and parent involvement.
deleted text end
deleted text begin
(6) "Health, safety, and nutrition" means training in establishing and maintaining an
environment that ensures children's health, safety, and nourishment, including first aid,
cardiopulmonary resuscitation, child nutrition, and child abuse and neglect prevention.
deleted text end
deleted text begin
(7) "Program planning and evaluation" means training in establishing, implementing,
evaluating, and enhancing program operations.
deleted text end
new text begin
(2) "Developmentally appropriate learning experiences" means creating positive learning
experiences, promoting cognitive development, promoting social and emotional development,
promoting physical development, and promoting creative development.
new text end
new text begin
(3) "Relationships with families" means training on building a positive, respectful
relationship with the child's family.
new text end
new text begin
(4) "Assessment, evaluation, and individualization" means training in observing,
recording, and assessing development; assessing and using information to plan; and assessing
and using information to enhance and maintain program quality.
new text end
new text begin
(5) "Historical and contemporary development of early childhood education" means
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs.
new text end
new text begin
(6) "Professionalism" means training in knowledge, skills, and abilities that promote
ongoing professional development.
new text end
new text begin
(7) "Health, safety, and nutrition" means training in establishing health practices, ensuring
safety, and providing healthy nutrition.
new text end
(c) The director and all program staff persons must annually complete a number of hours
of in-service training equal to at least two percent of the hours for which the director or
program staff person is annually paid, unless one of the following is applicable.
(1) A teacher at a child care center must complete one percent of working hours of
in-service training annually if the teacher:
(i) possesses a baccalaureate or master's degree in early childhood education or school-age
care;
(ii) is licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to sixth grade teacher with a prekindergarten specialty, an early childhood
special education teacher, or an elementary teacher with a kindergarten endorsement; or
(iii) possesses a baccalaureate degree with a Montessori certificate.
(2) A teacher or assistant teacher at a child care center must complete one and one-half
percent of working hours of in-service training annually if the individual is:
(i) a registered nurse or licensed practical nurse with experience working with infants;
(ii) possesses a Montessori certificate, a technical college certificate in early childhood
development, or a child development associate certificate; or
(iii) possesses an associate of arts degree in early childhood education, a baccalaureate
degree in child development, or a technical college diploma in early childhood development.
(d) The number of required training hours may be prorated for individuals not employed
full time or for an entire year.
(e) The annual in-service training must be completed within the calendar year for which
it was required. In-service training completed by staff persons is transferable upon a staff
person's change in employment to another child care program.
(f) The license holder must ensure that, when a staff person completes in-service training,
the training is documented in the staff person's personnel record. The documentation must
include the date training was completed, the goal of the training and topics covered, trainer's
name and organizational affiliation, trainer's signed statement that training was successfully
completed, and the director's approval of the training.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 15.
Minnesota Statutes 2016, section 245A.40, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Ongoing health and safety training. new text end
new text begin
A staff person's orientation training on
maintaining health and safety and handling emergencies and accidents, as required in
subdivision 1, must be repeated at least once each calendar year by each staff person. The
completion of the annual training must be documented in the staff person's personnel record.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 16.
new text begin
[245A.41] CHILD CARE CENTER HEALTH AND SAFETY
REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Allergy prevention and response. new text end
new text begin
(a) Before admitting a child for care,
the license holder must obtain documentation of any known allergy from the child's parent
or legal guardian or the child's source of medical care. If a child has a known allergy, the
license holder must maintain current information about the allergy in the child's record and
develop an individual child care program plan as specified in Minnesota Rules, part
9503.0065, subpart 3. The individual child care program plan must include but not be limited
to a description of the allergy, specific triggers, avoidance techniques, symptoms of an
allergic reaction, and procedures for responding to an allergic reaction, including medication,
dosages, and a doctor's contact information.
new text end
new text begin
(b) The license holder must ensure that each staff person who is responsible for carrying
out the individual child care program plan review and follow the plan. Documentation of a
staff person's review must be kept on site.
new text end
new text begin
(c) At least annually or following any changes made to allergy-related information in
the child's record, the license holder must update the child's individual child care program
plan and inform each staff person who is responsible for carrying out the individual child
care program plan of the change. The license holder must keep on site documentation that
a staff person was informed of a change.
new text end
new text begin
(d) A child's allergy information must be available at all times including on site, when
on field trips, or during transportation. A child's food allergy information must be readily
available to a staff person in the area where food is prepared and served to the child.
new text end
new text begin
(e) The license holder must contact the child's parent or legal guardian as soon as possible
in any instance of exposure or allergic reaction that requires medication or medical
intervention. The license holder must call emergency medical services when epinephrine
is administered to a child in the license holder's care.
new text end
new text begin Subd. 2. new text end
new text begin Handling and disposal of bodily fluids. new text end
new text begin
The licensed child care center must
comply with the following procedures for safely handling and disposing of bodily fluids:
new text end
new text begin
(1) surfaces that come in contact with potentially infectious bodily fluids, including
blood and vomit, must be cleaned and disinfected according to Minnesota Rules, part
9503.0005, subpart 11;
new text end
new text begin
(2) blood-contaminated material must be disposed of in a plastic bag with a secure tie;
new text end
new text begin
(3) sharp items used for a child with special care needs must be disposed of in a "sharps
container." The sharps container must be stored out of reach of a child;
new text end
new text begin
(4) the license holder must have the following bodily fluid disposal supplies in the center:
disposable gloves, disposal bags, and eye protection; and
new text end
new text begin
(5) the license holder must ensure that each staff person is trained on universal precautions
to reduce the risk of spreading infectious disease. A staff person's completion of the training
must be documented in the staff person's personnel record.
new text end
new text begin Subd. 3. new text end
new text begin Emergency preparedness. new text end
new text begin
(a) No later than September 30, 2017, a licensed
child care center must have a written emergency plan for emergencies that require evacuation,
sheltering, or other protection of a child, such as fire, natural disaster, intruder, or other
threatening situation that may pose a health or safety hazard to a child. The plan must be
written on a form developed by the commissioner and must include:
new text end
new text begin
(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;
new text end
new text begin
(2) a designated relocation site and evacuation route;
new text end
new text begin
(3) procedures for notifying a child's parent or legal guardian of the evacuation, relocation,
shelter-in-place, or lockdown, including procedures for reunification with families;
new text end
new text begin
(4) accommodations for a child with a disability or a chronic medical condition;
new text end
new text begin
(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;
new text end
new text begin
(6) procedures for continuing operations in the period during and after a crisis; and
new text end
new text begin
(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authorities.
new text end
new text begin
(b) The license holder must train staff persons on the emergency plan at orientation,
when changes are made to the plan, and at least once each calendar year. Training must be
documented in each staff person's personnel file.
new text end
new text begin
(c) The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9503.0110, subpart 3. The date and time of the drills must be documented.
new text end
new text begin
(d) The license holder must review and update the emergency plan annually.
Documentation of the annual emergency plan review shall be maintained in the program's
administrative records.
new text end
new text begin
(e) The license holder must include the emergency plan in the program's policies and
procedures as specified under section 245A.04, subdivision 14. The license holder must
provide a physical or electronic copy of the emergency plan to the child's parent or legal
guardian upon enrollment.
new text end
new text begin
(f) The relocation site and evacuation route must be posted in a visible place as part of
the written procedures for emergencies and accidents in Minnesota Rules, part 9503.0140,
subpart 21.
new text end
Sec. 17.
Minnesota Statutes 2016, section 245A.50, subdivision 2, is amended to read:
Subd. 2.
Child deleted text begin growth anddeleted text end developmentnew text begin and learningnew text end and behavior guidance
training.
(a) For purposes of family and group family child care, the license holder and
each adult caregiver who provides care in the licensed setting for more than 30 days in any
12-month period shall complete and document at least four hours of child growth and
deleted text begin developmentdeleted text end new text begin learningnew text end and behavior guidance training prior to initial licensure, and before
caring for children. For purposes of this subdivision, "child deleted text begin growth anddeleted text end developmentnew text begin and
learningnew text end training" means training in understanding how children deleted text begin acquire language anddeleted text end
develop physically, cognitively, emotionally, and sociallynew text begin and learn as part of the children's
family, culture, and communitynew text end . "Behavior guidance training" means training in the
understanding of the functions of child behavior and strategies for managing challenging
situations. new text begin At least two hours of new text end child deleted text begin growth anddeleted text end development andnew text begin learning ornew text end behavior
guidance training must be repeated annually. Training curriculum shall be developed or
approved by the commissioner of human services deleted text begin by January 1, 2014deleted text end .
(b) Notwithstanding paragraph (a), individuals are exempt from this requirement if they:
(1) have taken a three-credit course on early childhood development within the past five
years;
(2) have received a baccalaureate or master's degree in early childhood education or
school-age child care within the past five years;
(3) are licensed in Minnesota as a prekindergarten teacher, an early childhood educator,
a kindergarten to grade 6 teacher with a prekindergarten specialty, an early childhood special
education teacher, or an elementary teacher with a kindergarten endorsement; or
(4) have received a baccalaureate degree with a Montessori certificate within the past
five years.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 18.
Minnesota Statutes 2016, section 245A.50, subdivision 7, is amended to read:
Subd. 7.
Training requirements for family and group family child care.
For purposes
of family and group family child care, the license holder and each primary caregiver must
complete 16 hours of ongoing training each year. For purposes of this subdivision, a primary
caregiver is an adult caregiver who provides services in the licensed setting for more than
30 days in any 12-month period. Repeat of topical training requirements in subdivisions 2
to 8 shall count toward the annual 16-hour training requirement. Additional ongoing training
subjects to meet the annual 16-hour training requirement must be selected from the following
areas:
(1) child deleted text begin growth anddeleted text end developmentnew text begin and learningnew text end training under subdivision 2, paragraph
(a);
deleted text begin
(2) learning environment and curriculum, including training in establishing an
environment and providing activities that provide learning experiences to meet each child's
needs, capabilities, and interests;
deleted text end
deleted text begin
(3) assessment and planning for individual needs, including training in observing and
assessing what children know and can do in order to provide curriculum and instruction
that addresses their developmental and learning needs, including children with special needs
and bilingual children or children for whom English is not their primary language;
deleted text end
deleted text begin
(4) interactions with children, including training in establishing supportive relationships
with children, guiding them as individuals and as part of a group;
deleted text end
deleted text begin
(5) families and communities, including training in working collaboratively with families
and agencies or organizations to meet children's needs and to encourage the community's
involvement;
deleted text end
deleted text begin
(6) health, safety, and nutrition, including training in establishing and maintaining an
environment that ensures children's health, safety, and nourishment, including child abuse,
maltreatment, prevention, and reporting; home and fire safety; child injury prevention;
communicable disease prevention and control; first aid; and CPR;
deleted text end
deleted text begin
(7) program planning and evaluation, including training in establishing, implementing,
evaluating, and enhancing program operations; and
deleted text end
deleted text begin
(8) behavior guidance, including training in the understanding of the functions of child
behavior and strategies for managing behavior.
deleted text end
new text begin
(2) developmentally appropriate learning experiences, including training in creating
positive learning experiences, promoting cognitive development, promoting social and
emotional development, promoting physical development, promoting creative development;
and behavior guidance;
new text end
new text begin
(3) relationships with families, including training in building a positive, respectful
relationship with the child's family;
new text end
new text begin
(4) assessment, evaluation, and individualization, including training in observing,
recording, and assessing development; assessing and using information to plan; and assessing
and using information to enhance and maintain program quality;
new text end
new text begin
(5) historical and contemporary development of early childhood education, including
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs;
new text end
new text begin
(6) professionalism, including training in knowledge, skills, and abilities that promote
ongoing professional development; and
new text end
new text begin
(7) health, safety, and nutrition, including training in establishing healthy practices;
ensuring safety; and providing healthy nutrition.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 19.
Minnesota Statutes 2016, section 245A.50, subdivision 9, is amended to read:
Subd. 9.
Supervising for safety; training requirement.
deleted text begin Effective July 1, 2014deleted text end new text begin (a)
Before initial licensure and before caring for a childnew text end , all family child care license holders
and each adult caregiver who provides care in the licensed family child care home for more
than 30 days in any 12-month period shall complete and document deleted text begin at least six hours of
approved training on supervising for safety prior to initial licensure, and before caring for
children. At least two hours of training on supervising for safety must be repeated annually.
For purposes of this subdivision, "supervising for safety" includes supervision basics,
supervision outdoors, equipment and materials, illness, injuries, and disaster preparedness.
The commissioner shall develop the supervising for safety curriculum by January 1, 2014.deleted text end new text begin
the completion of the six-hour Supervising for Safety for Family Child Care course developed
by the commissioner.
new text end
new text begin
(b) The family child care license holder and each adult caregiver who provides care in
the licensed family child care home for more than 30 days in any 12-month period shall
complete and document:
new text end
new text begin
(1) the annual completion of a two-hour active supervision course developed by the
commissioner; and
new text end
new text begin
(2) the completion at least once every five years of the two-hour courses Health and
Safety I and Health and Safety II. A license holder's or adult caregiver's completion of each
of these trainings meets the annual active supervision training requirement in clause (1).
new text end
Sec. 20.
new text begin
[245A.51] FAMILY CHILD CARE HEALTH AND SAFETY
REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Allergy prevention and response. new text end
new text begin
(a) Before admitting a child for care,
the license holder must obtain information about any known allergy from the child's parent
or legal guardian. The license holder must maintain current allergy information in each
child's record. The allergy information must include a description of the allergy, specific
triggers, avoidance techniques, symptoms of an allergic reaction, and procedures for
responding to an allergic reaction, including medication, dosages, and a doctor's contact
information.
new text end
new text begin
(b) The child's allergy information must be documented on a form approved by the
commissioner, readily available to all caregivers, and reviewed annually by the license
holder and each caregiver.
new text end
new text begin Subd. 2. new text end
new text begin Handling and disposal of bodily fluids. new text end
new text begin
The licensed family child care provider
must comply with the following procedures for safely handling and disposing of bodily
fluids:
new text end
new text begin
(1) surfaces that come in contact with potentially infectious bodily fluids, including
blood and vomit, must be cleaned and disinfected as described in section 245A.148;
new text end
new text begin
(2) blood-contaminated material must be disposed of in a plastic bag with a secure tie;
new text end
new text begin
(3) sharp items used for a child with special care needs must be disposed of in a "sharps
container." The sharps container must be stored out of reach of a child; and
new text end
new text begin
(4) the license holder must have the following bodily fluid disposal supplies available:
disposable gloves, disposal bags, and eye protection.
new text end
new text begin Subd. 3. new text end
new text begin Emergency preparedness plan. new text end
new text begin
(a) No later than September 30, 2017, a
licensed family child care provider must have a written emergency preparedness plan for
emergencies that require evacuation, sheltering, or other protection of children, such as fire,
natural disaster, intruder, or other threatening situation that may pose a health or safety
hazard to children. The plan must be written on a form developed by the commissioner and
updated at least annually. The plan must include:
new text end
new text begin
(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;
new text end
new text begin
(2) a designated relocation site and evacuation route;
new text end
new text begin
(3) procedures for notifying a child's parent or legal guardian of the evacuation,
shelter-in-place, or lockdown, including procedures for reunification with families;
new text end
new text begin
(4) accommodations for a child with a disability or a chronic medical condition;
new text end
new text begin
(5) procedures for storing a child's medically necessary medicine that facilitate easy
removal during an evacuation or relocation;
new text end
new text begin
(6) procedures for continuing operations in the period during and after a crisis; and
new text end
new text begin
(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authorities.
new text end
new text begin
(b) The license holder must train caregivers before the caregiver provides care and at
least annually on the emergency preparedness plan and document completion of this training.
new text end
new text begin
(c) The license holder must conduct drills according to the requirements in Minnesota
Rules, part 9502.0435, subpart 8. The date and time of the drills must be documented.
new text end
new text begin
(d) The license holder must have the emergency preparedness plan available for review
and posted in a prominent location. The license holder must provide a physical or electronic
copy of the plan to the child's parent or legal guardian upon enrollment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 21.
Minnesota Statutes 2016, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Child care staff person. new text end
new text begin
"Child care staff person" means an individual other
than an individual who is related to all children for whom child care services are provided
and:
new text end
new text begin
(1) who is employed by a child care provider for compensation;
new text end
new text begin
(2) whose activities involve the care or supervision of a child for a child care provider
or unsupervised access to a child who is cared for or supervised by a child care provider;
or
new text end
new text begin
(3) an individual 13 years of age or older residing in a licensed family child care home
or legal nonlicensed child care program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 22.
Minnesota Statutes 2016, section 245C.03, subdivision 1, is amended to read:
Subdivision 1.
Licensed programs.
(a) The commissioner shall conduct a background
study on:
(1) the person or persons applying for a license;
(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;
(3) current or prospective employees or contractors of the applicant who will have direct
contact with persons served by the facility, agency, or program;
(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);
(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause;
(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause; deleted text begin and
deleted text end
(7) all deleted text begin managerial officialsdeleted text end new text begin controlling individualsnew text end as defined deleted text begin underdeleted text end new text begin innew text end section 245A.02,
subdivision 5adeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) child care staff persons as defined in section 245C.02, subdivision 6a.
new text end
new text begin
(b) Paragraph (a), clauses (5) and (6), apply to legal nonlicensed child care and certified
license-exempt child care programs.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end For family child foster care settings, a short-term substitute caregiver providing
direct contact services for a child for less than 72 hours of continuous care is not required
to receive a background study under this chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective when the Department of Human Services
implements NETStudy 2.0 or October 1, 2017, whichever is later. The commissioner of
human services shall notify the revisor of statutes when the department implements
NETStudy 2.0.
new text end
Sec. 23.
Minnesota Statutes 2016, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 6a. new text end
new text begin Legal nonlicensed and certified child care programs. new text end
new text begin
The commissioner
shall conduct background studies on an individual required under sections 119B.125 and
245G.10 to complete a background study under this chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 24.
Minnesota Statutes 2016, section 245C.04, subdivision 1, is amended to read:
Subdivision 1.
Licensed programsnew text begin ; other child care programsnew text end .
(a) The commissioner
shall conduct a background study of an individual required to be studied under section
245C.03, subdivision 1, at least upon application for initial license for all license types.
(b) The commissioner shall conduct a background study of an individual required to be
studied under section 245C.03, subdivision 1,new text begin including a child care staff person as defined
in section 245C.02, subdivision 6a, in a family child care program, licensed child care center,
certified license-exempt child care center, or legal nonlicensed child care provider, on a
schedule determined by the commissioner. The background study must include submission
of fingerprints for a national criminal history record check and a review of the information
under section 245C.08. A background study for a child care program must be repeated
within five years from the most recent study conducted under this paragraph.
new text end
new text begin (c)new text end At reapplication deleted text begin for a licensedeleted text end for new text begin a new text end family child caredeleted text begin .deleted text end new text begin license:
new text end
new text begin
(1) for a background study affiliated with a licensed family child care center or legal
nonlicensed child care provider, the individual shall provide information required under
section 245C.05, subdivision 1, paragraphs (a), (b), and (d), to the county agency, and be
fingerprinted and photographed under section 245C.05, subdivision 5;
new text end
new text begin
(2) the county agency shall verify the information received under clause (1) and forward
the information to the commissioner to complete the background study; and
new text end
new text begin
(3) the background study conducted by the commissioner under this paragraph must
include a review of the information required under section 245C.08.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The commissioner is not required to conduct a study of an individual at the time
of reapplication for a license if the individual's background study was completed by the
commissioner of human services and the following conditions are met:
(1) a study of the individual was conducted either at the time of initial licensure or when
the individual became affiliated with the license holder;
(2) the individual has been continuously affiliated with the license holder since the last
study was conducted; and
(3) the last study of the individual was conducted on or after October 1, 1995.
deleted text begin (d)deleted text end new text begin (e)new text end The commissioner of human services shall conduct a background study of an
individual specified under section 245C.03, subdivision 1, paragraph (a), clauses (2) to (6),
who is newly affiliated with a child foster care license holder. The county or private agency
shall collect and forward to the commissioner the information required under section 245C.05,
subdivisions 1 and 5. The background study conducted by the commissioner of human
services under this paragraph must include a review of the information required under
section 245C.08, subdivisions 1, 3, and 4.
deleted text begin (e)deleted text end new text begin (f)new text end The commissioner shall conduct a background study of an individual specified
under section 245C.03, subdivision 1, paragraph (a), clauses (2) to (6), who is newly affiliated
with an adult foster care or family adult day servicesnew text begin and with a family child carenew text end license
holdernew text begin or a legal nonlicensed child care provider authorized under chapter 119Bnew text end : (1) the
county shall collect and forward to the commissioner the information required under section
245C.05, subdivision 1, paragraphs (a) and (b), and subdivision 5, paragraphs (a) deleted text begin anddeleted text end new text begin ,new text end (b),new text begin
and (d),new text end for background studies conducted by the commissioner for all family adult day
services deleted text begin anddeleted text end new text begin ,new text end for adult foster care when the adult foster care license holder resides in the
adult foster care residencenew text begin , and for family child care and legal nonlicensed child care
authorized under chapter 119Bnew text end ; (2) the license holder shall collect and forward to the
commissioner the information required under section 245C.05, subdivisions 1, paragraphs
(a) and (b); and 5, paragraphs (a) and (b), for background studies conducted by the
commissioner for adult foster care when the license holder does not reside in the adult foster
care residence; and (3) the background study conducted by the commissioner under this
paragraph must include a review of the information required under section 245C.08,
subdivision 1, paragraph (a), and subdivisions 3 and 4.
deleted text begin (f)deleted text end new text begin (g)new text end Applicants for licensure, license holders, and other entities as provided in this
chapter must submit completed background study requests to the commissioner using the
electronic system known as NETStudy before individuals specified in section 245C.03,
subdivision 1, begin positions allowing direct contact in any licensed program.
deleted text begin (g)deleted text end new text begin (h)new text end For an individual who is not on the entity's active roster, the entity must initiate
a new background study through NETStudy when:
(1) an individual returns to a position requiring a background study following an absence
of 120 or more consecutive days; or
(2) a program that discontinued providing licensed direct contact services for 120 or
more consecutive days begins to provide direct contact licensed services again.
The license holder shall maintain a copy of the notification provided to the commissioner
under this paragraph in the program's files. If the individual's disqualification was previously
set aside for the license holder's program and the new background study results in no new
information that indicates the individual may pose a risk of harm to persons receiving
services from the license holder, the previous set-aside shall remain in effect.
deleted text begin (h)deleted text end new text begin (i)new text end For purposes of this section, a physician licensed under chapter 147 is considered
to be continuously affiliated upon the license holder's receipt from the commissioner of
health or human services of the physician's background study results.
deleted text begin (i)deleted text end new text begin (j)new text end For purposes of family child care, a substitute caregiver must receive repeat
background studies at the time of each license renewal.
new text begin
(k) A repeat background study at the time of license renewal is not required if the family
child care substitute caregiver's background study was completed by the commissioner on
or after October 1, 2017, and the substitute caregiver is on the license holder's active roster
in NETStudy 2.0.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 25.
Minnesota Statutes 2016, section 245C.04, subdivision 8, is amended to read:
Subd. 8.
Current or prospective contractors serving multiple family child care
license holders.
new text begin (a) Before the implementation of NETStudy 2.0, new text end current or prospective
contractors who are required to have a background study under section 245C.03, subdivision
1, who provide services for multiple family child care license holders in a single county,
and will have direct contact with children served in the family child care setting are required
to have only one background study which is transferable to all family child care programs
in that county if:
(1) the county agency maintains a record of the contractor's background study results
which verify the contractor is approved to have direct contact with children receiving
services;
(2) the license holder contacts the county agency and obtains notice that the current or
prospective contractor is in compliance with background study requirements and approved
to have direct contact; and
(3) the contractor's background study is repeated every two years.
new text begin
(b) For a family child care license holder operating under NETStudy 2.0, the license
holder's active roster shall be the system used to document when a background study subject
is affiliated with the license holder.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 26.
Minnesota Statutes 2016, section 245C.05, subdivision 2b, is amended to read:
Subd. 2b.
County agency to collect and forward information to commissioner.
new text begin (a)
new text end For background studies related to all family adult day services and to adult foster care when
the adult foster care license holder resides in the adult foster care residence, the county
agency must collect the information required under subdivision 1 and forward it to the
commissioner.
new text begin
(b) Upon implementation of NETStudy 2.0, for background studies related to family
child care and legal nonlicensed child care authorized under chapter 119B, the county agency
must collect the information required under subdivision 1 and provide the information to
the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
Minnesota Statutes 2016, section 245C.05, subdivision 4, is amended to read:
Subd. 4.
Electronic transmission.
(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:
(1) background study information to the commissioner;
(2) background study results to the license holder;
(3) background study results to county and private agencies for background studies
conducted by the commissioner for child foster care; and
(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day servicesnew text begin and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119Bnew text end .
(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.
(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28.
Minnesota Statutes 2016, section 245C.05, subdivision 5, is amended to read:
Subd. 5.
Fingerprints and photograph.
(a) Before the implementation of NETStudy
2.0, except as provided in paragraph (c), for any background study completed under this
chapter, when the commissioner has reasonable cause to believe that further pertinent
information may exist on the subject of the background study, the subject shall provide the
commissioner with a set of classifiable fingerprints obtained from an authorized agency.
(b) Before the implementation of NETStudy 2.0, for purposes of requiring fingerprints,
the commissioner has reasonable cause when, but not limited to, the:
(1) information from the Bureau of Criminal Apprehension indicates that the subject is
a multistate offender;
(2) information from the Bureau of Criminal Apprehension indicates that multistate
offender status is undetermined; or
(3) commissioner has received a report from the subject or a third party indicating that
the subject has a criminal history in a jurisdiction other than Minnesota.
(c) Notwithstanding paragraph (d), for background studies conducted by the commissioner
for child foster care, adoptions, or a transfer of permanent legal and physical custody of a
child, the subject of the background study, who is 18 years of age or older, shall provide
the commissioner with a set of classifiable fingerprints obtained from an authorized agencynew text begin
for a national criminal history record checknew text end .
(d) For background studies initiated on or after the implementation of NETStudy 2.0,
every subject of a background study must provide the commissioner with a set of the
background study subject's classifiable fingerprints and photograph. The photograph and
fingerprints must be recorded at the same time by the commissioner's authorized fingerprint
collection vendor and sent to the commissioner through the commissioner's secure data
system described in section 245C.32, subdivision 1a, paragraph (b). The fingerprints shall
not be retained by the Department of Public Safety, Bureau of Criminal Apprehension, or
the commissioner, but will be retained by the Federal Bureau of Investigation. The
commissioner's authorized fingerprint collection vendor shall, for purposes of verifying the
identity of the background study subject, be able to view the identifying information entered
into NETStudy 2.0 by the entity that initiated the background study, but shall not retain the
subject's fingerprints, photograph, or information from NETStudy 2.0. The authorized
fingerprint collection vendor shall retain no more than the name and date and time the
subject's fingerprints were recorded and sent, only as necessary for auditing and billing
activities.
new text begin
(e) When specifically required by law, fingerprints collected under this section must be
submitted for a national criminal history record check.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 29.
Minnesota Statutes 2016, section 245C.05, subdivision 7, is amended to read:
Subd. 7.
Probation officer and corrections agent.
(a) A probation officer or corrections
agent shall notify the commissioner of an individual's conviction if the individual:
(1) has been affiliated with a program or facility regulated by the Department of Human
Services or Department of Health, a facility serving children or youth licensed by the
Department of Corrections, or any type of home care agency or provider of personal care
assistance services within the preceding year; and
(2) has been convicted of a crime constituting a disqualification under section 245C.14.
(b) For the purpose of this subdivision, "conviction" has the meaning given it in section
609.02, subdivision 5.
(c) The commissioner, in consultation with the commissioner of corrections, shall develop
forms and information necessary to implement this subdivision and shall provide the forms
and information to the commissioner of corrections for distribution to local probation officers
and corrections agents.
(d) The commissioner shall inform individuals subject to a background study that criminal
convictions for disqualifying crimes deleted text begin willdeleted text end new text begin shallnew text end be reported to the commissioner by the
corrections system.
(e) A probation officer, corrections agent, or corrections agency is not civilly or criminally
liable for disclosing or failing to disclose the information required by this subdivision.
(f) Upon receipt of disqualifying information, the commissioner shall provide the notice
required under section 245C.17, as appropriate, to agencies on record as having initiated a
background study or making a request for documentation of the background study status
of the individual.
(g) This subdivision does not apply to family child care programsnew text begin or legal nonlicensed
child care programs for individuals whose background study was completed in NETStudy
2.0new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 30.
Minnesota Statutes 2016, section 245C.08, subdivision 1, is amended to read:
Subdivision 1.
Background studies conducted by Department of Human Services.
(a) For a background study conducted by the Department of Human Services, the
commissioner shall review:
(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);
(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;
(3) information from juvenile courts as required in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;
(5) except as provided in clause (6), information deleted text begin from the national crime information
systemdeleted text end new text begin received as a result of submission of fingerprints for a national criminal history
record check,new text end when the commissioner has reasonable cause as defined under section 245C.05,
subdivision 5, or as required under section 144.057, subdivision 1, clause (2); deleted text begin and
deleted text end
(6) for a background study related to a child foster care application for licensure, a
transfer of permanent legal and physical custody of a child under sections 260C.503 to
260C.515, or adoptions,new text begin and for a background study required for family child care, certified
license-exempt child care, child care centers, and legal nonlicensed child care authorized
under chapter 119B,new text end the commissioner shall also review:
(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years; and
(ii) deleted text begin information from national crime information databases,deleted text end when the background study
subject is 18 years of age or olderdeleted text begin .deleted text end new text begin , information received following submission of fingerprints
for a national criminal history record check; and
new text end
new text begin
(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B. The background study shall also include a name and date-of-birth search of
the National Sex Offender Public Web site.
new text end
(b) Notwithstanding expungement by a court, the commissioner may consider information
obtained under paragraph (a), clauses (3) and (4), unless the commissioner received notice
of the petition for expungement and the court order for expungement is directed specifically
to the commissioner.
(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.
(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.
(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 31.
Minnesota Statutes 2016, section 245C.08, subdivision 2, is amended to read:
Subd. 2.
Background studies conducted by a county agencynew text begin for family child carenew text end .
(a) new text begin Before the implementation of NETStudy 2.0, new text end for a background study conducted by a
county agency for family child care services, the commissioner shall review:
(1) information from the county agency's record of substantiated maltreatment of adults
and the maltreatment of minors;
(2) information from juvenile courts as required in subdivision 4 for:
(i) individuals listed in section 245C.03, subdivision 1, paragraph (a), who are ages 13
through 23 living in the household where the licensed services will be provided; and
(ii) any other individual listed under section 245C.03, subdivision 1, when there is
reasonable cause; and
(3) information from the Bureau of Criminal Apprehension.
(b) If the individual has resided in the county for less than five years, the study shall
include the records specified under paragraph (a) for the previous county or counties of
residence for the past five years.
(c) Notwithstanding expungement by a court, the county agency may consider information
obtained under paragraph (a), clause (3), unless the commissioner received notice of the
petition for expungement and the court order for expungement is directed specifically to
the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 32.
Minnesota Statutes 2016, section 245C.08, subdivision 4, is amended to read:
Subd. 4.
Juvenile court records.
(a) For a background study conducted by the
Department of Human Services, the commissioner shall review records from the juvenile
courts for an individual studied under section 245C.03, subdivision 1, paragraph (a), when
the commissioner has reasonable cause.
(b) For a background study conducted by a county agencynew text begin for family child care before
the implementation of NETStudy 2.0new text end , the commissioner shall review records from the
juvenile courts for individuals listed in section 245C.03, subdivision 1, who are ages 13
through 23 living in the household where the licensed services will be provided. The
commissioner shall also review records from juvenile courts for any other individual listed
under section 245C.03, subdivision 1, when the commissioner has reasonable cause.
(c) The juvenile courts shall help with the study by giving the commissioner existing
juvenile court records relating to delinquency proceedings held on individuals described in
section 245C.03, subdivision 1, paragraph (a), when requested pursuant to this subdivision.
(d) For purposes of this chapter, a finding that a delinquency petition is proven in juvenile
court shall be considered a conviction in state district court.
(e) Juvenile courts shall provide orders of involuntary and voluntary termination of
parental rights under section 260C.301 to the commissioner upon request for purposes of
conducting a background study under this chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2016, section 245C.09, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin False statement in connection with a background study. new text end
new text begin
An individual shall
be disqualified for knowingly making a materially false statement in connection with a
background study.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 34.
Minnesota Statutes 2016, section 245C.10, subdivision 9, is amended to read:
Subd. 9.
Human services licensed programs.
The commissioner shall recover the cost
of background studies required under section 245C.03, subdivision 1, for all programs that
are licensed by the commissioner, except child foster care deleted text begin anddeleted text end new text begin for certified license-exempt
child care centers, licensed child care centers, and legal nonlicensed care authorized under
chapter 119B, and licensednew text end family child care, through a fee of no more than $20 per study
charged to the license holder. The fees collected under this subdivision are appropriated to
the commissioner for the purpose of conducting background studies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35.
Minnesota Statutes 2016, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 9a. new text end
new text begin Child care programs. new text end
new text begin
The commissioner shall recover the cost of a background
study required for family child care, certified license-exempt child care centers, licensed
child care centers, and legal nonlicensed child care providers authorized under chapter 119B
through a fee of no more than $30 per study charged to the license holder. The fees collected
under this subdivision are appropriated to the commissioner to conduct background studies.
new text end
Sec. 36.
Minnesota Statutes 2016, section 245C.11, subdivision 3, is amended to read:
Subd. 3.
Criminal history data.
County agencies shall have access to the criminal
history data in the same manner as county licensing agencies under this chapter for purposes
of background studies completednew text begin before the implementation of NETStudy 2.0new text end by county
agencies on legal nonlicensed child care providers to determine eligibility for child care
funds under chapter 119B.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 37.
Minnesota Statutes 2016, section 245C.15, is amended to read:
245C.15 DISQUALIFYING CRIMES OR CONDUCT.
Subdivision 1.
Permanent disqualification.
(a) An individual is disqualified under
section 245C.14 if: (1) regardless of how much time has passed since the discharge of the
sentence imposed, if any, for the offense; and (2) unless otherwise specified, regardless of
the level of the offense, the individual has committed any of the following offenses: sections
243.166 (violation of predatory offender registration law); 609.185 (murder in the first
degree); 609.19 (murder in the second degree); 609.195 (murder in the third degree); 609.20
(manslaughter in the first degree); 609.205 (manslaughter in the second degree); a felony
offense under 609.221 or 609.222 (assault in the first or second degree);new text begin a felony conviction
under section 609.223 or 609.2231 (assault in the third or fourth degree);new text end a felony offense
under sections 609.2242 and 609.2243 (domestic assault), spousal abuse, child abuse or
neglect, or a crime against children; 609.2247 (domestic assault by strangulation);new text begin any
conviction under section 609.224 or 609.2242 (assault in the fifth degree or domestic assault)
for an offense committed by an adult against a child;new text end 609.228 (great bodily harm caused by
distribution of drugs); 609.245 (aggravated robbery); 609.25 (kidnapping); 609.2661 (murder
of an unborn child in the first degree); 609.2662 (murder of an unborn child in the second
degree); 609.2663 (murder of an unborn child in the third degree);new text begin 609.282 (labor trafficking);new text end
609.322 (solicitation, inducement, and promotion of prostitution); 609.324, subdivision 1
(other prohibited acts); 609.342 (criminal sexual conduct in the first degree); 609.343
(criminal sexual conduct in the second degree); 609.344 (criminal sexual conduct in the
third degree); 609.345 (criminal sexual conduct in the fourth degree); 609.3451 (criminal
sexual conduct in the fifth degree); 609.3453 (criminal sexual predatory conduct); 609.352
(solicitation of children to engage in sexual conduct); 609.365 (incest); a felony offense
under 609.377 (malicious punishment of a child); a felony offense under 609.378 (neglect
or endangerment of a child); 609.561 (arson in the first degree);new text begin a felony conviction under
section 609.562 or 609.563 (arson in the second or third degree);new text end 609.66, subdivision 1e
(drive-by shooting);new text begin 609.746, subdivision 1, paragraph (e) (interference with privacy
involving a minor);new text end 609.749, subdivision 3, 4, or 5 (felony-level stalking); 609.855,
subdivision 5 (shooting at or in a public transit vehicle or facility); 617.23, subdivision 2,
clause (1), or subdivision 3, clause (1) (indecent exposure involving a minor); 617.246 (use
of minors in sexual performance prohibited); or 617.247 (possession of pictorial
representations of minors)new text begin ; a felony-level conviction for a crime against a child or involving
child pornography. For a background study required for family child care, child care centers,
and legal nonlicensed child care authorized under chapter 119B, an individual is permanently
disqualified for a conviction at any level for child abuse or child neglectnew text end .
(b) An individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraph (a), as each of these offenses is defined in Minnesota Statutes,
permanently disqualifies the individual under section 245C.14.
(c) An individual's offense in any other state or country, where the elements of the offense
are substantially similar to any of the offenses listed in paragraph (a), permanently disqualifies
the individual under section 245C.14.
(d) When a disqualification is based on a judicial determination other than a conviction,
the disqualification period begins from the date of the court order. When a disqualification
is based on an admission, the disqualification period begins from the date of an admission
in court. When a disqualification is based on an Alford Plea, the disqualification period
begins from the date the Alford Plea is entered in court. When a disqualification is based
on a preponderance of evidence of a disqualifying act, the disqualification date begins from
the date of the dismissal, the date of discharge of the sentence imposed for a conviction for
a disqualifying crime of similar elements, or the date of the incident, whichever occurs last.
(e) If the individual studied commits one of the offenses listed in paragraph (a) that is
specified as a felony-level only offense, but the sentence or level of offense is a gross
misdemeanor or misdemeanor, the individual is disqualified, but the disqualification
look-back period for the offense is the period applicable to gross misdemeanor or
misdemeanor offenses.
new text begin
(f) An individual shall be disqualified as long as the individual is registered, or required
to be registered, on a state sex offender registry or repository or the National Sex Offender
Registry.
new text end
Subd. 2.
15-year disqualification.
(a) An individual is disqualified under section 245C.14
if: (1) less than 15 years have passed since the discharge of the sentence imposed, if any,
for the offense; and (2) the individual has committed a felony-level violation of any of the
following offenses: sections 256.98 (wrongfully obtaining assistance); 268.182 (false
representation; concealment of facts); 393.07, subdivision 10, paragraph (c) (federal Food
Stamp Program fraud); 609.165 (felon ineligible to possess firearm); 609.2112, 609.2113,
or 609.2114 (criminal vehicular homicide or injury); 609.215 (suicide);new text begin a preponderance
of evidence ofnew text end 609.223 or 609.2231 (assault in the third or fourth degree); repeat offenses
under 609.224 (assault in the fifth degree); 609.229 (crimes committed for benefit of a
gang); 609.2325 (criminal abuse of a vulnerable adult); 609.2335 (financial exploitation of
a vulnerable adult); 609.235 (use of drugs to injure or facilitate crime); 609.24 (simple
robbery); 609.255 (false imprisonment); 609.2664 (manslaughter of an unborn child in the
first degree); 609.2665 (manslaughter of an unborn child in the second degree); 609.267
(assault of an unborn child in the first degree); 609.2671 (assault of an unborn child in the
second degree); 609.268 (injury or death of an unborn child in the commission of a crime);
609.27 (coercion); 609.275 (attempt to coerce); 609.466 (medical assistance fraud); 609.495
(aiding an offender); 609.498, subdivision 1 or 1b (aggravated first-degree or first-degree
tampering with a witness); 609.52 (theft); 609.521 (possession of shoplifting gear); 609.525
(bringing stolen goods into Minnesota); 609.527 (identity theft); 609.53 (receiving stolen
property); 609.535 (issuance of dishonored checks);new text begin a preponderance of evidence ofnew text end 609.562
(arson in the second degree);new text begin a preponderance of evidence ofnew text end 609.563 (arson in the third
degree); 609.582 (burglary); 609.59 (possession of burglary tools); 609.611 (insurance
fraud); 609.625 (aggravated forgery); 609.63 (forgery); 609.631 (check forgery; offering a
forged check); 609.635 (obtaining signature by false pretense); 609.66 (dangerous weapons);
609.67 (machine guns and short-barreled shotguns); 609.687 (adulteration); 609.71 (riot);
609.713 (terroristic threats); 609.82 (fraud in obtaining credit); 609.821 (financial transaction
card fraud); 617.23 (indecent exposure), not involving a minor; repeat offenses under 617.241
(obscene materials and performances; distribution and exhibition prohibited; penalty);
624.713 (certain persons not to possess firearms); chapter 152 (drugs; controlled substance);
or Minnesota Statutes 2012, section 609.21; or a felony-level conviction involving alcohol
or drug use.
(b) An individual is disqualified under section 245C.14 if less than 15 years has passed
since the individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraph (a), as each of these offenses is defined in Minnesota Statutes.
(c) An individual is disqualified under section 245C.14 if less than 15 years has passed
since the termination of the individual's parental rights under section 260C.301, subdivision
1, paragraph (b), or subdivision 3.
(d) An individual is disqualified under section 245C.14 if less than 15 years has passed
since the discharge of the sentence imposed for an offense in any other state or country, the
elements of which are substantially similar to the elements of the offenses listed in paragraph
(a).
(e) If the individual studied commits one of the offenses listed in paragraph (a), but the
sentence or level of offense is a gross misdemeanor or misdemeanor, the individual is
disqualified but the disqualification look-back period for the offense is the period applicable
to the gross misdemeanor or misdemeanor disposition.
(f) When a disqualification is based on a judicial determination other than a conviction,
the disqualification period begins from the date of the court order. When a disqualification
is based on an admission, the disqualification period begins from the date of an admission
in court. When a disqualification is based on an Alford Plea, the disqualification period
begins from the date the Alford Plea is entered in court. When a disqualification is based
on a preponderance of evidence of a disqualifying act, the disqualification date begins from
the date of the dismissal, the date of discharge of the sentence imposed for a conviction for
a disqualifying crime of similar elements, or the date of the incident, whichever occurs last.
Subd. 3.
Ten-year disqualification.
(a) An individual is disqualified under section
245C.14 if: (1) less than ten years have passed since the discharge of the sentence imposed,
if any, for the offense; and (2) the individual has committed a gross misdemeanor-level
violation of any of the following offenses: sections 256.98 (wrongfully obtaining assistance);
268.182 (false representation; concealment of facts); 393.07, subdivision 10, paragraph (c)
(federal Food Stamp Program fraud); 609.2112, 609.2113, or 609.2114 (criminal vehicular
homicide or injury); 609.221 or 609.222 (assault in the first or second degree); 609.223 or
609.2231 (assault in the third or fourth degree); 609.224 (assault in the fifth degreenew text begin not by
an adult against a minornew text end ); 609.224, subdivision 2, paragraph (c) (assault in the fifth degree
by a caregiver against a vulnerable adult); 609.2242 and 609.2243 (domestic assaultnew text begin not by
an adult against a minornew text end ); 609.23 (mistreatment of persons confined); 609.231 (mistreatment
of residents or patients); 609.2325 (criminal abuse of a vulnerable adult); 609.233 (criminal
neglect of a vulnerable adult); 609.2335 (financial exploitation of a vulnerable adult);
609.234 (failure to report maltreatment of a vulnerable adult); 609.265 (abduction); 609.275
(attempt to coerce); 609.324, subdivision 1a (other prohibited acts; minor engaged in
prostitution); 609.33 (disorderly house); 609.377 (malicious punishment of a child); 609.378
(neglect or endangerment of a child); 609.466 (medical assistance fraud); 609.52 (theft);
609.525 (bringing stolen goods into Minnesota); 609.527 (identity theft); 609.53 (receiving
stolen property); 609.535 (issuance of dishonored checks); 609.582 (burglary); 609.59
(possession of burglary tools); 609.611 (insurance fraud); 609.631 (check forgery; offering
a forged check); 609.66 (dangerous weapons); 609.71 (riot); 609.72, subdivision 3 (disorderly
conduct against a vulnerable adult); repeatnew text begin gross-misdemeanor levelnew text end offenses under 609.746
(interference with privacy); 609.749, subdivision 2 (stalking); 609.82 (fraud in obtaining
credit); 609.821 (financial transaction card fraud); 617.23 (indecent exposure), not involving
a minor; 617.241 (obscene materials and performances); 617.243 (indecent literature,
distribution); 617.293 (harmful materials; dissemination and display to minors prohibited);
or Minnesota Statutes 2012, section 609.21; or violation of an order for protection under
section 518B.01, subdivision 14.
(b) An individual is disqualified under section 245C.14 if less than ten years has passed
since the individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraph (a), as each of these offenses is defined in Minnesota Statutes.
(c) An individual is disqualified under section 245C.14 if less than ten years has passed
since the discharge of the sentence imposed for an offense in any other state or country, the
elements of which are substantially similar to the elements of any of the offenses listed in
paragraph (a).
(d) If the individual studied commits one of the offenses listed in paragraph (a), but the
sentence or level of offense is a misdemeanor disposition, the individual is disqualified but
the disqualification lookback period for the offense is the period applicable to misdemeanors.
(e) When a disqualification is based on a judicial determination other than a conviction,
the disqualification period begins from the date of the court order. When a disqualification
is based on an admission, the disqualification period begins from the date of an admission
in court. When a disqualification is based on an Alford Plea, the disqualification period
begins from the date the Alford Plea is entered in court. When a disqualification is based
on a preponderance of evidence of a disqualifying act, the disqualification date begins from
the date of the dismissal, the date of discharge of the sentence imposed for a conviction for
a disqualifying crime of similar elements, or the date of the incident, whichever occurs last.
Subd. 4.
Seven-year disqualification.
(a) An individual is disqualified under section
245C.14 if: (1) less than seven years has passed since the discharge of the sentence imposed,
if any, for the offense; and (2) the individual has committed a misdemeanor-level violation
of any of the following offenses: sections 256.98 (wrongfully obtaining assistance); 268.182
(false representation; concealment of facts); 393.07, subdivision 10, paragraph (c) (federal
Food Stamp Program fraud); 609.2112, 609.2113, or 609.2114 (criminal vehicular homicide
or injury); 609.221 (assault in the first degree); 609.222 (assault in the second degree);
609.223 (assault in the third degree); 609.2231 (assault in the fourth degree); 609.224 (assault
in the fifth degreenew text begin not by an adult against a minornew text end ); 609.2242 (domestic assaultnew text begin not by an
adult against a minornew text end ); 609.2335 (financial exploitation of a vulnerable adult); 609.234
(failure to report maltreatment of a vulnerable adult); 609.2672 (assault of an unborn child
in the third degree); 609.27 (coercion); violation of an order for protection under 609.3232
(protective order authorized; procedures; penalties); 609.466 (medical assistance fraud);
609.52 (theft); 609.525 (bringing stolen goods into Minnesota); 609.527 (identity theft);
609.53 (receiving stolen property); 609.535 (issuance of dishonored checks); 609.611
(insurance fraud); 609.66 (dangerous weapons); 609.665 (spring guns); 609.746 (interference
with privacy); 609.79 (obscene or harassing telephone calls); 609.795 (letter, telegram, or
package; opening; harassment); 609.82 (fraud in obtaining credit); 609.821 (financial
transaction card fraud); 617.23 (indecent exposure), not involving a minor; 617.293 (harmful
materials; dissemination and display to minors prohibited); or Minnesota Statutes 2012,
section 609.21; or violation of an order for protection under section 518B.01 (Domestic
Abuse Act).
(b) An individual is disqualified under section 245C.14 if less than seven years has
passed since a determination or disposition of the individual's:
(1) failure to make required reports under section 626.556, subdivision 3, or 626.557,
subdivision 3, for incidents in which: (i) the final disposition under section 626.556 or
626.557 was substantiated maltreatment, and (ii) the maltreatment was recurring or serious;
or
(2) substantiated serious or recurring maltreatment of a minor under section 626.556, a
vulnerable adult under section 626.557, or serious or recurring maltreatment in any other
state, the elements of which are substantially similar to the elements of maltreatment under
section 626.556 or 626.557 for which: (i) there is a preponderance of evidence that the
maltreatment occurred, and (ii) the subject was responsible for the maltreatment.
(c) An individual is disqualified under section 245C.14 if less than seven years has
passed since the individual's aiding and abetting, attempt, or conspiracy to commit any of
the offenses listed in paragraphs (a) and (b), as each of these offenses is defined in Minnesota
Statutes.
(d) An individual is disqualified under section 245C.14 if less than seven years has
passed since the discharge of the sentence imposed for an offense in any other state or
country, the elements of which are substantially similar to the elements of any of the offenses
listed in paragraphs (a) and (b).
(e) When a disqualification is based on a judicial determination other than a conviction,
the disqualification period begins from the date of the court order. When a disqualification
is based on an admission, the disqualification period begins from the date of an admission
in court. When a disqualification is based on an Alford Plea, the disqualification period
begins from the date the Alford Plea is entered in court. When a disqualification is based
on a preponderance of evidence of a disqualifying act, the disqualification date begins from
the date of the dismissal, the date of discharge of the sentence imposed for a conviction for
a disqualifying crime of similar elements, or the date of the incident, whichever occurs last.
(f) An individual is disqualified under section 245C.14 if less than seven years has passed
since the individual was disqualified under section 256.98, subdivision 8.
Subd. 5.
Mental illness.
The commissioner may not disqualify an individual subject to
a background study under this chapter because that individual has, or has had, a mental
illness as defined in section 245.462, subdivision 20.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 38.
Minnesota Statutes 2016, section 245C.16, subdivision 1, is amended to read:
Subdivision 1.
Determining immediate risk of harm.
(a) If the commissioner determines
that the individual studied has a disqualifying characteristic, the commissioner shall review
the information immediately available and make a determination as to the subject's immediate
risk of harm to persons served by the program where the individual studied will have direct
contact with, or access to, people receiving services.
(b) The commissioner shall consider all relevant information available, including the
following factors in determining the immediate risk of harm:
(1) the recency of the disqualifying characteristic;
(2) the recency of discharge from probation for the crimes;
(3) the number of disqualifying characteristics;
(4) the intrusiveness or violence of the disqualifying characteristic;
(5) the vulnerability of the victim involved in the disqualifying characteristic;
(6) the similarity of the victim to the persons served by the program where the individual
studied will have direct contact;
(7) whether the individual has a disqualification from a previous background study that
has not been set aside; and
(8) if the individual has a disqualification which may not be set aside because it is a
permanent bar under section 245C.24, subdivision 1,new text begin or the individual has a felony-level
conviction for a drug-related offense in the last five years,new text end the commissioner may order the
immediate removal of the individual from any position allowing direct contact with, or
access to, persons receiving services from the program.
(c) This section does not apply when the subject of a background study is regulated by
a health-related licensing board as defined in chapter 214, and the subject is determined to
be responsible for substantiated maltreatment under section 626.556 or 626.557.
(d) This section does not apply to a background study related to an initial application
for a child foster care license.
(e) Except for paragraph (f), this section does not apply to a background study that is
also subject to the requirements under section 256B.0659, subdivisions 11 and 13, for a
personal care assistant or a qualified professional as defined in section 256B.0659,
subdivision 1.
(f) If the commissioner has reason to believe, based on arrest information or an active
maltreatment investigation, that an individual poses an imminent risk of harm to persons
receiving services, the commissioner may order that the person be continuously supervised
or immediately removed pending the conclusion of the maltreatment investigation or criminal
proceedings.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 39.
Minnesota Statutes 2016, section 245C.17, subdivision 6, is amended to read:
Subd. 6.
Notice to county agency.
For studies on individuals related to a license to
provide adult foster care and family adult day servicesnew text begin and, effective upon implementation
of NETStudy 2.0, family child care and legal nonlicensed child care authorized under chapter
119Bnew text end , the commissioner shall also provide a notice of the background study results to the
county agency that initiated the background study.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 40.
Minnesota Statutes 2016, section 245C.21, subdivision 1, is amended to read:
Subdivision 1.
Who may request reconsideration.
An individual who is the subject of
a disqualification may request a reconsideration of the disqualificationnew text begin pursuant to this
sectionnew text end . The individual must submit the request for reconsideration to the commissioner in
writing.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 41.
Minnesota Statutes 2016, section 245C.22, subdivision 5, is amended to read:
Subd. 5.
Scope of set-aside.
(a) If the commissioner sets aside a disqualification under
this section, the disqualified individual remains disqualified, but may hold a license and
have direct contact with or access to persons receiving services. Except as provided in
paragraph (b), the commissioner's set-aside of a disqualification is limited solely to the
licensed program, applicant, or agency specified in the set aside notice under section 245C.23.
For personal care provider organizations, the commissioner's set-aside may further be limited
to a specific individual who is receiving services. For new background studies required
under section 245C.04, subdivision 1, paragraph deleted text begin (g)deleted text end new text begin (h)new text end , if an individual's disqualification
was previously set aside for the license holder's program and the new background study
results in no new information that indicates the individual may pose a risk of harm to persons
receiving services from the license holder, the previous set-aside shall remain in effect.
(b) If the commissioner has previously set aside an individual's disqualification for one
or more programs or agencies, and the individual is the subject of a subsequent background
study for a different program or agency, the commissioner shall determine whether the
disqualification is set aside for the program or agency that initiated the subsequent
background study. A notice of a set-aside under paragraph (c) shall be issued within 15
working days if all of the following criteria are met:
(1) the subsequent background study was initiated in connection with a program licensed
or regulated under the same provisions of law and rule for at least one program for which
the individual's disqualification was previously set aside by the commissioner;
(2) the individual is not disqualified for an offense specified in section 245C.15,
subdivision 1 or 2;
(3) the commissioner has received no new information to indicate that the individual
may pose a risk of harm to any person served by the program; and
(4) the previous set-aside was not limited to a specific person receiving services.
(c) When a disqualification is set aside under paragraph (b), the notice of background
study results issued under section 245C.17, in addition to the requirements under section
245C.17, shall state that the disqualification is set aside for the program or agency that
initiated the subsequent background study. The notice must inform the individual that the
individual may request reconsideration of the disqualification under section 245C.21 on the
basis that the information used to disqualify the individual is incorrect.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 42.
Minnesota Statutes 2016, section 245C.22, subdivision 7, is amended to read:
Subd. 7.
Classification of certain data.
(a) Notwithstanding section 13.46, except as
provided in paragraph (f), upon setting aside a disqualification under this section, the identity
of the disqualified individual who received the set-aside and the individual's disqualifying
characteristics are public data if the set-aside was:
(1) for any disqualifying characteristic under section 245C.15,new text begin except a felony-level
conviction for a drug-related offense within the past five years,new text end when the set-aside relates
to a child care center or a family child care provider licensed under chapter 245Anew text begin , certified
license-exempt child care center, or legal nonlicensed family child care centernew text end ; or
(2) for a disqualifying characteristic under section 245C.15, subdivision 2.
(b) Notwithstanding section 13.46, upon granting a variance to a license holder under
section 245C.30, the identity of the disqualified individual who is the subject of the variance,
the individual's disqualifying characteristics under section 245C.15, and the terms of the
variance are public data, new text begin except as provided in paragraph (c), clause (6), new text end when the variance:
(1) is issued to a child care center or a family child care provider licensed under chapter
245A; or
(2) relates to an individual with a disqualifying characteristic under section 245C.15,
subdivision 2.
(c) The identity of a disqualified individual and the reason for disqualification remain
private data when:
(1) a disqualification is not set aside and no variance is granted, except as provided under
section 13.46, subdivision 4;
(2) the data are not public under paragraph (a) or (b);
(3) the disqualification is rescinded because the information relied upon to disqualify
the individual is incorrect;
(4) the disqualification relates to a license to provide relative child foster care. As used
in this clause, "relative" has the meaning given it under section 260C.007, subdivision 26b
or 27; deleted text begin or
deleted text end
(5) the disqualified individual is a household member of a licensed foster care provider
and:
(i) the disqualified individual previously received foster care services from this licensed
foster care provider;
(ii) the disqualified individual was subsequently adopted by this licensed foster care
provider; and
(iii) the disqualifying act occurred before the adoptionnew text begin ; or
new text end
new text begin (6) a variance is granted to a child care center or family child care license holder for an
individual's disqualification that is based on a felony-level conviction for a drug-related
offense that occurred within the past five yearsnew text end .
(d) Licensed family child care providers and child care centers must provide notices as
required under section 245C.301.
(e) Notwithstanding paragraphs (a) and (b), the identity of household members who are
the subject of a disqualification related set-aside or variance is not public data if:
(1) the household member resides in the residence where the family child care is provided;
(2) the subject of the set-aside or variance is under the age of 18 years; and
(3) the set-aside or variance only relates to a disqualification under section 245C.15,
subdivision 4, for a misdemeanor-level theft crime as defined in section 609.52.
(f) When the commissioner has reason to know that a disqualified individual has received
an order for expungement for the disqualifying record that does not limit the commissioner's
access to the record, and the record was opened or exchanged with the commissioner for
purposes of a background study under this chapter, the data that would otherwise become
public under paragraph (a) or (b) remain private data.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 43.
Minnesota Statutes 2016, section 245C.23, is amended to read:
245C.23 COMMISSIONER'S RECONSIDERATION NOTICE.
Subdivision 1.
Disqualification that is rescinded or set aside.
(a) If the commissioner
rescinds or sets aside a disqualification, the commissioner shall notify the applicant, license
holder, or other entity in writing or by electronic transmission of the decision.
(b) In the notice from the commissioner that a disqualification has been rescinded, the
commissioner must inform the applicant, license holder, or other entity that the information
relied upon to disqualify the individual was incorrect.
(c) Except as provided in deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (d)new text begin and (e)new text end , in the notice from the
commissioner that a disqualification has been set aside, the commissioner must inform the
applicant, license holder, or other entity of the reason for the individual's disqualification
and that information about which factors under section 245C.22, subdivision 4, were the
basis of the decision to set aside the disqualification are available to the license holder upon
request without the consent of the background study subject.
(d) When the commissioner has reason to know that a disqualified individual has received
an order for expungement for the disqualifying record that does not limit the commissioner's
access to the record, and the record was opened or exchanged with the commissioner for
purposes of a background study under this chapter, the information provided under paragraph
(c) must only inform the applicant, license holder, or other entity that the disqualifying
criminal record is sealed under a court order.
new text begin
(e) The notification requirements in paragraph (c) do not apply when the set aside is
granted to an individual related to a background study for a licensed child care center,
certified license-exempt child care center, or family child care license holder, or for a legal
nonlicensed child care provider authorized under chapter 119B, and the individual is
disqualified for a felony-level conviction for a drug-related offense that occurred within the
past five years. The notice that the individual's disqualification is set aside must inform the
applicant, license holder, or legal nonlicensed child care provider that the disqualifying
criminal record is not public.
new text end
Subd. 2.
Commissioner's notice of disqualification that is not set aside.
(a) The
commissioner shall notify the license holder of the disqualification and order the license
holder to immediately remove the individual from any position allowing direct contact with
persons receiving services from the license holder if:
(1) the individual studied does not submit a timely request for reconsideration under
section 245C.21;
(2) the individual submits a timely request for reconsideration, but the commissioner
does not set aside the disqualification for that license holder under section 245C.22, unless
the individual has a right to request a hearing under section 245C.27, 245C.28, or 256.045;
(3) an individual who has a right to request a hearing under sections 245C.27 and 256.045,
or 245C.28 and chapter 14 for a disqualification that has not been set aside, does not request
a hearing within the specified time; or
(4) an individual submitted a timely request for a hearing under sections 245C.27 and
256.045, or 245C.28 and chapter 14, but the commissioner does not set aside the
disqualification under section 245A.08, subdivision 5, or 256.045.
(b) If the commissioner does not set aside the disqualification under section 245C.22,
and the license holder was previously ordered under section 245C.17 to immediately remove
the disqualified individual from direct contact with persons receiving services or to ensure
that the individual is under continuous, direct supervision when providing direct contact
services, the order remains in effect pending the outcome of a hearing under sections 245C.27
and 256.045, or 245C.28 and chapter 14.
(c) If the commissioner does not set aside the disqualification under section 245C.22,
and the license holder was not previously ordered under section 245C.17 to immediately
remove the disqualified individual from direct contact with persons receiving services or
to ensure that the individual is under continuous direct supervision when providing direct
contact services, the commissioner shall order the individual to remain under continuous
direct supervision pending the outcome of a hearing under sections 245C.27 and 256.045,
or 245C.28 and chapter 14.
(d) For background studies related to child foster care, the commissioner shall also notify
the county or private agency that initiated the study of the results of the reconsideration.
(e) For background studies related to new text begin family child care, legal nonlicensed child care,
new text end adult foster carenew text begin ,new text end and family adult day services, the commissioner shall also notify the county
that initiated the study of the results of the reconsideration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 44.
Minnesota Statutes 2016, section 245C.24, subdivision 3, is amended to read:
Subd. 3.
Ten-year bar to set aside disqualification.
(a) The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for children, foster care for children in the provider's home, or foster care or day
care services for adults in the provider's home if: (1) less than ten years has passed since
the discharge of the sentence imposed, if any, for the offense; or (2) when disqualified based
on a preponderance of evidence determination under section 245C.14, subdivision 1,
paragraph (a), clause (2), or an admission under section 245C.14, subdivision 1, paragraph
(a), clause (1), and less than ten years has passed since the individual committed the act or
admitted to committing the act, whichever is later; and (3) the individual has committed a
violation of any of the following offenses: sections 609.165 (felon ineligible to possess
firearm); criminal vehicular homicide or criminal vehicular operation causing death under
609.2112, 609.2113, or 609.2114 (criminal vehicular homicide or injury); 609.215 (aiding
suicide or aiding attempted suicide);new text begin preponderance of evidence ofnew text end felony violations under
609.223 or 609.2231 (assault in the third or fourth degree); 609.229 (crimes committed for
benefit of a gang); 609.713 (terroristic threats); 609.235 (use of drugs to injure or to facilitate
crime); 609.24 (simple robbery); 609.255 (false imprisonment); 609.562 (arson in the second
degree); 609.71 (riot); 609.498, subdivision 1 or 1b (aggravated first-degree or first-degree
tampering with a witness); burglary in the first or second degree under 609.582 (burglary);
609.66 (dangerous weapon); 609.665 (spring guns); 609.67 (machine guns and short-barreled
shotguns); 609.749, subdivision 2 (gross misdemeanor stalking); 152.021 or 152.022
(controlled substance crime in the first or second degree); 152.023, subdivision 1, clause
(3) or (4) or subdivision 2, clause (4) (controlled substance crime in the third degree);
152.024, subdivision 1, clause (2), (3), or (4) (controlled substance crime in the fourth
degree); 609.224, subdivision 2, paragraph (c) (fifth-degree assault by a caregiver against
a vulnerable adult); 609.23 (mistreatment of persons confined); 609.231 (mistreatment of
residents or patients); 609.2325 (criminal abuse of a vulnerable adult); 609.233 (criminal
neglect of a vulnerable adult); 609.2335 (financial exploitation of a vulnerable adult);
609.234 (failure to report); 609.265 (abduction); 609.2664 to 609.2665 (manslaughter of
an unborn child in the first or second degree); 609.267 to 609.2672 (assault of an unborn
child in the first, second, or third degree); 609.268 (injury or death of an unborn child in
the commission of a crime); repeat offenses under 617.23 (indecent exposure); 617.293
(disseminating or displaying harmful material to minors); a felony-level conviction involving
alcohol or drug use, a gross misdemeanor offense under 609.324, subdivision 1 (other
prohibited acts); a gross misdemeanor offense under 609.378 (neglect or endangerment of
a child); a gross misdemeanor offense under 609.377 (malicious punishment of a child);
609.72, subdivision 3 (disorderly conduct against a vulnerable adult); or 624.713 (certain
persons not to possess firearms); or Minnesota Statutes 2012, section 609.21.
(b) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the individual's aiding and abetting, attempt, or conspiracy to
commit any of the offenses listed in paragraph (a) as each of these offenses is defined in
Minnesota Statutes.
(c) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the discharge of the sentence imposed for an offense in any
other state or country, the elements of which are substantially similar to the elements of any
of the offenses listed in paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 45.
Minnesota Statutes 2016, section 245C.25, is amended to read:
245C.25 CONSOLIDATED RECONSIDERATION OF MALTREATMENT
DETERMINATION AND DISQUALIFICATION.
deleted text begin (a)deleted text end If an individual is disqualified on the basis of a determination of maltreatment under
section 626.556 or 626.557, which was serious or recurring, and the individual requests
reconsideration of the maltreatment determination under section 626.556, subdivision 10i,
or 626.557, subdivision 9d, and also requests reconsideration of the disqualification under
section 245C.21, the commissioner shall consolidate the reconsideration of the maltreatment
determination and the disqualification into a single reconsideration.
deleted text begin
(b) For maltreatment and disqualification determinations made by county agencies, the
county agency shall conduct the consolidated reconsideration. If the county agency has
disqualified an individual on multiple bases, one of which is a county maltreatment
determination for which the individual has a right to request reconsideration, the county
shall conduct the reconsideration of all disqualifications.
deleted text end
deleted text begin
(c) If the county has previously conducted a consolidated reconsideration under paragraph
(b) of a maltreatment determination and a disqualification based on serious or recurring
maltreatment, and the county subsequently disqualifies the individual based on that
determination, the county shall conduct the reconsideration of the subsequent disqualification.
The scope of the subsequent disqualification shall be limited to whether the individual poses
a risk of harm in accordance with section 245C.22, subdivision 4. If the commissioner
subsequently disqualifies the individual in connection with a child foster care license based
on the county's previous maltreatment determination, the commissioner shall conduct the
reconsideration of the subsequent disqualification.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 46.
Minnesota Statutes 2016, section 245C.30, subdivision 2, is amended to read:
Subd. 2.
Disclosure of reason for disqualification.
(a) The commissioner may not grant
a variance for a disqualified individual unless the applicant or license holder requests the
variance and the disqualified individual provides written consent for the commissioner to
disclose to the applicant or license holder the reason for the disqualification.
(b) This subdivision does not apply to programs licensed to provide family child care
for children, foster care for children in the provider's own home, or foster care or day care
services for adults in the provider's own home. When the commissioner grants a variance
for a disqualified individual in connection with a license to provide the services specified
in this paragraph, the disqualified individual's consent is not required to disclose the reason
for the disqualification to the license holder in the variance issued under subdivision 1new text begin ,
provided that the commissioner may not disclose the reason for the disqualification if the
disqualification is based on a felony-level conviction for a drug-related offense within the
past five yearsnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2017.
new text end
Sec. 47.
new text begin
[245G.01] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
The terms used in this chapter have the meanings given in this
section.
new text end
new text begin Subd. 2. new text end
new text begin Applicant. new text end
new text begin
"Applicant" means an individual or organization that is subject to
certification under this chapter and that applied for but is not yet granted certification under
this chapter.
new text end
new text begin Subd. 3. new text end
new text begin Center operator or program operator. new text end
new text begin
"Center operator" or "program operator"
means the person exercising supervision or control over the center's or program's operations,
planning, and functioning. There may be more than one designated center operator or
program operator.
new text end
new text begin Subd. 4. new text end
new text begin Certification holder. new text end
new text begin
"Certification holder" means the individual or organization
that is legally responsible for the operation of the center, and granted certification by the
commissioner under this chapter.
new text end
new text begin Subd. 5. new text end
new text begin Certified license-exempt child care center. new text end
new text begin
"Certified license-exempt child
care center" means the commissioner's written authorization for a child care center excluded
from licensure under section 245A.03, subdivision 2, paragraph (a), clause (5), (11) to (13),
(15), (18), or (26), to register to receive child care assistance payments under chapter 119B.
new text end
new text begin Subd. 6. new text end
new text begin Disinfecting. new text end
new text begin
"Disinfecting" means the use of a product capable of destroying
or inactivating harmful germs, except bacterial spores, consistent with label directions on
environmental surfaces including bathroom toilets and floors, diaper-changing surfaces,
and surfaces exposed to blood or other bodily fluids.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 48.
new text begin
[245G.02] WHO MUST BE CERTIFIED.
new text end
new text begin
A program that is exempt from licensure under section 245A.03, subdivision 2, paragraph
(a), clause (5), (11) to (13), (15), (18), or (26), and is authorized to receive child care
assistance payments under chapter 119B, must be a certified license-exempt child care
center according to this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 49.
new text begin
[245G.03] APPLICATION PROCEDURES.
new text end
new text begin Subdivision 1. new text end
new text begin Schedule. new text end
new text begin
The certification of license-exempt child care centers shall be
implemented by September 30, 2017. Certification applications shall be received and
processed on a phased-in schedule as determined by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Application submission. new text end
new text begin
The commissioner shall provide application
instructions and information about the rules and requirements of other state agencies that
affect the applicant. The certification application must be submitted in a manner prescribed
by the commissioner. The commissioner shall act on the application within 90 working days
of receiving a completed application.
new text end
new text begin Subd. 3. new text end
new text begin Incomplete applications. new text end
new text begin
When the commissioner receives an application for
initial certification that is incomplete because the applicant failed to submit required
documents or is deficient because the documents submitted do not meet certification
requirements, the commissioner shall provide the applicant written notice that the application
is incomplete or deficient. In the notice, the commissioner shall identify documents that are
missing or deficient and give the applicant 45 days to resubmit a second application that is
complete. An applicant's failure to submit a complete application after receiving notice from
the commissioner is basis for certification denial.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 50.
new text begin
[245G.04] COMMISSIONER'S RIGHT OF ACCESS.
new text end
new text begin
(a) When the commissioner is exercising the powers conferred by this chapter, whenever
the center is in operation and the information is relevant to the commissioner's inspection
or investigation, the commissioner must be given access to:
new text end
new text begin
(1) the physical facility and grounds where the program is provided;
new text end
new text begin
(2) documentation and records, including electronically maintained records;
new text end
new text begin
(3) children served by the center; and
new text end
new text begin
(4) staff and personnel records of current and former staff.
new text end
new text begin
(b) The commissioner must be given access without prior notice and as often as the
commissioner considers necessary if the commissioner is investigating alleged maltreatment
or a violation of a law or rule, or conducting an inspection. When conducting an inspection,
the commissioner may request and shall receive assistance from other state, county, and
municipal governmental agencies and departments. The applicant or certification holder
shall allow the commissioner, at the commissioner's expense, to photocopy, photograph,
and make audio and video recordings during an inspection at the commissioner's expense.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51.
new text begin
[245G.05] MONITORING AND INSPECTIONS.
new text end
new text begin
(a) The commissioner must conduct an on-site inspection of a certified license-exempt
child care center at least annually to determine compliance with the health, safety, and fire
standards specific to a certified license-exempt child care center.
new text end
new text begin
(b) No later than November 19, 2017, the commissioner shall make publicly available
on the department's Web site the results of inspection reports for all certified centers including
the number of deaths, serious injuries, and instances of substantiated child maltreatment
that occurred in certified centers each year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 52.
new text begin
[245G.06] CORRECTION ORDER.
new text end
new text begin Subdivision 1. new text end
new text begin Correction order requirements. new text end
new text begin
If the applicant or certification holder
failed to comply with a law or rule, the commissioner may issue a correction order. The
correction order must state:
new text end
new text begin
(1) the condition that constitutes a violation of the law or rule;
new text end
new text begin
(2) the specific law or rule violated; and
new text end
new text begin
(3) the time allowed to correct each violation.
new text end
new text begin Subd. 2. new text end
new text begin Reconsideration request. new text end
new text begin
(a) If the applicant or certification holder believes
that the commissioner's correction order is erroneous, the applicant or certification holder
may ask the commissioner to reconsider the part of the correction order that is allegedly
erroneous. A request for reconsideration must be made in writing, postmarked, and sent to
the commissioner within 20 calendar days after the applicant or certification holder received
the correction order, and must:
new text end
new text begin
(1) specify the part of the correction order that is allegedly erroneous;
new text end
new text begin
(2) explain why the specified part is erroneous; and
new text end
new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
(b) A request for reconsideration does not stay any provision or requirement of the
correction order. The commissioner's disposition of a request for reconsideration is final
and not subject to appeal.
new text end
new text begin Subd. 3. new text end
new text begin Decertification following a correction order. new text end
new text begin
(a) If the commissioner finds
that the applicant or certification holder failed to correct the violation specified in the
correction order, the commissioner may decertify the license-exempt center pursuant to
section 245G.07.
new text end
new text begin
(b) Nothing in this section prohibits the commissioner from decertifying a center
according to section 245G.07.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 53.
new text begin
[245G.07] DECERTIFICATION.
new text end
new text begin
(a) The commissioner may decertify a center if a certification holder:
new text end
new text begin
(1) failed to comply with an applicable law or rule; or
new text end
new text begin
(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, in connection with
the background study status of an individual, during an investigation, or regarding compliance
with applicable laws or rules.
new text end
new text begin
(b) When considering decertification, the commissioner shall consider the nature,
chronicity, or severity of the violation of law or rule.
new text end
new text begin
(c) When a center is decertified, the center is ineligible to receive a child care assistance
payment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 54.
new text begin
[245G.08] STAFFING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Staffing requirements. new text end
new text begin
During hours of operation, a certified center
must have a director or designee on site who is responsible for overseeing implementation
of written policies relating to the management and control of the daily activities of the
program, ensuring the health and safety of program participants, and supervising staff and
volunteers.
new text end
new text begin Subd. 2. new text end
new text begin Director qualifications. new text end
new text begin
The director must be 18 years of age or older and have
completed at least 16 hours of training in any of the following topic areas: child development
and learning; developmentally appropriate learning experiences; relationships with families;
assessment, evaluation, and individualization; historical and contemporary development of
early childhood education; professionalism; and health, safety, and nutrition.
new text end
new text begin Subd. 3. new text end
new text begin Staff qualifications. new text end
new text begin
A staff person must be 16 years of age or older before
providing direct, unsupervised care to a child.
new text end
new text begin Subd. 4. new text end
new text begin Maximum group size. new text end
new text begin
(a) For a child six weeks old through 16 months old,
the maximum group size shall be no more than eight children.
new text end
new text begin
(b) For a child 16 months old through 33 months old, the maximum group size shall be
no more than 14 children.
new text end
new text begin
(c) For a child 33 months old through prekindergarten, a maximum group size shall be
no more than 20 children.
new text end
new text begin
(d) For a child in kindergarten through 13 years old, a maximum group size shall be no
more than 30 children.
new text end
new text begin
(e) The maximum group size applies at all times except during group activity coordination
time not exceeding 15 minutes, during a meal, outdoor activity, field trip, nap and rest, and
special activity including a film, guest speaker, indoor large muscle activity, or holiday
program.
new text end
new text begin Subd. 5. new text end
new text begin Ratios. new text end
new text begin
(a) The minimally acceptable staff-to-child ratios are:
new text end
|
new text begin
six weeks old through 16 months old new text end |
new text begin
1:4 new text end |
|
new text begin
16 months old through 33 months old new text end |
new text begin
1:7 new text end |
|
new text begin
33 months old through prekindergarten new text end |
new text begin
1:10 new text end |
|
new text begin
kindergarten through 13 years old new text end |
new text begin
1:15 new text end |
new text begin
(b) Kindergarten includes a child of sufficient age to have attended the first day of
kindergarten or who is eligible to enter kindergarten within the next four months.
new text end
new text begin
(c) For mixed groups, the ratio for the age group of the youngest child applies.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 55.
new text begin
[245G.10] BACKGROUND STUDIES.
new text end
new text begin Subdivision 1. new text end
new text begin Documentation. new text end
new text begin
(a) The applicant or certification holder must submit
and maintain documentation of a completed background study for:
new text end
new text begin
(1) each person applying for the certification;
new text end
new text begin
(2) each person identified as a center operator or program operator as defined in section
245G.01, subdivision 5;
new text end
new text begin
(3) each current or prospective staff person or contractor of the certified center who will
have direct contact with a child served by the center;
new text end
new text begin
(4) each volunteer who has direct contact with a child served by the center if the contact
is not under the continuous, direct supervision by an individual listed in clause (1), (2), or
(3); and
new text end
new text begin
(5) each managerial staff of the certification holder with oversight and supervision of
the certified center.
new text end
new text begin
(b) To be accepted for certification, a background study on every individual in subdivision
1, clause (1), must be completed under chapter 245C and result in a not disqualified
determination under section 245C.14 or a disqualification that was set aside under section
245C.22.
new text end
new text begin Subd. 2. new text end
new text begin Direct contact. new text end
new text begin
(a) The subject of the background study may not provide direct
contact services to a child served by a certified center unless the subject is under continuous
direct supervision pending completion of the background study.
new text end
new text begin
(b) The certified center must document in the staff person's personnel file the date the
program initiates a background study and the date the subject of the study first had direct
contact with a child served by the center.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 56.
new text begin
[245G.11] REPORTING.
new text end
new text begin
(a) The certification holder must comply with the reporting requirements for abuse and
neglect specified in section 626.556. A person mandated to report physical or sexual child
abuse or neglect occurring within a certified center shall report the information to the
commissioner.
new text end
new text begin
(b) The certification holder must inform the commissioner within 24 hours of:
new text end
new text begin
(1) the death of a child in the program; and
new text end
new text begin
(2) any injury to a child in the program that required treatment by a physician.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 57.
new text begin
[245G.12] FEES.
new text end
new text begin
The commissioner shall consult with stakeholders to develop an administrative fee to
implement this chapter. By February 15, 2019, the commissioner shall provide
recommendations on the amount of an administrative fee to the legislative committees with
jurisdiction over health and human services policy and finance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 58.
new text begin
[245G.13] HEALTH AND SAFETY REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin
Exclusion of sick children and infectious disease outbreak control.
new text end
new text begin
(a) A certified center must supervise and isolate a child from other children in the program
when a child becomes sick and immediately notify the sick child's parent or legal guardian.
new text end
new text begin
(b) A certified center must post or give notice to the parent or legal guardian of an
exposed child the same day the program is notified of a child's contagious reportable disease
specified in Minnesota Rules, part 4605.7040, or scabies, impetigo, ringworm, or chicken
pox.
new text end
new text begin Subd. 2. new text end
new text begin Immunizations. new text end
new text begin
By a child's date of attendance, the certified center must
maintain or have access to a record detailing the child's current immunizations or applicable
exemption.
new text end
new text begin Subd. 3. new text end
new text begin Administration of medication. new text end
new text begin
(a) A certified center that chooses to administer
medicine must meet the requirements in this subdivision.
new text end
new text begin
(b) The certified center must obtain written permission from the child's parent or legal
guardian before administering prescription medicine, diapering product, sunscreen lotion,
and insect repellent.
new text end
new text begin
(c) The certified center must administer nonprescription medicine, diapering product,
sunscreen lotion, and insect repellent according to the manufacturer's instructions unless
provided written instructions by a licensed health professional to use a product differently.
new text end
new text begin
(d) The certified center must obtain and follow written instructions from the prescribing
health professional before administering prescription medicine. Medicine with the child's
first and last name and current prescription information on the label is considered written
instructions.
new text end
new text begin
(e) The certified center must ensure all medicine is:
new text end
new text begin
(1) kept in the medicine's original container with a legible label stating the child's first
and last name;
new text end
new text begin
(2) given only to the child whose name is on the label;
new text end
new text begin
(3) not given after an expiration date on the label; and
new text end
new text begin
(4) returned to the child's parent or legal guardian or destroyed, if unused.
new text end
new text begin
(f) The certified center must document in the child's record the administration of
medication, including the child's first and last name; the name of the medication or
prescription number; the date, time, and dosage; and the name and signature of the person
who administered the medicine. This documentation must be available to the child's parent
or legal guardian.
new text end
new text begin
(g) The certified center must store medicines, insect repellents, and diapering products
according to directions on the original container.
new text end
new text begin Subd. 4. new text end
new text begin Preventing and responding to allergies. new text end
new text begin
(a) Before admitting a child for care,
the certified center must obtain documentation of any known allergies from the child's parent
or legal guardian. The certified center must maintain current allergy information in each
child's record. The allergy information must include:
new text end
new text begin
(1) a description of the allergy, specific triggers, avoidance techniques, and symptoms
of an allergic reaction; and
new text end
new text begin
(2) procedures for responding to an allergic reaction, including medication, dosages,
and a doctor's contact information.
new text end
new text begin
(b) The certified center must inform staff of each child's current allergy information. At
least annually and when a change is made to allergy-related information in a child's record,
the certified center must inform staff of any change. Documentation that staff were informed
of the child's current allergy information must be kept on site.
new text end
new text begin
(c) A child's allergy information must be available at all times including on site, when
on field trips, or during transportation. Food allergy information must be readily available
to staff in the area where food is prepared and served to the child.
new text end
new text begin Subd. 5. new text end
new text begin Building and physical premises; free of hazards. new text end
new text begin
(a) The certified center
must document compliance with the State Fire Code by providing documentation of a fire
marshal inspection completed within the previous three years by a state fire marshal or a
local fire code inspector trained by the state fire marshal.
new text end
new text begin
(b) The certified center must designate a primary indoor and outdoor space used for
child care on a facility site floor plan.
new text end
new text begin
(c) The certified center must ensure the areas used by a child are clean and in good repair,
with structurally sound and functional furniture and equipment that is appropriate to the
age and size of a child who uses the area.
new text end
new text begin
(d) The certified center must ensure hazardous items including but not limited to sharp
objects, medicines, cleaning supplies, poisonous plants, and chemicals are out of reach of
a child.
new text end
new text begin
(e) The certified center must safely handle and dispose of bodily fluids and other
potentially infectious fluids by using gloves, disinfecting surfaces that come in contact with
potentially infectious bodily fluids, and disposing of bodily fluid in a securely sealed plastic
bag.
new text end
new text begin Subd. 6. new text end
new text begin Transporting children. new text end
new text begin
(a) If a certified center chooses to transport a child,
the certified center must ensure that the driver of the vehicle holds a valid driver's license,
appropriate to the vehicle driven.
new text end
new text begin
(b) If a certified center chooses to transport a child, the center must comply with all seat
belt and child passenger restraint system requirements under sections 169.685 and 169.686.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 59.
new text begin
[245G.14] TRAINING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin First aid and cardiopulmonary resuscitation. new text end
new text begin
At least one designated
staff person who completed first aid training and cardiopulmonary resuscitation (CPR)
training must be present at all times at the program, during field trips, and when transporting
a child. The designated staff person must repeat first aid training and CPR training at least
once every two years.
new text end
new text begin Subd. 2. new text end
new text begin Sudden unexpected infant death. new text end
new text begin
A certified center that cares for an infant
who is younger than one year of age must ensure that staff persons and volunteers receive
training according to section 245A.1435 on reducing the risk of sudden unexpected infant
death before assisting in the care of an infant.
new text end
new text begin Subd. 3. new text end
new text begin Abusive head trauma. new text end
new text begin
A certified center that cares for a child through four
years of age must ensure that staff persons and volunteers receive training on abusive head
trauma from shaking infants and young children before assisting in the care of a child through
four years of age.
new text end
new text begin Subd. 4. new text end
new text begin Child development. new text end
new text begin
The certified center must ensure each staff person completes
at least two hours of child development and learning training within 14 days of employment
and annually thereafter. For purposes of this subdivision, "child development and learning
training" means how a child develops physically, cognitively, emotionally, and socially and
learns as part of the child's family, culture, and community.
new text end
new text begin Subd. 5. new text end
new text begin Orientation. new text end
new text begin
The certified center must ensure each staff person is trained at
orientation on health and safety requirements in sections 245G.11, 245G.13, 245G.14, and
245G.15. The certified center must provide staff with an orientation within 14 days of
employment. Before the completion of orientation, a staff person must be supervised while
providing direct care to a child.
new text end
new text begin Subd. 6. new text end
new text begin In service. new text end
new text begin
(a) The certified center must ensure each staff person is trained at
least annually on health and safety requirements in sections 245G.11, 245G.13, 245G.14,
and 245G.15.
new text end
new text begin
(b) Each staff person must annually complete at least six hours of training. Training
required under paragraph (a) may be used toward the hourly training requirements of this
subdivision.
new text end
new text begin Subd. 7. new text end
new text begin Documentation. new text end
new text begin
A certified center must document the date of a completed
training required by this section in the personnel record of each staff person.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 60.
new text begin
[245G.15] EMERGENCY PREPAREDNESS.
new text end
new text begin Subdivision 1. new text end
new text begin Written emergency plan. new text end
new text begin
(a) A certified center must have a written
emergency plan for emergencies that require evacuation, sheltering, or other protection of
children, such as fire, natural disaster, intruder, or other threatening situation that may pose
a health or safety hazard to children. The plan must be written on a form developed by the
commissioner and reviewed and updated at least once each calendar year. The annual review
of the emergency plan must be documented.
new text end
new text begin
(b) The plan must include:
new text end
new text begin
(1) procedures for an evacuation, relocation, shelter-in-place, or lockdown;
new text end
new text begin
(2) a designated relocation site and evacuation route;
new text end
new text begin
(3) procedures for notifying a child's parent or legal guardian of the relocation and
reunification with families;
new text end
new text begin
(4) accommodations for a child with a disability or a chronic medical condition;
new text end
new text begin
(5) procedures for storing a child's medically necessary medicine that facilitates easy
removal during an evacuation or relocation;
new text end
new text begin
(6) procedures for continuing operations in the period during and after a crisis; and
new text end
new text begin
(7) procedures for communicating with local emergency management officials, law
enforcement officials, or other appropriate state or local authorities.
new text end
new text begin
(c) The certification holder must have an emergency plan available for review upon
request by the child's parent or legal guardian.
new text end
new text begin Subd. 2. new text end
new text begin Staff person training. new text end
new text begin
The certification holder must train a staff person at
orientation and at least once each calendar year on the emergency plan and document training
in each personnel file. The certified center must conduct at least quarterly one evacuation
drill and one shelter-in-place drill. The date and time of the drills must be documented.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 61.
new text begin
[245G.16] PERSONNEL RECORD.
new text end
new text begin
The certification holder must maintain a personnel record for each staff person at the
program that must contain:
new text end
new text begin
(1) the staff person's name, home address, telephone number, and date of birth;
new text end
new text begin
(2) documentation that the staff person completed training required by section 245G.14;
new text end
new text begin
(3) documentation of the date the program initiated a background study for the staff
person; and
new text end
new text begin
(4) documentation of the date the staff person first had direct contact and access to a
child while supervised, and the date the staff person first had direct contact and access to a
child while unsupervised.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 62.
new text begin
[245G.17] CERTIFICATION STANDARDS.
new text end
new text begin
The commissioner shall regularly consult with stakeholders for input related to
implementing the standards in this chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 63.
new text begin
[245G.18] PARENTAL ACCESS.
new text end
new text begin
An enrolled child's parent or legal guardian must be allowed access to the parent's or
legal guardian's child at any time while the child is in care.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2017.
new text end
Sec. 64.
Minnesota Statutes 2016, section 256.98, subdivision 8, is amended to read:
Subd. 8.
Disqualification from program.
(a) Any person found to be guilty of
wrongfully obtaining assistance by a federal or state court or by an administrative hearing
determination, or waiver thereof, through a disqualification consent agreement, or as part
of any approved diversion plan under section 401.065, or any court-ordered stay which
carries with it any probationary or other conditions, in the Minnesota family investment
program and any affiliated program to include the diversionary work program and the work
participation cash benefit program, the food stamp or food support program, the general
assistance program, the group residential housing program, or the Minnesota supplemental
aid program shall be disqualified from that program. In addition, any person disqualified
from the Minnesota family investment program shall also be disqualified from the food
stamp or food support program. The needs of that individual shall not be taken into
consideration in determining the grant level for that assistance unit:
(1) for one year after the first offense;
(2) for two years after the second offense; and
(3) permanently after the third or subsequent offense.
The period of program disqualification shall begin on the date stipulated on the advance
notice of disqualification without possibility of postponement for administrative stay or
administrative hearing and shall continue through completion unless and until the findings
upon which the sanctions were imposed are reversed by a court of competent jurisdiction.
The period for which sanctions are imposed is not subject to review. The sanctions provided
under this subdivision are in addition to, and not in substitution for, any other sanctions that
may be provided for by law for the offense involved. A disqualification established through
hearing or waiver shall result in the disqualification period beginning immediately unless
the person has become otherwise ineligible for assistance. If the person is ineligible for
assistance, the disqualification period begins when the person again meets the eligibility
criteria of the program from which they were disqualified and makes application for that
program.
(b) A family receiving assistance through child care assistance programs under chapter
119B with a family member who is found to be guilty of wrongfully obtaining child care
assistance by a federal court, state court, or an administrative hearing determination or
waiver, through a disqualification consent agreement, as part of an approved diversion plan
under section 401.065, or a court-ordered stay with probationary or other conditions, is
disqualified from child care assistance programs. The disqualifications must be for periods
of one year and two years for the first and second offenses, respectively. Subsequent
violations must result in permanent disqualification. During the disqualification period,
disqualification from any child care program must extend to all child care programs and
must be immediately applied.
(c) A provider caring for children receiving assistance through child care assistance
programs under chapter 119B is disqualified from receiving payment for child care services
from the child care assistance program under chapter 119B when the provider is found to
have wrongfully obtained child care assistance by a federal court, state court, or an
administrative hearing determination or waiver under section 256.046, through a
disqualification consent agreement, as part of an approved diversion plan under section
401.065, or a court-ordered stay with probationary or other conditions. The disqualification
must be for a period of deleted text begin one yeardeleted text end new text begin two yearsnew text end for the first offense deleted text begin and two years for the second
offensedeleted text end . Any subsequent violation must result in permanent disqualification. The
disqualification period must be imposed immediately after a determination is made under
this paragraph. During the disqualification period, the provider is disqualified from receiving
payment from any child care program under chapter 119B.
(d) Any person found to be guilty of wrongfully obtaining MinnesotaCare for adults
without children and upon federal approval, all categories of medical assistance and
remaining categories of MinnesotaCare, except for children through age 18, by a federal or
state court or by an administrative hearing determination, or waiver thereof, through a
disqualification consent agreement, or as part of any approved diversion plan under section
401.065, or any court-ordered stay which carries with it any probationary or other conditions,
is disqualified from that program. The period of disqualification is one year after the first
offense, two years after the second offense, and permanently after the third or subsequent
offense. The period of program disqualification shall begin on the date stipulated on the
advance notice of disqualification without possibility of postponement for administrative
stay or administrative hearing and shall continue through completion unless and until the
findings upon which the sanctions were imposed are reversed by a court of competent
jurisdiction. The period for which sanctions are imposed is not subject to review. The
sanctions provided under this subdivision are in addition to, and not in substitution for, any
other sanctions that may be provided for by law for the offense involved.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 5, 2017.
new text end
Sec. 65.
Minnesota Statutes 2016, section 626.556, subdivision 2, is amended to read:
Subd. 2.
Definitions.
As used in this section, the following terms have the meanings
given them unless the specific content indicates otherwise:
(a) "Accidental" means a sudden, not reasonably foreseeable, and unexpected occurrence
or event which:
(1) is not likely to occur and could not have been prevented by exercise of due care; and
(2) if occurring while a child is receiving services from a facility, happens when the
facility and the employee or person providing services in the facility are in compliance with
the laws and rules relevant to the occurrence or event.
(b) "Commissioner" means the commissioner of human services.
(c) "Facility" means:
(1) a licensed or unlicensed day care facility,new text begin certified license-exempt child care center,new text end
residential facility, agency, hospital, sanitarium, or other facility or institution required to
be licensed under sections 144.50 to 144.58, 241.021, or 245A.01 to 245A.16, or chapter
245Dnew text begin or 245Gnew text end ;
(2) a school as defined in section 120A.05, subdivisions 9, 11, and 13; and chapter 124E;
or
(3) a nonlicensed personal care provider organization as defined in section 256B.0625,
subdivision 19a.
(d) "Family assessment" means a comprehensive assessment of child safety, risk of
subsequent child maltreatment, and family strengths and needs that is applied to a child
maltreatment report that does not allege sexual abuse or substantial child endangerment.
Family assessment does not include a determination as to whether child maltreatment
occurred but does determine the need for services to address the safety of family members
and the risk of subsequent maltreatment.
(e) "Investigation" means fact gathering related to the current safety of a child and the
risk of subsequent maltreatment that determines whether child maltreatment occurred and
whether child protective services are needed. An investigation must be used when reports
involve sexual abuse or substantial child endangerment, and for reports of maltreatment in
facilities required to be licensednew text begin or certifiednew text end under chapter 245A deleted text begin ordeleted text end new text begin ,new text end 245Dnew text begin , or 245Gnew text end ; under
sections 144.50 to 144.58 and 241.021; in a school as defined in section 120A.05,
subdivisions 9, 11, and 13, and chapter 124E; or in a nonlicensed personal care provider
association as defined in section 256B.0625, subdivision 19a.
(f) "Mental injury" means an injury to the psychological capacity or emotional stability
of a child as evidenced by an observable or substantial impairment in the child's ability to
function within a normal range of performance and behavior with due regard to the child's
culture.
(g) "Neglect" means the commission or omission of any of the acts specified under
clauses (1) to (9), other than by accidental means:
(1) failure by a person responsible for a child's care to supply a child with necessary
food, clothing, shelter, health, medical, or other care required for the child's physical or
mental health when reasonably able to do so;
(2) failure to protect a child from conditions or actions that seriously endanger the child's
physical or mental health when reasonably able to do so, including a growth delay, which
may be referred to as a failure to thrive, that has been diagnosed by a physician and is due
to parental neglect;
(3) failure to provide for necessary supervision or child care arrangements appropriate
for a child after considering factors as the child's age, mental ability, physical condition,
length of absence, or environment, when the child is unable to care for the child's own basic
needs or safety, or the basic needs or safety of another child in their care;
(4) failure to ensure that the child is educated as defined in sections 120A.22 and
260C.163, subdivision 11, which does not include a parent's refusal to provide the parent's
child with sympathomimetic medications, consistent with section 125A.091, subdivision
5;
(5) nothing in this section shall be construed to mean that a child is neglected solely
because the child's parent, guardian, or other person responsible for the child's care in good
faith selects and depends upon spiritual means or prayer for treatment or care of disease or
remedial care of the child in lieu of medical care; except that a parent, guardian, or caretaker,
or a person mandated to report pursuant to subdivision 3, has a duty to report if a lack of
medical care may cause serious danger to the child's health. This section does not impose
upon persons, not otherwise legally responsible for providing a child with necessary food,
clothing, shelter, education, or medical care, a duty to provide that care;
(6) prenatal exposure to a controlled substance, as defined in section 253B.02, subdivision
2, used by the mother for a nonmedical purpose, as evidenced by withdrawal symptoms in
the child at birth, results of a toxicology test performed on the mother at delivery or the
child at birth, medical effects or developmental delays during the child's first year of life
that medically indicate prenatal exposure to a controlled substance, or the presence of a
fetal alcohol spectrum disorder;
(7) "medical neglect" as defined in section 260C.007, subdivision 6, clause (5);
(8) chronic and severe use of alcohol or a controlled substance by a parent or person
responsible for the care of the child that adversely affects the child's basic needs and safety;
or
(9) emotional harm from a pattern of behavior which contributes to impaired emotional
functioning of the child which may be demonstrated by a substantial and observable effect
in the child's behavior, emotional response, or cognition that is not within the normal range
for the child's age and stage of development, with due regard to the child's culture.
(h) "Nonmaltreatment mistake" means:
(1) at the time of the incident, the individual was performing duties identified in the
center's child care program plan required under Minnesota Rules, part 9503.0045;
(2) the individual has not been determined responsible for a similar incident that resulted
in a finding of maltreatment for at least seven years;
(3) the individual has not been determined to have committed a similar nonmaltreatment
mistake under this paragraph for at least four years;
(4) any injury to a child resulting from the incident, if treated, is treated only with
remedies that are available over the counter, whether ordered by a medical professional or
not; and
(5) except for the period when the incident occurred, the facility and the individual
providing services were both in compliance with all licensing requirements relevant to the
incident.
This definition only applies to child care centers licensed under Minnesota Rules, chapter
9503. If clauses (1) to (5) apply, rather than making a determination of substantiated
maltreatment by the individual, the commissioner of human services shall determine that a
nonmaltreatment mistake was made by the individual.
(i) "Operator" means an operator or agency as defined in section 245A.02.
(j) "Person responsible for the child's care" means (1) an individual functioning within
the family unit and having responsibilities for the care of the child such as a parent, guardian,
or other person having similar care responsibilities, or (2) an individual functioning outside
the family unit and having responsibilities for the care of the child such as a teacher, school
administrator, other school employees or agents, or other lawful custodian of a child having
either full-time or short-term care responsibilities including, but not limited to, day care,
babysitting whether paid or unpaid, counseling, teaching, and coaching.
(k) "Physical abuse" means any physical injury, mental injury, or threatened injury,
inflicted by a person responsible for the child's care on a child other than by accidental
means, or any physical or mental injury that cannot reasonably be explained by the child's
history of injuries, or any aversive or deprivation procedures, or regulated interventions,
that have not been authorized under section 125A.0942 or 245.825.
Abuse does not include reasonable and moderate physical discipline of a child
administered by a parent or legal guardian which does not result in an injury. Abuse does
not include the use of reasonable force by a teacher, principal, or school employee as allowed
by section 121A.582. Actions which are not reasonable and moderate include, but are not
limited to, any of the following:
(1) throwing, kicking, burning, biting, or cutting a child;
(2) striking a child with a closed fist;
(3) shaking a child under age three;
(4) striking or other actions which result in any nonaccidental injury to a child under 18
months of age;
(5) unreasonable interference with a child's breathing;
(6) threatening a child with a weapon, as defined in section 609.02, subdivision 6;
(7) striking a child under age one on the face or head;
(8) striking a child who is at least age one but under age four on the face or head, which
results in an injury;
(9) purposely giving a child poison, alcohol, or dangerous, harmful, or controlled
substances which were not prescribed for the child by a practitioner, in order to control or
punish the child; or other substances that substantially affect the child's behavior, motor
coordination, or judgment or that results in sickness or internal injury, or subjects the child
to medical procedures that would be unnecessary if the child were not exposed to the
substances;
(10) unreasonable physical confinement or restraint not permitted under section 609.379,
including but not limited to tying, caging, or chaining; or
(11) in a school facility or school zone, an act by a person responsible for the child's
care that is a violation under section 121A.58.
(l) "Practice of social services," for the purposes of subdivision 3, includes but is not
limited to employee assistance counseling and the provision of guardian ad litem and
parenting time expeditor services.
(m) "Report" means any communication received by the local welfare agency, police
department, county sheriff, or agency responsible for child protection pursuant to this section
that describes neglect or physical or sexual abuse of a child and contains sufficient content
to identify the child and any person believed to be responsible for the neglect or abuse, if
known.
(n) "Sexual abuse" means the subjection of a child by a person responsible for the child's
care, by a person who has a significant relationship to the child, as defined in section 609.341,
or by a person in a position of authority, as defined in section 609.341, subdivision 10, to
any act which constitutes a violation of section 609.342 (criminal sexual conduct in the first
degree), 609.343 (criminal sexual conduct in the second degree), 609.344 (criminal sexual
conduct in the third degree), 609.345 (criminal sexual conduct in the fourth degree), or
609.3451 (criminal sexual conduct in the fifth degree). Sexual abuse also includes any act
which involves a minor which constitutes a violation of prostitution offenses under sections
609.321 to 609.324 or 617.246. Effective May 29, 2017, sexual abuse includes all reports
of known or suspected child sex trafficking involving a child who is identified as a victim
of sex trafficking. Sexual abuse includes child sex trafficking as defined in section 609.321,
subdivisions 7a and 7b. Sexual abuse includes threatened sexual abuse which includes the
status of a parent or household member who has committed a violation which requires
registration as an offender under section 243.166, subdivision 1b, paragraph (a) or (b), or
required registration under section 243.166, subdivision 1b, paragraph (a) or (b).
(o) "Substantial child endangerment" means a person responsible for a child's care, by
act or omission, commits or attempts to commit an act against a child under their care that
constitutes any of the following:
(1) egregious harm as defined in section 260C.007, subdivision 14;
(2) abandonment under section 260C.301, subdivision 2;
(3) neglect as defined in paragraph (g), clause (2), that substantially endangers the child's
physical or mental health, including a growth delay, which may be referred to as failure to
thrive, that has been diagnosed by a physician and is due to parental neglect;
(4) murder in the first, second, or third degree under section 609.185, 609.19, or 609.195;
(5) manslaughter in the first or second degree under section 609.20 or 609.205;
(6) assault in the first, second, or third degree under section 609.221, 609.222, or 609.223;
(7) solicitation, inducement, and promotion of prostitution under section 609.322;
(8) criminal sexual conduct under sections 609.342 to 609.3451;
(9) solicitation of children to engage in sexual conduct under section 609.352;
(10) malicious punishment or neglect or endangerment of a child under section 609.377
or 609.378;
(11) use of a minor in sexual performance under section 617.246; or
(12) parental behavior, status, or condition which mandates that the county attorney file
a termination of parental rights petition under section 260C.503, subdivision 2.
(p) "Threatened injury" means a statement, overt act, condition, or status that represents
a substantial risk of physical or sexual abuse or mental injury. Threatened injury includes,
but is not limited to, exposing a child to a person responsible for the child's care, as defined
in paragraph (j), clause (1), who has:
(1) subjected a child to, or failed to protect a child from, an overt act or condition that
constitutes egregious harm, as defined in section 260C.007, subdivision 14, or a similar law
of another jurisdiction;
(2) been found to be palpably unfit under section 260C.301, subdivision 1, paragraph
(b), clause (4), or a similar law of another jurisdiction;
(3) committed an act that has resulted in an involuntary termination of parental rights
under section 260C.301, or a similar law of another jurisdiction; or
(4) committed an act that has resulted in the involuntary transfer of permanent legal and
physical custody of a child to a relative under Minnesota Statutes 2010, section 260C.201,
subdivision 11, paragraph (d), clause (1), section 260C.515, subdivision 4, or a similar law
of another jurisdiction.
A child is the subject of a report of threatened injury when the responsible social services
agency receives birth match data under paragraph (q) from the Department of Human
Services.
(q) Upon receiving data under section 144.225, subdivision 2b, contained in a birth
record or recognition of parentage identifying a child who is subject to threatened injury
under paragraph (p), the Department of Human Services shall send the data to the responsible
social services agency. The data is known as "birth match" data. Unless the responsible
social services agency has already begun an investigation or assessment of the report due
to the birth of the child or execution of the recognition of parentage and the parent's previous
history with child protection, the agency shall accept the birth match data as a report under
this section. The agency may use either a family assessment or investigation to determine
whether the child is safe. All of the provisions of this section apply. If the child is determined
to be safe, the agency shall consult with the county attorney to determine the appropriateness
of filing a petition alleging the child is in need of protection or services under section
260C.007, subdivision 6, clause (16), in order to deliver needed services. If the child is
determined not to be safe, the agency and the county attorney shall take appropriate action
as required under section 260C.503, subdivision 2.
(r) Persons who conduct assessments or investigations under this section shall take into
account accepted child-rearing practices of the culture in which a child participates and
accepted teacher discipline practices, which are not injurious to the child's health, welfare,
and safety.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 66.
Minnesota Statutes 2016, section 626.556, subdivision 3, is amended to read:
Subd. 3.
Persons mandated to report; persons voluntarily reporting.
(a) A person
who knows or has reason to believe a child is being neglected or physically or sexually
abused, as defined in subdivision 2, or has been neglected or physically or sexually abused
within the preceding three years, shall immediately report the information to the local welfare
agency, agency responsible for assessing or investigating the report, police department,
county sheriff, tribal social services agency, or tribal police department if the person is:
(1) a professional or professional's delegate who is engaged in the practice of the healing
arts, social services, hospital administration, psychological or psychiatric treatment, child
care, education, correctional supervision, probation and correctional services, or law
enforcement; or
(2) employed as a member of the clergy and received the information while engaged in
ministerial duties, provided that a member of the clergy is not required by this subdivision
to report information that is otherwise privileged under section 595.02, subdivision 1,
paragraph (c).
(b) Any person may voluntarily report to the local welfare agency, agency responsible
for assessing or investigating the report, police department, county sheriff, tribal social
services agency, or tribal police department if the person knows, has reason to believe, or
suspects a child is being or has been neglected or subjected to physical or sexual abuse.
(c) A person mandated to report physical or sexual child abuse or neglect occurring
within a licensed facility shall report the information to the agency responsible for licensingnew text begin
or certifyingnew text end the facility under sections 144.50 to 144.58; 241.021; 245A.01 to 245A.16;
or chapter 245Dnew text begin or 245Gnew text end ; or a nonlicensed personal care provider organization as defined
in section 256B.0625, subdivision 19. A health or corrections agency receiving a report
may request the local welfare agency to provide assistance pursuant to subdivisions 10, 10a,
and 10b. A board or other entity whose licensees perform work within a school facility,
upon receiving a complaint of alleged maltreatment, shall provide information about the
circumstances of the alleged maltreatment to the commissioner of education. Section 13.03,
subdivision 4, applies to data received by the commissioner of education from a licensing
entity.
(d) Notification requirements under subdivision 10 apply to all reports received under
this section.
(e) For purposes of this section, "immediately" means as soon as possible but in no event
longer than 24 hours.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 67.
Minnesota Statutes 2016, section 626.556, subdivision 3c, is amended to read:
Subd. 3c.
Local welfare agency, Department of Human Services or Department of
Health responsible for assessing or investigating reports of maltreatment.
(a) The deleted text begin countydeleted text end
local welfare agency is the agency responsible for assessing or investigating allegations of
maltreatment in child foster care, family child care, legally deleted text begin unlicenseddeleted text end new text begin nonlicensednew text end child
care, deleted text begin juvenile correctional facilities licensed under section 241.021 located in the local
welfare agency's county,deleted text end and reports involving children served by an unlicensed personal
care provider organization under section 256B.0659. Copies of findings related to personal
care provider organizations under section 256B.0659 must be forwarded to the Department
of Human Services provider enrollment.
(b) The Department of Human Services is the agency responsible for assessing or
investigating allegations of maltreatment in new text begin juvenile correctional facilities listed under
section 241.021 located in the local welfare agency's county and in new text end facilities licensednew text begin or
certifiednew text end under chapters 245A deleted text begin anddeleted text end new text begin ,new text end 245D,new text begin and 245G,new text end except for child foster care and family
child care.
(c) The Department of Health is the agency responsible for assessing or investigating
allegations of child maltreatment in facilities licensed under sections 144.50 to 144.58 and
144A.43 to 144A.482.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 68.
Minnesota Statutes 2016, section 626.556, subdivision 4, is amended to read:
Subd. 4.
Immunity from liability.
(a) The following persons are immune from any civil
or criminal liability that otherwise might result from their actions, if they are acting in good
faith:
(1) any person making a voluntary or mandated report under subdivision 3 or under
section 626.5561 or assisting in an assessment under this section or under section 626.5561;
(2) any person with responsibility for performing duties under this section or supervisor
employed by a local welfare agency, the commissioner of an agency responsible for operating
or supervising a licensed or unlicensed day care facility, residential facility, agency, hospital,
sanitarium, or other facility or institution required to be licensed new text begin or certified new text end under sections
144.50 to 144.58; 241.021; 245A.01 to 245A.16; or new text begin chapter new text end 245Bdeleted text begin ,deleted text end new text begin or 245G;new text end or a school as
defined in section 120A.05, subdivisions 9, 11, and 13; and chapter 124E; or a nonlicensed
personal care provider organization as defined in section 256B.0625, subdivision 19a,
complying with subdivision 10d; and
(3) any public or private school, facility as defined in subdivision 2, or the employee of
any public or private school or facility who permits access by a local welfare agency, the
Department of Education, or a local law enforcement agency and assists in an investigation
or assessment pursuant to subdivision 10 or under section 626.5561.
(b) A person who is a supervisor or person with responsibility for performing duties
under this section employed by a local welfare agency, the commissioner of human services,
or the commissioner of education complying with subdivisions 10 and 11 or section 626.5561
or any related rule or provision of law is immune from any civil or criminal liability that
might otherwise result from the person's actions, if the person is (1) acting in good faith
and exercising due care, or (2) acting in good faith and following the information collection
procedures established under subdivision 10, paragraphs (h), (i), and (j).
(c) This subdivision does not provide immunity to any person for failure to make a
required report or for committing neglect, physical abuse, or sexual abuse of a child.
(d) If a person who makes a voluntary or mandatory report under subdivision 3 prevails
in a civil action from which the person has been granted immunity under this subdivision,
the court may award the person attorney fees and costs.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 69.
Minnesota Statutes 2016, section 626.556, subdivision 10d, is amended to read:
Subd. 10d.
Notification of neglect or abuse in facility.
(a) When a report is received
that alleges neglect, physical abuse, sexual abuse, or maltreatment of a child while in the
care of a licensed or unlicensed day care facility, residential facility, agency, hospital,
sanitarium, or other facility or institution required to be licensednew text begin or certifiednew text end according to
sections 144.50 to 144.58; 241.021; or 245A.01 to 245A.16; or chapter 245Dnew text begin or 245Gnew text end , or
a school as defined in section 120A.05, subdivisions 9, 11, and 13; and chapter 124E; or a
nonlicensed personal care provider organization as defined in section 256B.0625, subdivision
19a, the commissioner of the agency responsible for assessing or investigating the report
or local welfare agency investigating the report shall provide the following information to
the parent, guardian, or legal custodian of a child alleged to have been neglected, physically
abused, sexually abused, or the victim of maltreatment of a child in the facility: the name
of the facility; the fact that a report alleging neglect, physical abuse, sexual abuse, or
maltreatment of a child in the facility has been received; the nature of the alleged neglect,
physical abuse, sexual abuse, or maltreatment of a child in the facility; that the agency is
conducting an assessment or investigation; any protective or corrective measures being
taken pending the outcome of the investigation; and that a written memorandum will be
provided when the investigation is completed.
(b) The commissioner of the agency responsible for assessing or investigating the report
or local welfare agency may also provide the information in paragraph (a) to the parent,
guardian, or legal custodian of any other child in the facility if the investigative agency
knows or has reason to believe the alleged neglect, physical abuse, sexual abuse, or
maltreatment of a child in the facility has occurred. In determining whether to exercise this
authority, the commissioner of the agency responsible for assessing or investigating the
report or local welfare agency shall consider the seriousness of the alleged neglect, physical
abuse, sexual abuse, or maltreatment of a child in the facility; the number of children
allegedly neglected, physically abused, sexually abused, or victims of maltreatment of a
child in the facility; the number of alleged perpetrators; and the length of the investigation.
The facility shall be notified whenever this discretion is exercised.
(c) When the commissioner of the agency responsible for assessing or investigating the
report or local welfare agency has completed its investigation, every parent, guardian, or
legal custodian previously notified of the investigation by the commissioner or local welfare
agency shall be provided with the following information in a written memorandum: the
name of the facility investigated; the nature of the alleged neglect, physical abuse, sexual
abuse, or maltreatment of a child in the facility; the investigator's name; a summary of the
investigation findings; a statement whether maltreatment was found; and the protective or
corrective measures that are being or will be taken. The memorandum shall be written in a
manner that protects the identity of the reporter and the child and shall not contain the name,
or to the extent possible, reveal the identity of the alleged perpetrator or of those interviewed
during the investigation. If maltreatment is determined to exist, the commissioner or local
welfare agency shall also provide the written memorandum to the parent, guardian, or legal
custodian of each child in the facility who had contact with the individual responsible for
the maltreatment. When the facility is the responsible party for maltreatment, the
commissioner or local welfare agency shall also provide the written memorandum to the
parent, guardian, or legal custodian of each child who received services in the population
of the facility where the maltreatment occurred. This notification must be provided to the
parent, guardian, or legal custodian of each child receiving services from the time the
maltreatment occurred until either the individual responsible for maltreatment is no longer
in contact with a child or children in the facility or the conclusion of the investigation. In
the case of maltreatment within a school facility, as defined in section 120A.05, subdivisions
9, 11, and 13, and chapter 124E, the commissioner of education need not provide notification
to parents, guardians, or legal custodians of each child in the facility, but shall, within ten
days after the investigation is completed, provide written notification to the parent, guardian,
or legal custodian of any student alleged to have been maltreated. The commissioner of
education may notify the parent, guardian, or legal custodian of any student involved as a
witness to alleged maltreatment.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 70.
Minnesota Statutes 2016, section 626.556, subdivision 10e, is amended to read:
Subd. 10e.
Determinations.
(a) The local welfare agency shall conclude the family
assessment or the investigation within 45 days of the receipt of a report. The conclusion of
the assessment or investigation may be extended to permit the completion of a criminal
investigation or the receipt of expert information requested within 45 days of the receipt of
the report.
(b) After conducting a family assessment, the local welfare agency shall determine
whether services are needed to address the safety of the child and other family members
and the risk of subsequent maltreatment.
(c) After conducting an investigation, the local welfare agency shall make two
determinations: first, whether maltreatment has occurred; and second, whether child
protective services are needed. No determination of maltreatment shall be made when the
alleged perpetrator is a child under the age of ten.
(d) If the commissioner of education conducts an assessment or investigation, the
commissioner shall determine whether maltreatment occurred and what corrective or
protective action was taken by the school facility. If a determination is made that
maltreatment has occurred, the commissioner shall report to the employer, the school board,
and any appropriate licensing entity the determination that maltreatment occurred and what
corrective or protective action was taken by the school facility. In all other cases, the
commissioner shall inform the school board or employer that a report was received, the
subject of the report, the date of the initial report, the category of maltreatment alleged as
defined in paragraph (f), the fact that maltreatment was not determined, and a summary of
the specific reasons for the determination.
(e) When maltreatment is determined in an investigation involving a facility, the
investigating agency shall also determine whether the facility or individual was responsible,
or whether both the facility and the individual were responsible for the maltreatment using
the mitigating factors in paragraph (i). Determinations under this subdivision must be made
based on a preponderance of the evidence and are private data on individuals or nonpublic
data as maintained by the commissioner of education.
(f) For the purposes of this subdivision, "maltreatment" means any of the following acts
or omissions:
(1) physical abuse as defined in subdivision 2, paragraph (k);
(2) neglect as defined in subdivision 2, paragraph (g);
(3) sexual abuse as defined in subdivision 2, paragraph (n);
(4) mental injury as defined in subdivision 2, paragraph (f); or
(5) maltreatment of a child in a facility as defined in subdivision 2, paragraph (c).
(g) For the purposes of this subdivision, a determination that child protective services
are needed means that the local welfare agency has documented conditions during the
assessment or investigation sufficient to cause a child protection worker, as defined in
section 626.559, subdivision 1, to conclude that a child is at significant risk of maltreatment
if protective intervention is not provided and that the individuals responsible for the child's
care have not taken or are not likely to take actions to protect the child from maltreatment
or risk of maltreatment.
(h) This subdivision does not mean that maltreatment has occurred solely because the
child's parent, guardian, or other person responsible for the child's care in good faith selects
and depends upon spiritual means or prayer for treatment or care of disease or remedial care
of the child, in lieu of medical care. However, if lack of medical care may result in serious
danger to the child's health, the local welfare agency may ensure that necessary medical
services are provided to the child.
(i) When determining whether the facility or individual is the responsible party, or
whether both the facility and the individual are responsible for determined maltreatment in
a facility, the investigating agency shall consider at least the following mitigating factors:
(1) whether the actions of the facility or the individual caregivers were according to,
and followed the terms of, an erroneous physician order, prescription, individual care plan,
or directive; however, this is not a mitigating factor when the facility or caregiver was
responsible for the issuance of the erroneous order, prescription, individual care plan, or
directive or knew or should have known of the errors and took no reasonable measures to
correct the defect before administering care;
(2) comparative responsibility between the facility, other caregivers, and requirements
placed upon an employee, including the facility's compliance with related regulatory standards
and the adequacy of facility policies and procedures, facility training, an individual's
participation in the training, the caregiver's supervision, and facility staffing levels and the
scope of the individual employee's authority and discretion; and
(3) whether the facility or individual followed professional standards in exercising
professional judgment.
The evaluation of the facility's responsibility under clause (2) must not be based on the
completeness of the risk assessment or risk reduction plan required under section 245A.66,
but must be based on the facility's compliance with the regulatory standards for policies
and procedures, training, and supervision as cited in Minnesota Statutes and Minnesota
Rules.
(j) Notwithstanding paragraph (i), when maltreatment is determined to have been
committed by an individual who is also the facility licensenew text begin or certificationnew text end holder, both the
individual and the facility must be determined responsible for the maltreatment, and both
the background study disqualification standards under section 245C.15, subdivision 4, and
the licensingnew text begin or certificationnew text end actions under deleted text begin sectionsdeleted text end new text begin sectionnew text end 245A.06 deleted text begin ordeleted text end new text begin ,new text end 245A.07new text begin , 245G.06,
or 245G.07new text end apply.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 71.
Minnesota Statutes 2016, section 626.556, subdivision 10f, is amended to read:
Subd. 10f.
Notice of determinations.
Within ten working days of the conclusion of a
family assessment, the local welfare agency shall notify the parent or guardian of the child
of the need for services to address child safety concerns or significant risk of subsequent
child maltreatment. The local welfare agency and the family may also jointly agree that
family support and family preservation services are needed. Within ten working days of the
conclusion of an investigation, the local welfare agency or agency responsible for
investigating the report shall notify the parent or guardian of the child, the person determined
to be maltreating the child, and, if applicable, the director of the facility, of the determination
and a summary of the specific reasons for the determination. When the investigation involves
a child foster care setting that is monitored by a private licensing agency under section
245A.16, the local welfare agency responsible for investigating the report shall notify the
private licensing agency of the determination and shall provide a summary of the specific
reasons for the determination. The notice to the private licensing agency must include
identifying private data, but not the identity of the reporter of maltreatment. The notice must
also include a certification that the information collection procedures under subdivision 10,
paragraphs (h), (i), and (j), were followed and a notice of the right of a data subject to obtain
access to other private data on the subject collected, created, or maintained under this section.
In addition, the notice shall include the length of time that the records will be kept under
subdivision 11c. The investigating agency shall notify the parent or guardian of the child
who is the subject of the report, and any person or facility determined to have maltreated a
child, of their appeal or review rights under this section. The notice must also state that a
finding of maltreatment may result in denial of a licensenew text begin or certificationnew text end application or
background study disqualification under chapter 245C related to employment or services
that are licensednew text begin or certifiednew text end by the Department of Human Services under chapter 245Anew text begin or
245Gnew text end , the Department of Health under chapter 144 or 144A, the Department of Corrections
under section 241.021, and from providing services related to an unlicensed personal care
provider organization under chapter 256B.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 72.
Minnesota Statutes 2016, section 626.556, subdivision 10i, is amended to read:
Subd. 10i.
Administrative reconsideration; review panel.
(a) Administrative
reconsideration is not applicable in family assessments since no determination concerning
maltreatment is made. For investigations, except as provided under paragraph (e), an
individual or facility that the commissioner of human services, a local social service agency,
or the commissioner of education determines has maltreated a child, an interested person
acting on behalf of the child, regardless of the determination, who contests the investigating
agency's final determination regarding maltreatment, may request the investigating agency
to reconsider its final determination regarding maltreatment. The request for reconsideration
must be submitted in writing to the investigating agency within 15 calendar days after receipt
of notice of the final determination regarding maltreatment or, if the request is made by an
interested person who is not entitled to notice, within 15 days after receipt of the notice by
the parent or guardian of the child. If mailed, the request for reconsideration must be
postmarked and sent to the investigating agency within 15 calendar days of the individual's
or facility's receipt of the final determination. If the request for reconsideration is made by
personal service, it must be received by the investigating agency within 15 calendar days
after the individual's or facility's receipt of the final determination. Effective January 1,
2002, an individual who was determined to have maltreated a child under this section and
who was disqualified on the basis of serious or recurring maltreatment under sections
245C.14 and 245C.15, may request reconsideration of the maltreatment determination and
the disqualification. The request for reconsideration of the maltreatment determination and
the disqualification must be submitted within 30 calendar days of the individual's receipt
of the notice of disqualification under sections 245C.16 and 245C.17. If mailed, the request
for reconsideration of the maltreatment determination and the disqualification must be
postmarked and sent to the investigating agency within 30 calendar days of the individual's
receipt of the maltreatment determination and notice of disqualification. If the request for
reconsideration is made by personal service, it must be received by the investigating agency
within 30 calendar days after the individual's receipt of the notice of disqualification.
(b) Except as provided under paragraphs (e) and (f), if the investigating agency denies
the request or fails to act upon the request within 15 working days after receiving the request
for reconsideration, the person or facility entitled to a fair hearing under section 256.045
may submit to the commissioner of human services or the commissioner of education a
written request for a hearing under that section. Section 256.045 also governs hearings
requested to contest a final determination of the commissioner of education. The investigating
agency shall notify persons who request reconsideration of their rights under this paragraph.
The hearings specified under this section are the only administrative appeal of a decision
issued under paragraph (a). Determinations under this section are not subject to accuracy
and completeness challenges under section 13.04.
(c) If, as a result of a reconsideration or review, the investigating agency changes the
final determination of maltreatment, that agency shall notify the parties specified in
subdivisions 10b, 10d, and 10f.
(d) Except as provided under paragraph (f), if an individual or facility contests the
investigating agency's final determination regarding maltreatment by requesting a fair
hearing under section 256.045, the commissioner of human services shall assure that the
hearing is conducted and a decision is reached within 90 days of receipt of the request for
a hearing. The time for action on the decision may be extended for as many days as the
hearing is postponed or the record is held open for the benefit of either party.
(e) If an individual was disqualified under sections 245C.14 and 245C.15, on the basis
of a determination of maltreatment, which was serious or recurring, and the individual has
requested reconsideration of the maltreatment determination under paragraph (a) and
requested reconsideration of the disqualification under sections 245C.21 to 245C.27,
reconsideration of the maltreatment determination and reconsideration of the disqualification
shall be consolidated into a single reconsideration. If reconsideration of the maltreatment
determination is denied and the individual remains disqualified following a reconsideration
decision, the individual may request a fair hearing under section 256.045. If an individual
requests a fair hearing on the maltreatment determination and the disqualification, the scope
of the fair hearing shall include both the maltreatment determination and the disqualification.
(f) If a maltreatment determination or a disqualification based on serious or recurring
maltreatment is the basis for a denial of a license under section 245A.05 or a licensing
sanction under section 245A.07, the license holder has the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. As provided for
under section 245A.08, subdivision 2a, the scope of the contested case hearing shall include
the maltreatment determination, disqualification, and licensing sanction or denial of a license.
In such cases, a fair hearing regarding the maltreatment determination and disqualification
shall not be conducted under section 256.045. Except for family child care and child foster
care, reconsideration of a maltreatment determination as provided under this subdivision,
and reconsideration of a disqualification as provided under section 245C.22, shall also not
be conducted when:
(1) a denial of a license under section 245A.05 or a licensing sanction under section
245A.07, is based on a determination that the license holder is responsible for maltreatment
or the disqualification of a license holder based on serious or recurring maltreatment;
(2) the denial of a license or licensing sanction is issued at the same time as the
maltreatment determination or disqualification; and
(3) the license holder appeals the maltreatment determination or disqualification, and
denial of a license or licensing sanction.
Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
determination or disqualification, but does not appeal the denial of a license or a licensing
sanction, reconsideration of the maltreatment determination shall be conducted under sections
626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
disqualification shall be conducted under section 245C.22. In such cases, a fair hearing shall
also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
626.557, subdivision 9d.
If the disqualified subject is an individual other than the license holder and upon whom
a background study must be conducted under chapter 245C, the hearings of all parties may
be consolidated into a single contested case hearing upon consent of all parties and the
administrative law judge.
(g) For purposes of this subdivision, "interested person acting on behalf of the child"
means a parent or legal guardian; stepparent; grandparent; guardian ad litem; adult
stepbrother, stepsister, or sibling; or adult aunt or uncle; unless the person has been
determined to be the perpetrator of the maltreatment.
new text begin
(h) If a maltreatment determination is the basis for a correction order under section
245G.06 or decertification under section 245G.07, the certification holder has the right to
request reconsideration under sections 245G.06 and 245G.07. If the certification holder
appeals the maltreatment determination or disqualification, but does not appeal the correction
order or decertification, reconsideration of the maltreatment determination shall be conducted
under section 626.556, subdivision 10i, and reconsideration of the disqualification shall be
conducted under section 245C.22.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 73.
Laws 2012, chapter 247, article 6, section 2, subdivision 2, is amended to read:
Subd. 2.Central Office Operations
|
||||||
| (a) Operations |
118,000 |
356,000 |
||||
Base Level Adjustment. The general fund
base is increased by $91,000 in fiscal year
2014 and $44,000 in fiscal year 2015.
| (b) Health Care |
24,000 |
346,000 |
||||
This is a onetime appropriation.
Managed Care Audit Activities. In fiscal
year 2014, deleted text begin and in each even-numbered year
thereafter,deleted text end the commissioner shall transfer
from the health care access fund $1,740,000
to the legislative auditor for managed care
audit services under Minnesota Statutes,
section 256B.69, subdivision 9d. This is a
biennial appropriation. The health care access
fund base is increased by $1,842,000 in fiscal
year 2014. deleted text begin Notwithstanding any contrary
provision in this article, this paragraph does
not expire.
deleted text end
| (c) Continuing Care |
19,000 |
375,000 |
||||
Base Level Adjustment. The general fund
base is decreased by $159,000 in fiscal years
2014 and 2015.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 74. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2016, sections 245C.11, subdivision 4; 245C.16, subdivision 3;
and 245C.17, subdivision 4,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, part 9503.0145, subpart 6,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 10
DEPARTMENT OF HEALTH
Section 1.
Minnesota Statutes 2016, section 103I.005, subdivision 2, is amended to read:
Subd. 2.
Boring.
"Boring" means a hole or excavation that is not used to extract water
and includes exploratory borings, deleted text begin environmental bore holes,deleted text end bored geothermal heat
exchangers, and elevator deleted text begin shaftsdeleted text end new text begin boringsnew text end .
Sec. 2.
Minnesota Statutes 2016, section 103I.005, subdivision 2a, is amended to read:
Subd. 2a.
Certified representative.
"Certified representative" means a person certified
by the commissioner to represent a well contractor, limited well/boring contractor, deleted text begin monitoringdeleted text end new text begin
environmentalnew text end well contractor, or elevator boring contractor.
Sec. 3.
Minnesota Statutes 2016, section 103I.005, is amended by adding a subdivision
to read:
new text begin Subd. 8a. new text end
new text begin Environmental well. new text end
new text begin
"Environmental well" means an excavation 15 or more
feet in depth that is drilled, cored, bored, washed, driven, dug, jetted, or otherwise constructed
to:
new text end
new text begin
(1) conduct physical, chemical, or biological testing of groundwater, and includes a
groundwater quality monitoring or sampling well;
new text end
new text begin
(2) lower a groundwater level to control or remove contamination in groundwater, and
includes a remedial well and excludes horizontal trenches; or
new text end
new text begin
(3) monitor or measure physical, chemical, radiological, or biological parameters of the
earth and earth fluids, or for vapor recovery or venting systems. An environmental well
includes an excavation used to:
new text end
new text begin
(i) measure groundwater levels, including a piezometer;
new text end
new text begin
(ii) determine groundwater flow direction or velocity;
new text end
new text begin
(iii) measure earth properties such as hydraulic conductivity, bearing capacity, or
resistance;
new text end
new text begin
(iv) obtain samples of geologic materials for testing or classification; or
new text end
new text begin
(v) remove or remediate pollution or contamination from groundwater or soil through
the use of a vent, vapor recovery system, or sparge point.
new text end
Sec. 4.
Minnesota Statutes 2016, section 103I.005, is amended by adding a subdivision
to read:
new text begin Subd. 8b. new text end
new text begin Environmental well contractor. new text end
new text begin
"Environmental well contractor" means a
person with an environmental well contractor's license issued by the commissioner.
new text end
Sec. 5.
Minnesota Statutes 2016, section 103I.005, subdivision 12, is amended to read:
Subd. 12.
Limited well/boring contractor.
"Limited well/boring contractor" means a
person with a limited well/boring contractor's license issued by the commissioner. Limited
well/boring contractor's licenses are issued fornew text begin :
new text end
new text begin (1)new text end constructing, repairing, and sealing bored geothermal heat exchangers;
new text begin (2)new text end installing, repairing, and modifying pitless units and pitless adaptors, well casings
above the pitless unit or pitless adaptor, well screens, deleted text begin ordeleted text end well diametersdeleted text begin ; constructing,
repairing, and sealing drive point wells or dug wellsdeleted text end new text begin , and well pumps and pumping
equipmentnew text end ;
new text begin (3)new text end constructing, repairing, and sealing dewatering wells;new text begin and
new text end
new text begin (4)new text end sealing wellsdeleted text begin ; and installing well pumps or pumping equipmentdeleted text end new text begin and boringsnew text end .
Sec. 6.
Minnesota Statutes 2016, section 103I.005, is amended by adding a subdivision
to read:
new text begin Subd. 17a. new text end
new text begin Temporary environmental well. new text end
new text begin
"Temporary environmental well" means
an environmental well as defined in section 103I.005, subdivision 8a, that is sealed within
72 hours of the time construction on the well begins.
new text end
Sec. 7.
Minnesota Statutes 2016, section 103I.005, subdivision 20a, is amended to read:
Subd. 20a.
Water supply well.
"Water supply well" means a well that is not a dewatering
well or deleted text begin monitoringdeleted text end new text begin environmentalnew text end well and includes wells used:
(1) for potable water supply;
(2) for irrigation;
(3) for agricultural, commercial, or industrial water supply;
(4) for heating or cooling;new text begin and
new text end
(5) deleted text begin as a remedial well; and
deleted text end
deleted text begin (6)deleted text end for testing water yield for irrigation, commercial or industrial uses, residential supply,
or public water supply.
Sec. 8.
Minnesota Statutes 2016, section 103I.005, subdivision 21, is amended to read:
Subd. 21.
Well.
"Well" means an excavation that is drilled, cored, bored, washed, driven,
dug, jetted, or otherwise constructed if the excavation is intended for the location, diversion,
artificial recharge, new text begin monitoring, testing, remediation, new text end or acquisition of groundwater. Well
includes deleted text begin monitoringdeleted text end new text begin environmentalnew text end wells, drive point wells, and dewatering wells. "Well"
does not include:
(1) an excavation by backhoe, or otherwise for temporary dewatering of groundwater
for nonpotable use during construction, if the depth of the excavation is 25 feet or less;
(2) an excavation made to obtain or prospect for oil, natural gas, minerals, or products
of mining or quarrying;
(3) an excavation to insert media to repressure oil or natural gas bearing formations or
to store petroleum, natural gas, or other products;
(4) an excavation for nonpotable use for wildfire suppression activities; or
(5) borings.
Sec. 9.
Minnesota Statutes 2016, section 103I.101, subdivision 2, is amended to read:
Subd. 2.
Duties.
The commissioner shall:
(1) regulate the drilling, construction, modification, repair, and sealing of wells and
borings;
(2) examine and licensenew text begin :
new text end
new text begin (i)new text end well contractors;
new text begin (ii)new text end persons constructing, repairing, and sealing bored geothermal heat exchangers;
new text begin (iii)new text end persons modifying or repairing well casingsnew text begin above the pitless unit or adaptornew text end , well
screens, deleted text begin ordeleted text end well diametersdeleted text begin ; persons constructing, repairing, and sealing drive point wells or
dug wellsdeleted text end new text begin , and installing well pumps or pumping equipmentnew text end ;
new text begin (iv)new text end persons constructing, repairing, and sealing dewatering wells;
new text begin (v)new text end persons sealing wellsdeleted text begin ; persons installing well pumps or pumping equipmentdeleted text end new text begin or
boringsnew text end ; and
new text begin (vi)new text end persons excavating or drilling holes for the installation of elevator borings deleted text begin or
hydraulic cylindersdeleted text end ;
(3) deleted text begin registerdeleted text end new text begin examinenew text end and deleted text begin examine monitoringdeleted text end new text begin license environmentalnew text end well contractors;
(4) license explorers engaged in exploratory boring and examine individuals who
supervise or oversee exploratory boring;
(5) after consultation with the commissioner of natural resources and the Pollution
Control Agency, establish standards for the design, location, construction, repair, and sealing
of wells and borings within the state; and
(6) issue permits for wells, groundwater thermal devices, bored geothermal heat
exchangers, and elevator borings.
Sec. 10.
Minnesota Statutes 2016, section 103I.101, subdivision 5, is amended to read:
Subd. 5.
Commissioner to adopt rules.
The commissioner shall adopt rules including:
(1) issuance of licenses for:
(i) qualified well contractorsdeleted text begin , persons modifying or repairing well casings, well screens,
or well diametersdeleted text end ;
(ii) deleted text begin persons constructing, repairing, and sealing drive point wells or dug wells;
deleted text end
deleted text begin (iii)deleted text end persons constructing, repairing, and sealing dewatering wells;
deleted text begin (iv)deleted text end new text begin (iii)new text end persons sealing wellsnew text begin or boringsnew text end ;
deleted text begin (v)deleted text end new text begin (iv)new text end persons installingnew text begin , modifying, or repairing well casings, well screens, well
diameters, andnew text end well pumps or pumping equipment;
deleted text begin (vi)deleted text end new text begin (v)new text end persons constructing, repairing, and sealing bored geothermal heat exchangers;
deleted text begin and
deleted text end
deleted text begin (vii)deleted text end new text begin (vi)new text end persons constructing, repairing, and sealing elevator borings;new text begin and
new text end
new text begin
(vii) persons constructing, repairing, and sealing environmental wells;
new text end
(2) deleted text begin issuance of registration for monitoring well contractors;
deleted text end
deleted text begin (3)deleted text end establishment of conditions for examination and review of applications for license
and deleted text begin registrationdeleted text end new text begin certificationnew text end ;
deleted text begin (4)deleted text end new text begin (3)new text end establishment of conditions for revocation and suspension of license and
deleted text begin registrationdeleted text end new text begin certificationnew text end ;
deleted text begin (5)deleted text end new text begin (4)new text end establishment of minimum standards for design, location, construction, repair,
and sealing of wells and borings to implement the purpose and intent of this chapter;
deleted text begin (6)deleted text end new text begin (5)new text end establishment of a system for reporting on wells and borings drilled and sealed;
deleted text begin (7)deleted text end new text begin (6)new text end establishment of standards for the construction, maintenance, sealing, and water
quality monitoring of wells in areas of known or suspected contamination;
deleted text begin (8)deleted text end new text begin (7)new text end establishment of wellhead protection measures for wells serving public water
supplies;
deleted text begin (9)deleted text end new text begin (8)new text end establishment of procedures to coordinate collection of well and boring data with
other state and local governmental agencies;
deleted text begin (10)deleted text end new text begin (9)new text end establishment of criteria and procedures for submission of well and boring logs,
formation samples or well or boring cuttings, water samples, or other special information
required for and water resource mapping; and
deleted text begin (11)deleted text end new text begin (10)new text end establishment of minimum standards for design, location, construction,
maintenance, repair, sealing, safety, and resource conservation related to borings, including
exploratory borings as defined in section 103I.005, subdivision 9.
Sec. 11.
Minnesota Statutes 2016, section 103I.101, subdivision 6, is amended to read:
Subd. 6.
Fees for variances.
The commissioner shall charge a nonrefundable application
fee of deleted text begin $235deleted text end new text begin $275new text end to cover the administrative cost of processing a request for a variance or
modification of rules adopted by the commissioner under this chapter.
Sec. 12.
Minnesota Statutes 2016, section 103I.105, is amended to read:
103I.105 ADVISORY COUNCIL ON WELLS AND BORINGS.
(a) The Advisory Council on Wells and Borings is established as an advisory council
to the commissioner. The advisory council shall consist of 18 voting members. Of the 18
voting members:
(1) one member must be from the Department of Health, appointed by the commissioner
of health;
(2) one member must be from the Department of Natural Resources, appointed by the
commissioner of natural resources;
(3) one member must be a member of the Minnesota Geological Survey of the University
of Minnesota, appointed by the director;
(4) one member must be a responsible individual for a licensed explorer;
(5) one member must be a certified representative of a licensed elevator boring contractor;
(6) two members must be members of the public who are not connected with the boring
or well drilling industry;
(7) one member must be from the Pollution Control Agency, appointed by the
commissioner of the Pollution Control Agency;
(8) one member must be from the Department of Transportation, appointed by the
commissioner of transportation;
(9) one member must be from the Board of Water and Soil Resources appointed by its
chair;
(10) one member must be a certified representative of deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end
well contractor;
(11) six members must be residents of this state appointed by the commissioner, who
are certified representatives of licensed well contractors, with not more than two from the
seven-county metropolitan area and at least four from other areas of the state who represent
different geographical regions; and
(12) one member must be a certified representative of a licensed bored geothermal heat
exchanger contractor.
(b) An appointee of the well drilling industry may not serve more than two consecutive
terms.
(c) The appointees to the advisory council from the well drilling industry must:
(1) have been residents of this state for at least three years before appointment; and
(2) have at least five years' experience in the well drilling business.
(d) The terms of the appointed members and the compensation and removal of all
members are governed by section 15.059.
Sec. 13.
Minnesota Statutes 2016, section 103I.111, subdivision 6, is amended to read:
Subd. 6.
Unsealed wells new text begin and borings new text end are public health nuisances.
A well new text begin or boring
new text end that is required to be sealed under section 103I.301 but is not sealed is a public health
nuisance. A county may abate the unsealed well new text begin or boring new text end with the same authority of a
community health board to abate a public health nuisance under section 145A.04, subdivision
8.
Sec. 14.
Minnesota Statutes 2016, section 103I.111, subdivision 8, is amended to read:
Subd. 8.
Municipal regulation of drilling.
A municipality may regulate all drilling,
except well, elevator deleted text begin shaftdeleted text end new text begin boringnew text end , and exploratory drilling that is subject to the provisions
of this chapter, above, in, through, and adjacent to subsurface areas designated for mined
underground space development and existing mined underground space. The regulations
may prohibit, restrict, control, and require permits for the drilling.
Sec. 15.
Minnesota Statutes 2016, section 103I.205, subdivision 1, is amended to read:
Subdivision 1.
Notification required.
(a) Except as provided in deleted text begin paragraphsdeleted text end new text begin paragraphnew text end
(d) deleted text begin and (e)deleted text end , a person may not construct a new text begin water-supply, dewatering, or environmental new text end well
until a notification of the proposed well on a form prescribed by the commissioner is filed
with the commissioner with the filing fee in section 103I.208, and, when applicable, the
person has met the requirements of paragraph deleted text begin (f)deleted text end new text begin (e)new text end . If after filing the well notification an
attempt to construct a well is unsuccessful, a new notification is not required unless the
information relating to the successful well has substantially changed.new text begin A notification is not
required prior to construction of a temporary environmental well.
new text end
(b) The property owner, the property owner's agent, or the deleted text begin welldeleted text end new text begin licensednew text end contractor where
a well is to be located must file the well notification with the commissioner.
(c) The well notification under this subdivision preempts local permits and notifications,
and counties or home rule charter or statutory cities may not require a permit or notification
for wells unless the commissioner has delegated the permitting or notification authority
under section 103I.111.
(d) A person who is an individual that constructs a drive point new text begin water-supply new text end well on
property owned or leased by the individual for farming or agricultural purposes or as the
individual's place of abode must notify the commissioner of the installation and location of
the well. The person must complete the notification form prescribed by the commissioner
and mail it to the commissioner by ten days after the well is completed. A fee may not be
charged for the notification. A person who sells drive point wells at retail must provide
buyers with notification forms and informational materials including requirements regarding
wells, their location, construction, and disclosure. The commissioner must provide the
notification forms and informational materials to the sellers.
deleted text begin
(e) A person may not construct a monitoring well until a permit is issued by the
commissioner for the construction. If after obtaining a permit an attempt to construct a well
is unsuccessful, a new permit is not required as long as the initial permit is modified to
indicate the location of the successful well.
deleted text end
deleted text begin (f)deleted text end new text begin (e)new text end When the operation of a well will require an appropriation permit from the
commissioner of natural resources, a person may not begin construction of the well until
the person submits the following information to the commissioner of natural resources:
(1) the location of the well;
(2) the formation or aquifer that will serve as the water source;
(3) the maximum daily, seasonal, and annual pumpage rates and volumes that will be
requested in the appropriation permit; and
(4) other information requested by the commissioner of natural resources that is necessary
to conduct the preliminary assessment required under section 103G.287, subdivision 1,
paragraph (c).
The person may begin construction after receiving preliminary approval from the
commissioner of natural resources.
Sec. 16.
Minnesota Statutes 2016, section 103I.205, subdivision 2, is amended to read:
Subd. 2.
Emergency permit and notification exemptions.
The commissioner may
adopt rules that modify the procedures for filing a well notification or well new text begin or boring new text end permit
if conditions occur that:
(1) endanger the public health and welfare or cause a need to protect the groundwater;
or
(2) require the deleted text begin monitoringdeleted text end new text begin environmentalnew text end well contractor, limited well/boring contractor,
or well contractor to begin constructing a well new text begin or boring new text end before obtaining a permit or
notification.
Sec. 17.
Minnesota Statutes 2016, section 103I.205, subdivision 3, is amended to read:
Subd. 3.
Maintenance permit.
(a) Except as provided under paragraph (b), a well that
is not in use must be sealed or have a maintenance permit.
(b) If deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well or a dewatering well is not sealed by 14 months
after completion of construction, the owner of the property on which the well is located
must obtain and annually renew a maintenance permit from the commissioner.
Sec. 18.
Minnesota Statutes 2016, section 103I.205, subdivision 4, is amended to read:
Subd. 4.
License required.
(a) Except as provided in paragraph (b), (c), (d), or (e),
section 103I.401, subdivision 2, or 103I.601, subdivision 2, a person may not drill, construct,
repair, or seal a well or boring unless the person has a well contractor's license in possession.
(b) A person may construct, repair, and seal deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well if the
person:
(1) is a professional engineer licensed under sections 326.02 to 326.15 in the branches
of civil or geological engineering;
(2) is a hydrologist or hydrogeologist certified by the American Institute of Hydrology;
(3) is a professional geoscientist licensed under sections 326.02 to 326.15;
(4) is a geologist certified by the American Institute of Professional Geologists; or
(5) meets the qualifications established by the commissioner in rule.
A person must deleted text begin register withdeleted text end new text begin be licensed bynew text end the commissioner as deleted text begin a monitoringdeleted text end new text begin an
environmentalnew text end well contractor on forms provided by the commissioner.
(c) A person may do the following work with a limited well/boring contractor's license
in possession. A separate license is required for each of the deleted text begin sixdeleted text end new text begin fournew text end activities:
(1) installing deleted text begin ordeleted text end new text begin ,new text end repairingnew text begin , and modifyingnew text end well screens deleted text begin ordeleted text end new text begin ,new text end pitless units deleted text begin ordeleted text end new text begin andnew text end pitless
adaptorsnew text begin , well pumps and pumping equipment,new text end and well casings from the pitless adaptor or
pitless unit to the upper termination of the well casing;
(2) deleted text begin constructing, repairing, and sealing drive point wells or dug wells;
deleted text end
deleted text begin
(3) installing well pumps or pumping equipment;
deleted text end
deleted text begin (4)deleted text end sealing wellsnew text begin and boringsnew text end ;
deleted text begin (5)deleted text end new text begin (3)new text end constructing, repairing, deleted text begin ordeleted text end new text begin andnew text end sealing dewatering wells; or
deleted text begin (6)deleted text end new text begin (4)new text end constructing, repairing, deleted text begin ordeleted text end new text begin andnew text end sealing bored geothermal heat exchangers.
(d) A person may construct, repair, and seal an elevator boring with an elevator boring
contractor's license.
(e) Notwithstanding other provisions of this chapter requiring a license deleted text begin or registrationdeleted text end ,
a license deleted text begin or registrationdeleted text end is not required for a person who complies with the other provisions
of this chapter if the person is:
(1) an individual who constructs a new text begin water-supply new text end well on land that is owned or leased by
the individual and is used by the individual for farming or agricultural purposes or as the
individual's place of abode;
(2) an individual who performs labor or services for a contractor licensed deleted text begin or registereddeleted text end
under the provisions of this chapter in connection with the construction, sealing, or repair
of a well or boring at the direction and under the personal supervision of a contractor licensed
deleted text begin or registereddeleted text end under the provisions of this chapter; or
(3) a licensed plumber who is repairing submersible pumps or water pipes associated
with well water systems if: (i) the repair location is within an area where there is no licensed
deleted text begin or registereddeleted text end well contractor within 50 miles, and (ii) the licensed plumber complies with
all relevant sections of the plumbing code.
Sec. 19.
Minnesota Statutes 2016, section 103I.205, subdivision 5, is amended to read:
Subd. 5.
At-grade deleted text begin monitoringdeleted text end new text begin environmentalnew text end wells.
At-grade deleted text begin monitoringdeleted text end new text begin environmentalnew text end
wells are authorized without variance and may be installed for the purpose of evaluating
groundwater conditions or for use as a leak detection device. An at-grade deleted text begin monitoringdeleted text end new text begin
environmentalnew text end well must be installed in accordance with the rules of the commissioner. The
at-grade deleted text begin monitoringdeleted text end new text begin environmentalnew text end wells must be installed with an impermeable double
locking cap approved by the commissioner and must be labeled new text begin environmental or new text end monitoring
wells.
Sec. 20.
Minnesota Statutes 2016, section 103I.205, subdivision 6, is amended to read:
Subd. 6.
Distance requirements for sources of contaminationnew text begin buildings, gas pipes,
liquid propane tanks, and electric linesnew text end .
(a) A person may not place, construct, or install
an actual or potential source of contaminationnew text begin , building, gas pipe, liquid propane tank, or
electric linenew text end any closer to a well new text begin or boring new text end than the isolation distances prescribed by the
commissioner by rule unless a variance has been prescribed by rule.
(b) The commissioner shall establish by rule reduced isolation distances for facilities
which have safeguards in accordance with sections 18B.01, subdivision 26, and 18C.005,
subdivision 29.
Sec. 21.
Minnesota Statutes 2016, section 103I.208, subdivision 1, is amended to read:
Subdivision 1.
Well notification fee.
The well notification fee to be paid by a property
owner is:
(1) for new text begin construction of new text end a deleted text begin newdeleted text end water supply well, deleted text begin $235deleted text end new text begin $275new text end , which includes the state
core function fee;
(2) for a well sealing, deleted text begin $65deleted text end new text begin $75new text end for each well, which includes the state core function fee,
except that new text begin a single fee of $75 is required new text end for deleted text begin monitoringdeleted text end new text begin all temporary environmentalnew text end wells
deleted text begin constructed ondeleted text end new text begin recorded on the sealing notification fornew text end a single property, having depths
within a 25 foot range, and sealed within deleted text begin 48deleted text end new text begin 72new text end hours of start of constructiondeleted text begin , a single fee
of $65deleted text end ; deleted text begin and
deleted text end
(3) for construction of a dewatering well, deleted text begin $235deleted text end new text begin $275new text end , which includes the state core
function fee, for each dewatering well except a dewatering project comprising five or more
dewatering wells shall be assessed a single fee of deleted text begin $1,175deleted text end new text begin $1,375new text end for the dewatering wells
recorded on the notificationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) for construction of an environmental well, $275, which includes the state core function
fee, except that a single fee of $275 is required for all environmental wells recorded on the
notification that are located on a single property, and except that no fee is required for
construction of a temporary environmental well.
new text end
Sec. 22.
Minnesota Statutes 2016, section 103I.208, subdivision 2, is amended to read:
Subd. 2.
Permit fee.
The permit fee to be paid by a property owner is:
(1) for a water supply well that is not in use under a maintenance permit, $175 annually;
(2) deleted text begin for construction of a monitoring well, $235, which includes the state core function
fee;
deleted text end
deleted text begin (3)deleted text end for deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well that is unsealed under a maintenance permit,
$175 annuallynew text begin except no fee is required for an environmental well owned by a federal
agency, state agency, or local unit of government that is unsealed under a maintenance
permit. "Local unit of government" means a statutory or home rule charter city, town, county,
or soil and water conservation district, watershed district, an organization formed for the
joint exercise of powers under section 471.59, a community health board, or other special
purpose district or authority with local jurisdiction in water and related land resources
managementnew text end ;
deleted text begin
(4) for a monitoring well owned by a federal agency, state agency, or local unit of
government that is unsealed under a maintenance permit, $50 annually. "Local unit of
government" means a statutory or home rule charter city, town, county, or soil and water
conservation district, watershed district, an organization formed for the joint exercise of
powers under section 471.59, a community health board, or other special purpose district
or authority with local jurisdiction in water and related land resources management;
deleted text end
deleted text begin (5)deleted text end new text begin (3)new text end for deleted text begin monitoringdeleted text end new text begin environmentalnew text end wells deleted text begin used as a leak detection device at a single
motor fuel retail outlet, a single petroleum bulk storage site excluding tank farms, or a single
agricultural chemical facility site, the construction permit fee is $235, which includes the
state core function fee, per site regardless of the number of wells constructed on the site,
and the annual fee fordeleted text end new text begin that are unsealed undernew text end a maintenance permit deleted text begin for unsealed monitoring
wells isdeleted text end new text begin ,new text end $175 new text begin annually new text end per site regardless of the number of deleted text begin monitoringdeleted text end new text begin environmentalnew text end wells
located on site;
deleted text begin (6)deleted text end new text begin (4)new text end for a groundwater thermal exchange device, in addition to the notification fee
for water supply wells, deleted text begin $235deleted text end new text begin $275new text end , which includes the state core function fee;
deleted text begin (7)deleted text end new text begin (5)new text end for a bored geothermal heat exchanger with less than ten tons of heating/cooling
capacity, deleted text begin $235deleted text end new text begin $275new text end ;
deleted text begin (8)deleted text end new text begin (6)new text end for a bored geothermal heat exchanger with ten to 50 tons of heating/cooling
capacity, deleted text begin $475deleted text end new text begin $515new text end ;
deleted text begin (9)deleted text end new text begin (7)new text end for a bored geothermal heat exchanger with greater than 50 tons of heating/cooling
capacity, deleted text begin $700deleted text end new text begin $740new text end ;
deleted text begin (10)deleted text end new text begin (8)new text end for a dewatering well that is unsealed under a maintenance permit, $175 annually
for each dewatering well, except a dewatering project comprising more than five dewatering
wells shall be issued a single permit for $875 annually for dewatering wells recorded on
the permit; and
deleted text begin (11)deleted text end new text begin (9)new text end for an elevator boring, deleted text begin $235deleted text end new text begin $275new text end for each boring.
Sec. 23.
Minnesota Statutes 2016, section 103I.235, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Temporary environmental well and unsuccessful well exemption. new text end
new text begin
This
section does not apply to temporary environmental wells or unsuccessful wells that have
been sealed by a licensed contractor in compliance with this chapter.
new text end
Sec. 24.
Minnesota Statutes 2016, section 103I.301, subdivision 1, is amended to read:
Subdivision 1.
Wells and borings.
(a) A property owner must have a well or boring
sealed if:
(1) the well or boring is contaminated or may contribute to the spread of contamination;
(2) the well or boring was attempted to be sealed but was not sealed according to the
provisions of this chapter; or
(3) the well or boring is located, constructed, or maintained in a manner that its continued
use or existence endangers groundwater quality or is a safety or health hazard.
(b) A well new text begin or boring new text end that is not in use must be sealed unless the property owner has a
maintenance permit for the well.
(c) The property owner must have a well or boring sealed by a deleted text begin registered ordeleted text end licensed
person authorized to seal the well or boring, consistent with provisions of this chapter.
Sec. 25.
Minnesota Statutes 2016, section 103I.301, subdivision 2, is amended to read:
Subd. 2.
deleted text begin Monitoringdeleted text end new text begin Environmental new text end wells.
The owner of the property where deleted text begin a
monitoringdeleted text end new text begin an environmentalnew text end well is located must have the deleted text begin monitoringdeleted text end new text begin environmentalnew text end well
sealed when the well is no longer in use. The owner must have a well contractor, limited
well/boring sealing contractor, or deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well contractor seal the
deleted text begin monitoringdeleted text end new text begin environmentalnew text end well.
Sec. 26.
Minnesota Statutes 2016, section 103I.315, subdivision 1, is amended to read:
Subdivision 1.
Order to seal well or boring.
The commissioner may order a property
owner to seal a well or boring if:
(1) the commissioner determines that without being sealed the well or boring is an
imminent threat to public health or public safety;
(2) the well or boring is required to be sealed under section 103I.301; or
(3) a well is deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well or dewatering well and by 14 months
after construction of the well, the owner has not obtained a maintenance permit, or after a
maintenance permit has been issued the owner has not renewed a maintenance permit.
Sec. 27.
Minnesota Statutes 2016, section 103I.501, is amended to read:
103I.501 LICENSING AND REGULATION OF WELLS AND BORINGS.
(a) The commissioner shall regulate and license:
(1) drilling, constructing, and repair of wells;
(2) sealing of wells;
(3) installing of well pumps and pumping equipment;
(4) excavating, drilling, repairing, and sealing of elevator borings;
(5) construction, repair, and sealing of environmental deleted text begin bore holesdeleted text end new text begin wellsnew text end ; and
(6) construction, repair, and sealing of bored geothermal heat exchangers.
(b) The commissioner shall examine and license well contractors, limited well/boring
contractors, deleted text begin anddeleted text end elevator boring contractors, and deleted text begin examine and register monitoringdeleted text end new text begin
environmentalnew text end well contractors.
(c) The commissioner shall license explorers engaged in exploratory boring and shall
examine persons who supervise or oversee exploratory boring.
Sec. 28.
Minnesota Statutes 2016, section 103I.505, subdivision 1, is amended to read:
Subdivision 1.
Reciprocity authorized.
The commissioner may issue a license or deleted text begin registerdeleted text end new text begin
certifynew text end a person under this chapter, without giving an examination, if the person is licensed
or deleted text begin registereddeleted text end new text begin certifiednew text end in another state and:
(1) the requirements for licensing or deleted text begin registrationdeleted text end new text begin certificationnew text end under which the well or
boring contractor was licensed or deleted text begin registereddeleted text end new text begin person was certifiednew text end do not conflict with this
chapter;
(2) the requirements are of a standard not lower than that specified by the rules adopted
under this chapter; and
(3) equal reciprocal privileges are granted to licensees or deleted text begin registrantsdeleted text end new text begin certified personsnew text end
of this state.
Sec. 29.
Minnesota Statutes 2016, section 103I.505, subdivision 2, is amended to read:
Subd. 2.
Fees required.
A well or boring contractor new text begin or certified person new text end must apply for
the license or deleted text begin registrationdeleted text end new text begin certificationnew text end and pay the fees under the provisions of this chapter
to receive a license or deleted text begin registrationdeleted text end new text begin certificationnew text end under this section.
Sec. 30.
Minnesota Statutes 2016, section 103I.515, is amended to read:
103I.515 LICENSES NOT TRANSFERABLE.
A license or deleted text begin registrationdeleted text end new text begin certificationnew text end issued under this chapter is not transferable.
Sec. 31.
Minnesota Statutes 2016, section 103I.525, subdivision 1, is amended to read:
Subdivision 1.
Certification application.
(a) A person must file an application and
application fee with the commissioner to represent a well contractor.
(b) The application must state the applicant's qualifications for certification as a
representative, and other information required by the commissioner. The application must
be on forms prescribed by the commissioner.
deleted text begin
(c) A person may apply as an individual if the person:
deleted text end
deleted text begin
(1) is not representing a firm, sole proprietorship, partnership, association, corporation,
or other entity including the United States government, any interstate body, the state, and
an agency, department, or political subdivision of the state; and
deleted text end
deleted text begin
(2) meets the well contractor certification and license requirements under this chapter.
deleted text end
Sec. 32.
Minnesota Statutes 2016, section 103I.525, subdivision 2, is amended to read:
Subd. 2.
Certification fee.
(a) The application fee for certification as a representative
of a well contractor is $75. The commissioner may not act on an application until the
application fee is paid.
(b) The renewal fee for certification as a representative of a well contractor is $75. The
commissioner may not renew a certification until the renewal fee is paid.
new text begin
(c) A certified representative must file an application and a renewal application fee to
renew the certification by the date stated in the certification. The renewal application must
include information that the certified representative has met continuing education
requirements established by the commissioner by rule.
new text end
Sec. 33.
Minnesota Statutes 2016, section 103I.525, subdivision 5, is amended to read:
Subd. 5.
Bond.
(a) As a condition of being issued a well contractor's license, the applicantdeleted text begin ,
except a person applying for an individual well contractor's license,deleted text end must submit a corporate
surety bond for $25,000 approved by the commissioner. The bond must be conditioned to
pay the state on performance of work in this state that is not in compliance with this chapter
or rules adopted under this chapter. The bond is in lieu of other license bonds required by
a political subdivision of the state.
(b) From proceeds of the bond, the commissioner may compensate persons injured or
suffering financial loss because of a failure of the applicant to perform work or duties in
compliance with this chapter or rules adopted under this chapter.
Sec. 34.
Minnesota Statutes 2016, section 103I.525, subdivision 6, is amended to read:
Subd. 6.
License fee.
The fee for a well contractor's license is $250deleted text begin , except the fee for
an individual well contractor's license is $75deleted text end .
Sec. 35.
Minnesota Statutes 2016, section 103I.525, subdivision 8, is amended to read:
Subd. 8.
Renewal.
(a) A licensee must file an application and a renewal application fee
to renew the license by the date stated in the license.
(b) The renewal application fee for a well contractor's license is $250deleted text begin , except the fee for
an individual well contractor's license is $75deleted text end .
(c) The renewal application must include information that the certified representative
of the applicant has met continuing education requirements established by the commissioner
by rule.
(d) At the time of the renewal, the commissioner must have on file all properly completed
well and boring construction reports, well and boring sealing reports, reports of elevator
borings, water sample analysis reports, well and boring permits, and well notifications for
work conducted by the licensee since the last license renewal.
Sec. 36.
Minnesota Statutes 2016, section 103I.531, subdivision 2, is amended to read:
Subd. 2.
Certification fee.
(a) The application fee for certification as a representative
of a limited well/boring contractor is $75. The commissioner may not act on an application
until the application fee is paid.
(b) The renewal fee for certification as a representative of a limited well/boring contractor
is $75. The commissioner may not renew a certification until the renewal fee is paid.
new text begin
(c) The fee for three or more limited well/boring contractor certifications is $225.
new text end
new text begin
(d) A certified representative must file an application and a renewal application fee to
renew the certification by the date stated in the certification. The renewal application must
include information that the certified representative has met continuing education
requirements established by the commissioner by rule.
new text end
Sec. 37.
Minnesota Statutes 2016, section 103I.531, subdivision 5, is amended to read:
Subd. 5.
Bond.
(a) As a condition of being issued a limited well/boring contractor's
license for deleted text begin constructing, repairing, and sealing drive point wells or dug wells,deleted text end sealing wells
deleted text begin ordeleted text end new text begin andnew text end borings, constructing, repairing, and sealing dewatering wells, or constructing,
repairing, and sealing bored geothermal heat exchangers, the applicant must submit a
corporate surety bond for $10,000 approved by the commissioner. As a condition of being
issued a limited well/boring contractor's license for installing deleted text begin ordeleted text end new text begin ,new text end repairingnew text begin , and modifying
well pumps and pumping equipment,new text end well screens deleted text begin ordeleted text end new text begin ,new text end pitless units deleted text begin ordeleted text end new text begin andnew text end pitless adaptorsnew text begin ,new text end
and well casings from the pitless adaptor or pitless unit to the upper termination of the well
casing, deleted text begin or installing well pumps or pumping equipment,deleted text end the applicant must submit a corporate
surety bond for $2,000 approved by the commissioner. The bonds required in this paragraph
must be conditioned to pay the state on performance of work in this state that is not in
compliance with this chapter or rules adopted under this chapter. The bonds are in lieu of
other license bonds required by a political subdivision of the state.
(b) From proceeds of a bond required in paragraph (a), the commissioner may compensate
persons injured or suffering financial loss because of a failure of the applicant to perform
work or duties in compliance with this chapter or rules adopted under this chapter.
Sec. 38.
Minnesota Statutes 2016, section 103I.535, subdivision 2, is amended to read:
Subd. 2.
Certification fee.
(a) The application fee for certification as a representative
of an elevator boring contractor is $75. The commissioner may not act on an application
until the application fee is paid.
(b) The renewal fee for certification as a representative of an elevator boring contractor
is $75. The commissioner may not renew a certification until the renewal fee is paid.
new text begin
(c) A certified representative must file an application and a renewal application fee to
renew the certification by the date stated in the certification. The renewal application must
include information that the certified representative has met continuing education
requirements established by the commissioner by rule.
new text end
Sec. 39.
Minnesota Statutes 2016, section 103I.535, subdivision 6, is amended to read:
Subd. 6.
License fee.
The fee for an elevator deleted text begin shaftdeleted text end new text begin boringnew text end contractor's license is $75.
Sec. 40.
Minnesota Statutes 2016, section 103I.541, subdivision 1, is amended to read:
Subdivision 1.
deleted text begin Registrationdeleted text end new text begin Certificationnew text end .
A person seeking deleted text begin registration as a monitoringdeleted text end new text begin
certification to represent an environmentalnew text end well contractor must meet examination and
experience requirements adopted by the commissioner by rule.
Sec. 41.
Minnesota Statutes 2016, section 103I.541, subdivision 2, is amended to read:
Subd. 2.
Validity.
deleted text begin A monitoringdeleted text end new text begin An environmentalnew text end well contractor's deleted text begin registrationdeleted text end new text begin
certificationnew text end is valid until the date prescribed in the deleted text begin registrationdeleted text end new text begin certificationnew text end by the
commissioner.
Sec. 42.
Minnesota Statutes 2016, section 103I.541, subdivision 2a, is amended to read:
Subd. 2a.
Certification application.
(a) An individual must submit an application and
application fee to the commissioner to apply for certification as a representative of deleted text begin a
monitoringdeleted text end new text begin an environmentalnew text end well contractor.
(b) The application must be on forms prescribed by the commissioner. The application
must state the applicant's qualifications for the certification, and other information required
by the commissioner.
Sec. 43.
Minnesota Statutes 2016, section 103I.541, subdivision 2b, is amended to read:
Subd. 2b.
Issuance of deleted text begin registrationdeleted text end new text begin licensenew text end .
If a person employs a certified representative,
submits the bond under subdivision 3, and pays the deleted text begin registrationdeleted text end new text begin licensenew text end fee of $75 for deleted text begin a
monitoringdeleted text end new text begin an environmentalnew text end well contractor deleted text begin registrationdeleted text end new text begin licensenew text end , the commissioner shall
issue deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well contractor deleted text begin registrationdeleted text end new text begin licensenew text end to the applicant.
The fee for an individual registration is $75. The commissioner may not act on an application
until the application fee is paid.
Sec. 44.
Minnesota Statutes 2016, section 103I.541, subdivision 2c, is amended to read:
Subd. 2c.
Certification fee.
(a) The application fee for certification as a representative
of deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well contractor is $75. The commissioner may not act on
an application until the application fee is paid.
(b) The renewal fee for certification as a representative of deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end
well contractor is $75. The commissioner may not renew a certification until the renewal
fee is paid.
new text begin
(c) A certified representative must file an application and a renewal application fee to
renew the certification by the date stated in the certification. The renewal application must
include information that the certified representative has met continuing education
requirements established by the commissioner by rule.
new text end
Sec. 45.
Minnesota Statutes 2016, section 103I.541, subdivision 2e, is amended to read:
Subd. 2e.
Issuance of certification.
If the applicant meets the experience requirements
established by rule and passes the examination as determined by the commissioner, the
commissioner shall issue the applicant a certification to represent deleted text begin a monitoringdeleted text end new text begin an
environmentalnew text end well contractor.
Sec. 46.
Minnesota Statutes 2016, section 103I.541, subdivision 3, is amended to read:
Subd. 3.
Bond.
(a) As a condition of being issued deleted text begin a monitoringdeleted text end new text begin an environmentalnew text end well
contractor's deleted text begin registrationdeleted text end new text begin licensenew text end , the applicant must submit a corporate surety bond for
$10,000 approved by the commissioner. The bond must be conditioned to pay the state on
performance of work in this state that is not in compliance with this chapter or rules adopted
under this chapter. The bond is in lieu of other license bonds required by a political
subdivision of the state.
(b) From proceeds of the bond, the commissioner may compensate persons injured or
suffering financial loss because of a failure of the applicant to perform work or duties in
compliance with this chapter or rules adopted under this chapter.
Sec. 47.
Minnesota Statutes 2016, section 103I.541, subdivision 4, is amended to read:
Subd. 4.
new text begin License new text end renewal.
(a) A person must file an application and a renewal application
fee to renew the deleted text begin registrationdeleted text end new text begin licensenew text end by the date stated in the deleted text begin registrationdeleted text end new text begin licensenew text end .
(b) The renewal application fee for deleted text begin a monitoringdeleted text end new text begin an environmental new text end well contractor's
deleted text begin registrationdeleted text end new text begin licensenew text end is $75.
(c) The renewal application must include information that the certified representative
of the applicant has met continuing education requirements established by the commissioner
by rule.
(d) At the time of the renewal, the commissioner must have on file all well and boring
construction reports, well and boring sealing reports, well permits, and notifications for
work conducted by the deleted text begin registereddeleted text end new text begin licensednew text end person since the last deleted text begin registrationdeleted text end new text begin licensenew text end renewal.
Sec. 48.
Minnesota Statutes 2016, section 103I.541, subdivision 5, is amended to read:
Subd. 5.
Incomplete or late renewal.
If a deleted text begin registereddeleted text end new text begin licensednew text end person submits a renewal
application after the required renewal date:
(1) the deleted text begin registereddeleted text end new text begin licensednew text end person must include a late fee of $75; and
(2) the deleted text begin registereddeleted text end new text begin licensednew text end person may not conduct activities authorized by the deleted text begin monitoringdeleted text end new text begin
environmentalnew text end well contractor's deleted text begin registrationdeleted text end new text begin licensenew text end until the renewal application, renewal
application fee, late fee, and all other information required in subdivision 4 are submitted.
Sec. 49.
Minnesota Statutes 2016, section 103I.545, is amended to read:
103I.545 REGISTRATION OF DRILLING MACHINES AND HOISTS
REQUIRED.
Subdivision 1.
Drilling machine.
(a) A person may not use a drilling machine such as
a cable tool, rotary tool, hollow rod tool, or auger for a drilling activity requiring a license
deleted text begin or registrationdeleted text end under this chapter unless the drilling machine is registered with the
commissioner.
(b) A person must apply for the registration on forms prescribed by the commissioner
and submit a $75 registration fee.
(c) A registration is valid for one year.
Subd. 2.
Hoist.
(a) A person may not use a machine such as a hoist for an activity
requiring a license deleted text begin or registrationdeleted text end under this chapter to repair wells or borings, seal wells
or borings, or install pumps unless the machine is registered with the commissioner.
(b) A person must apply for the registration on forms prescribed by the commissioner
and submit a $75 registration fee.
(c) A registration is valid for one year.
Sec. 50.
new text begin
[103I.550] LIMITED PUMP, PITLESS, OR DUG WELL/DRIVE POINT
CONTRACTOR.
new text end
new text begin Subdivision 1. new text end
new text begin Limited pump or pitless license or certification. new text end
new text begin
A person with a limited
well/boring contractor's license or certification to install well pumps and pumping equipment;
or a person with a limited well/boring contractor's license or certification to install, repair,
and modify pitless units and pitless adapters, well casings above the pitless unit or pitless
adapter, and well screens and well diameters, will be issued a combined license or
certification to: (1) install well pumps and pumping equipment; and (2) install, repair, and
modify pitless units and pitless adapters, well casings above the pitless unit or pitless adapter,
well screens, and well diameters.
new text end
new text begin Subd. 2. new text end
new text begin Limited dug well/drive point license or certification. new text end
new text begin
A person with a limited
well/boring contractor's license or certification to construct, repair, and seal drive point
wells and dug wells will be issued a well contractor's license or certification.
new text end
Sec. 51.
Minnesota Statutes 2016, section 103I.601, subdivision 2, is amended to read:
Subd. 2.
License required to make borings.
(a) Except as provided in paragraph (d),
a person must not make an exploratory boring without an explorer's license. The fee for an
explorer's license is $75. The explorer's license is valid until the date prescribed in the license
by the commissioner.
(b) A person must file an application and renewal application fee to renew the explorer's
license by the date stated in the license. The renewal application fee is $75.
(c) If the licensee submits an application fee after the required renewal date, the licensee:
(1) must include a late fee of $75; and
(2) may not conduct activities authorized by an explorer's license until the renewal
application, renewal application fee, late fee, and sealing reports required in subdivision 9
are submitted.
(d) An explorer must designate a responsible individual to supervise and oversee the
making of exploratory borings.
new text begin (1)new text end Before an individual supervises or oversees an exploratory boring, the individual
must file an application and application fee of $75 to qualify as a new text begin certified new text end responsible
individual.
new text begin (2)new text end The individual must take and pass an examination relating to construction, location,
and sealing of exploratory borings. A professional engineer or geoscientist licensed under
sections 326.02 to 326.15 or a professional geologist certified by the American Institute of
Professional Geologists is not required to take the examination required in this subdivision,
but must be certified as a responsible individual to supervise an exploratory boring.
new text begin
(3) The individual must file an application and a renewal fee of $75 to renew the
responsible individual's certification by the date stated in the certification. If the certified
responsible individual submits an application fee after the renewal date, the certified
responsible individual must include a late fee of $75 and may not supervise or oversee
exploratory borings until the renewal application, application fee, and late fee are submitted.
new text end
Sec. 52.
Minnesota Statutes 2016, section 103I.601, subdivision 4, is amended to read:
Subd. 4.
new text begin Notification and new text end map of borings.
new text begin
(a) By ten days before beginning exploratory
boring, an explorer must submit to the commissioner of health a notification of the proposed
boring on a form prescribed by the commissioner, and a fee of $275 for each exploratory
boring.
new text end
new text begin (b) new text end By ten days before beginning exploratory boring, an explorer must submit to the
commissioners of health and natural resources a county road map having a scale of one-half
inch equal to one mile, as prepared by the Department of Transportation, or a 7.5 minute
series topographic map (1:24,000 scale), as prepared by the United States Geological Survey,
showing the location of each proposed exploratory boring to the nearest estimated 40 acre
parcel. Exploratory boring that is proposed on the map may not be commenced later than
180 days after submission of the map, unless a new map is submitted.
Sec. 53.
Minnesota Statutes 2016, section 103I.711, subdivision 1, is amended to read:
Subdivision 1.
Impoundment.
The commissioner may apply to district court for a
warrant authorizing seizure and impoundment of all drilling machines or hoists owned or
used by a person. The court shall issue an impoundment order upon the commissioner's
showing that a person is constructing, repairing, or sealing wells or borings or installing
pumps or pumping equipment or excavating holes for installing elevator deleted text begin shaftsdeleted text end new text begin boringsnew text end
without a license deleted text begin or registrationdeleted text end as required under this chapter. A sheriff on receipt of the
warrant must seize and impound all drilling machines and hoists owned or used by the
person. A person from whom equipment is seized under this subdivision may file an action
in district court for the purpose of establishing that the equipment was wrongfully seized.
Sec. 54.
Minnesota Statutes 2016, section 103I.715, subdivision 2, is amended to read:
Subd. 2.
Gross misdemeanors.
A person is guilty of a gross misdemeanor who:
(1) willfully violates a provision of this chapter or order of the commissioner;
(2) engages in the business of drilling or making wells, sealing wells, installing pumps
or pumping equipment, or constructing elevator deleted text begin shaftsdeleted text end new text begin boringsnew text end without a license required
by this chapter; or
(3) engages in the business of exploratory boring without an exploratory borer's license
under this chapter.
Sec. 55.
new text begin
[144.0572] CRIMINAL HISTORY BACKGROUND CHECKS ON
APPLICANTS, LICENSEES, AND OTHER OCCUPATIONS REGULATED BY
COMMISSIONER OF HEALTH.
new text end
new text begin Subdivision 1. new text end
new text begin Criminal history background check requirements. new text end
new text begin
(a) Beginning
January 1, 2018, an applicant for initial licensure, temporary licensure, or relicensure after
a lapse in licensure as an occupational therapist, occupational therapy assistant, audiologist,
or speech-language pathologist, or an applicant for initial certification as a hearing instrument
dispenser, must submit to a criminal history records check of state data completed by the
Bureau of Criminal Apprehension (BCA) and a national criminal history records check,
including a search of the records of the Federal Bureau of Investigation (FBI).
new text end
new text begin
(b) Beginning January 1, 2020, an applicant for a renewal license or certificate as an
occupational therapist, occupational therapy assistant, audiologist, speech-language
pathologist, or hearing instrument dispenser who was licensed or obtained a certificate
before January 1, 2018, must submit to a criminal history records check of state data
completed by the BCA and a national criminal history records check, including a search of
the records of the FBI.
new text end
new text begin
(c) An applicant must submit to a background study under chapter 245C.
new text end
new text begin
(d) The criminal history records check must be structured so that any new crimes that
an applicant or licensee or certificate holder commits after the initial background check are
flagged in the BCA's or FBI's database and reported back to the commissioner of human
services.
new text end
new text begin Subd. 2. new text end
new text begin Procedures. new text end
new text begin
(a) The commissioner shall contract with the Department of Human
Services to process the criminal history background check requirements through NETStudy
2.0, as defined in section 245C.02.
new text end
new text begin
(b) The Department of Human Services shall conduct the criminal history background
checks according to section 144.057, except that:
new text end
new text begin
(1) all applicants must submit to a fingerprint-based criminal history records check of
state data completed by the BCA and a national criminal history records check, including
a search of the records of the FBI;
new text end
new text begin
(2) the Department of Human Services shall complete the check and the study and notify
the commissioner of health if the applicant, licensee, or certificate holder has a criminal
history as defined in section 245C.15; and
new text end
new text begin
(3) the Department of Human Services shall simultaneously conduct a background study
on each applicant according to chapter 245C.
new text end
new text begin
(c) When making a determination whether to issue a license, deny a license, or issue a
conditional license or other credential to practice an occupation regulated by the Department
of Health, the commissioner or the commissioner's designee shall evaluate a criminal
conviction, guilty plea, Alford plea, judicial determination, or preponderance of evidence
to determine an applicant's risk of harm using the criteria in section 364.03.
new text end
new text begin
(d) Before taking disciplinary action against an applicant or a licensee based on a criminal
conviction, judicial determination, admission in court, Alford plea, or preponderance of
evidence, the commissioner of health shall provide the applicant or licensee an opportunity
to complete or challenge the accuracy of the criminal history information. The applicant or
licensee shall have 30 calendar days following notice from the commissioner of the intent
to deny licensure or take disciplinary action to request an opportunity to correct or complete
the record prior to the commissioner taking disciplinary action. The commissioner shall
provide the applicant up to 180 days to challenge the accuracy or completeness of the report
with the agency responsible for the record. This subdivision does not affect the right of the
subject of the data to contest the accuracy or completeness under section 13.04, subdivision
4.
new text end
new text begin
(e) The checks and studies must be structured so that any new crimes that an applicant
or licensee commits after the initial background check are flagged in the BCA's or FBI's
database and reported back to the commissioner of human services.
new text end
new text begin Subd. 3. new text end
new text begin Applicant, licensee, or other regulated individual's responsibilities. new text end
new text begin
(a)
Applicants, licensees, and individuals seeking a credential to practice one of the public
health occupations listed in subdivision 1 must submit a complete criminal history records
check consent form, a complete background study consent form, and a full set of fingerprints
as required by the Department of Human Services in section 245C.05.
new text end
new text begin
(b) The applicant or license holder is responsible for paying to the Department of Human
Services all fees associated with the preparation of the fingerprints, the criminal records
check consent form, and the criminal background check.
new text end
Sec. 56.
Minnesota Statutes 2016, section 144.122, is amended to read:
144.122 LICENSE, PERMIT, AND SURVEY FEES.
(a) The state commissioner of health, by rule, may prescribe procedures and fees for
filing with the commissioner as prescribed by statute and for the issuance of original and
renewal permits, licenses, registrations, and certifications issued under authority of the
commissioner. The expiration dates of the various licenses, permits, registrations, and
certifications as prescribed by the rules shall be plainly marked thereon. Fees may include
application and examination fees and a penalty fee for renewal applications submitted after
the expiration date of the previously issued permit, license, registration, and certification.
The commissioner may also prescribe, by rule, reduced fees for permits, licenses,
registrations, and certifications when the application therefor is submitted during the last
three months of the permit, license, registration, or certification period. Fees proposed to
be prescribed in the rules shall be first approved by the Department of Management and
Budget. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be
in an amount so that the total fees collected by the commissioner will, where practical,
approximate the cost to the commissioner in administering the program. All fees collected
shall be deposited in the state treasury and credited to the state government special revenue
fund unless otherwise specifically appropriated by law for specific purposes.
(b) The commissioner may charge a fee for voluntary certification of medical laboratories
and environmental laboratories, and for environmental and medical laboratory services
provided by the department, without complying with paragraph (a) or chapter 14. Fees
charged for environment and medical laboratory services provided by the department must
be approximately equal to the costs of providing the services.
(c) The commissioner may develop a schedule of fees for diagnostic evaluations
conducted at clinics held by the services for children with disabilities program. All receipts
generated by the program are annually appropriated to the commissioner for use in the
maternal and child health program.
(d) The commissioner shall set license fees for hospitals and nursing homes that are not
boarding care homes at the following levels:
| Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and American Osteopathic Association (AOA) hospitals |
$7,655 plus $16 per bed |
| Non-JCAHO and non-AOA hospitals |
$5,280 plus $250 per bed |
| Nursing home |
$183 plus deleted text begin $91deleted text end new text begin $100new text end per bednew text begin between July 1, 2017, and June 30, 2019. $183 plus $105 per bed beginning July 1, 2019. new text end |
The commissioner shall set license fees for outpatient surgical centers, boarding care
homes, and supervised living facilities at the following levels:
| Outpatient surgical centers |
$3,712 |
| Boarding care homes |
$183 plus $91 per bed |
| Supervised living facilities |
$183 plus $91 per bed. |
new text begin
Fees collected under this paragraph are nonrefundable. The fees are nonrefundable even if
received before July 1, 2017, for licenses or registrations being issued effective July 1, 2017,
or later.
new text end
(e) Unless prohibited by federal law, the commissioner of health shall charge applicants
the following fees to cover the cost of any initial certification surveys required to determine
a provider's eligibility to participate in the Medicare or Medicaid program:
| Prospective payment surveys for hospitals |
$ |
900 |
| Swing bed surveys for nursing homes |
$ |
1,200 |
| Psychiatric hospitals |
$ |
1,400 |
| Rural health facilities |
$ |
1,100 |
| Portable x-ray providers |
$ |
500 |
| Home health agencies |
$ |
1,800 |
| Outpatient therapy agencies |
$ |
800 |
| End stage renal dialysis providers |
$ |
2,100 |
| Independent therapists |
$ |
800 |
| Comprehensive rehabilitation outpatient facilities |
$ |
1,200 |
| Hospice providers |
$ |
1,700 |
| Ambulatory surgical providers |
$ |
1,800 |
| Hospitals |
$ |
4,200 |
| Other provider categories or additional resurveys required to complete initial certification |
Actual surveyor costs: average surveyor cost x number of hours for the survey process. |
|
These fees shall be submitted at the time of the application for federal certification and
shall not be refunded. All fees collected after the date that the imposition of fees is not
prohibited by federal law shall be deposited in the state treasury and credited to the state
government special revenue fund.
Sec. 57.
Minnesota Statutes 2016, section 144.3831, subdivision 1, is amended to read:
Subdivision 1.
Fee setting.
The commissioner of health may assess an annual fee of
deleted text begin $6.36deleted text end new text begin $9new text end for every service connection to a public water supply that is owned or operated
by a home rule charter city, a statutory city, a city of the first class, or a town. The
commissioner of health may also assess an annual fee for every service connection served
by a water user district defined in section 110A.02.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2018.
new text end
Sec. 58.
Minnesota Statutes 2016, section 144A.472, subdivision 7, is amended to read:
Subd. 7.
Fees; application, change of ownership, and renewal.
(a) An initial applicant
seeking temporary home care licensure must submit the following application fee to the
commissioner along with a completed application:
(1) for a basic home care provider, $2,100; or
(2) for a comprehensive home care provider, $4,200.
(b) A home care provider who is filing a change of ownership as required under
subdivision 5 must submit the following application fee to the commissioner, along with
the documentation required for the change of ownership:
(1) for a basic home care provider, $2,100; or
(2) for a comprehensive home care provider, $4,200.
(c) A home care provider who is seeking to renew the provider's license shall pay a fee
to the commissioner based on revenues derived from the provision of home care services
during the calendar year prior to the year in which the application is submitted, according
to the following schedulenew text begin for the period between July 1, 2017, and June 30, 2019new text end :
License Renewal Fee
| Provider Annual Revenue |
Fee |
|
| greater than $1,500,000 |
deleted text begin
$6,625 deleted text end new text begin $7,287 new text end |
|
| greater than $1,275,000 and no more than $1,500,000 |
deleted text begin
$5,797 deleted text end new text begin $6,376 new text end |
|
| greater than $1,100,000 and no more than $1,275,000 |
deleted text begin
$4,969 deleted text end new text begin $5,466 new text end |
|
| greater than $950,000 and no more than $1,100,000 |
deleted text begin
$4,141 deleted text end new text begin $4,555 new text end |
|
| greater than $850,000 and no more than $950,000 |
deleted text begin
$3,727 deleted text end new text begin $4,099 new text end |
|
| greater than $750,000 and no more than $850,000 |
deleted text begin
$3,313 deleted text end new text begin $3,644 new text end |
|
| greater than $650,000 and no more than $750,000 |
deleted text begin
$2,898 deleted text end new text begin $3,188 new text end |
|
| greater than $550,000 and no more than $650,000 |
deleted text begin
$2,485 deleted text end new text begin $2,733 new text end |
|
| greater than $450,000 and no more than $550,000 |
deleted text begin
$2,070 deleted text end new text begin $2,277 new text end |
|
| greater than $350,000 and no more than $450,000 |
deleted text begin
$1,656 deleted text end new text begin $1,822 new text end |
|
| greater than $250,000 and no more than $350,000 |
deleted text begin
$1,242 deleted text end new text begin $1,366 new text end |
|
| greater than $100,000 and no more than $250,000 |
deleted text begin
$828 deleted text end new text begin $911 new text end |
|
| greater than $50,000 and no more than $100,000 |
deleted text begin
$500 deleted text end new text begin $550 new text end |
|
| greater than $25,000 and no more than $50,000 |
deleted text begin
$400 deleted text end new text begin $440 new text end |
|
| no more than $25,000 |
deleted text begin
$200 deleted text end new text begin $220 new text end |
new text begin
(d) Beginning July 1, 2019, a home care provider who is seeking to renew the provider's
license shall pay a fee to the commissioner based on revenues derived from the provision
of home care services during the calendar year prior to the year in which the application is
submitted, according to the following schedule:
new text end
new text begin
License Renewal Fee
new text end
|
new text begin
Provider Annual Revenue new text end |
new text begin
Fee new text end |
|
|
new text begin
greater than $1,500,000 new text end |
new text begin
$7,651 new text end |
|
|
new text begin
greater than $1,275,000 and no more than $1,500,000 new text end |
new text begin
$6,695 new text end |
|
|
new text begin
greater than $1,100,000 and no more than $1,275,000 new text end |
new text begin
$5,739 new text end |
|
|
new text begin
greater than $950,000 and no more than $1,100,000 new text end |
new text begin
$4,783 new text end |
|
|
new text begin
greater than $850,000 and no more than $950,000 new text end |
new text begin
$4,304 new text end |
|
|
new text begin
greater than $750,000 and no more than $850,000 new text end |
new text begin
$3,826 new text end |
|
|
new text begin
greater than $650,000 and no more than $750,000 new text end |
new text begin
$3,347 new text end |
|
|
new text begin
greater than $550,000 and no more than $650,000 new text end |
new text begin
$2,870 new text end |
|
|
new text begin
greater than $450,000 and no more than $550,000 new text end |
new text begin
$2,391 new text end |
|
|
new text begin
greater than $350,000 and no more than $450,000 new text end |
new text begin
$1,913 new text end |
|
|
new text begin
greater than $250,000 and no more than $350,000 new text end |
new text begin
$1,434 new text end |
|
|
new text begin
greater than $100,000 and no more than $250,000 new text end |
new text begin
$957 new text end |
|
|
new text begin
greater than $50,000 and no more than $100,000 new text end |
new text begin
$577 new text end |
|
|
new text begin
greater than $25,000 and no more than $50,000 new text end |
new text begin
$462 new text end |
|
|
new text begin
no more than $25,000 new text end |
new text begin
$231 new text end |
deleted text begin (d)deleted text end new text begin (e)new text end If requested, the home care provider shall provide the commissioner information
to verify the provider's annual revenues or other information as needed, including copies
of documents submitted to the Department of Revenue.
deleted text begin (e)deleted text end new text begin (f)new text end At each annual renewal, a home care provider may elect to pay the highest renewal
fee for its license category, and not provide annual revenue information to the commissioner.
deleted text begin (f)deleted text end new text begin (g)new text end A temporary license or license applicant, or temporary licensee or licensee that
knowingly provides the commissioner incorrect revenue amounts for the purpose of paying
a lower license fee, shall be subject to a civil penalty in the amount of double the fee the
provider should have paid.
deleted text begin (g)deleted text end new text begin (h)new text end Fees and penalties collected under this section shall be deposited in the state
treasury and credited to the state government special revenue fund.new text begin All fees are
nonrefundable. Fees collected under paragraphs (c) and (d) are nonrefundable even if
received before July 1, 2017, for temporary licenses or licenses being issued effective July
1, 2017, or later.
new text end
deleted text begin
(h) The license renewal fee schedule in this subdivision is effective July 1, 2016.
deleted text end
Sec. 59.
Minnesota Statutes 2016, section 146B.02, subdivision 2, is amended to read:
Subd. 2.
Requirementsnew text begin and term of licensenew text end .
(a) Each application for an initial mobile
or fixed-site establishment license and for renewal must be submitted to the commissioner
on a form provided by the commissioner accompanied with the applicable fee required
under section 146B.10. The application must contain:
(1) the name(s) of the owner(s) and operator(s) of the establishment;
(2) the location of the establishment;
(3) verification of compliance with all applicable local and state codes;
(4) a description of the general nature of the business; and
(5) any other relevant information deemed necessary by the commissioner.
(b) new text begin If the information submitted is complete and complies with the requirements of this
chapter, new text end the commissioner shall issue a provisional establishment licensenew text begin . The provisional
license isnew text end effective until the commissioner determinesnew text begin ,new text end after inspectionnew text begin ,new text end that the applicant
has met the requirements of this chapter. Upon approval, the commissioner shall issue a
body art establishment license deleted text begin effective for three yearsdeleted text end .
new text begin
(c) An establishment license must be renewed every two years.
new text end
Sec. 60.
Minnesota Statutes 2016, section 146B.02, subdivision 3, is amended to read:
Subd. 3.
Inspection.
(a) deleted text begin Within the period of the provisional establishment license, and deleted text end new text begin
The commissioner must inspect an establishment issued a provisional license within one
year of the date the license was issued. new text end Thereafter at least one time during each deleted text begin three-yeardeleted text end new text begin
two-yearnew text end licensure period, the commissioner shall conduct an inspection of the body art
establishment and a review of any records necessary to ensure that the standards required
under this chapter are met.
(b) The commissioner shall have the authority to enter a premises to make an inspection.
Refusal to permit an inspection constitutes valid grounds for licensure denial or revocation.
(c) If the establishment seeking licensure is new construction or if a licensed establishment
is remodeling, the establishment must meet all local building and zoning codes.
Sec. 61.
Minnesota Statutes 2016, section 146B.02, subdivision 5, is amended to read:
Subd. 5.
Transfer new text begin of ownership, relocation, new text end and display of license.
new text begin (a) new text end A body art
establishment license must be issued to a specific person and location and is not transferable.
A license must be prominently displayed in a public area of the establishment.
new text begin
(b) An owner who has purchased a body art establishment licensed under the previous
owner must submit an application to license the establishment within two weeks of the date
of sale. Notwithstanding subdivision 1, the new owner may continue to operate for 60 days
after the sale while waiting for a new license to be issued.
new text end
new text begin
(c) An owner of a licensed body art establishment who is relocating the establishment
must submit an application for the new location. The owner may request that the new
application become effective at a specified date in the future. If the relocation is not
accomplished by the date expected, and the license at the existing location expires, the
owner may apply for a temporary event permit to continue to operate at the old location.
The owner may apply for no more than four temporary event permits to continue operating
at the old location.
new text end
Sec. 62.
Minnesota Statutes 2016, section 146B.02, is amended by adding a subdivision
to read:
new text begin Subd. 7a. new text end
new text begin Supervisors. new text end
new text begin
(a) Only a technician who has been licensed as a body artist for
at least two years in Minnesota or in a jurisdiction with which Minnesota has reciprocity
may supervise a temporary technician.
new text end
new text begin
(b) Any technician who agrees to supervise more than two temporary technicians during
the same time period must explain, to the satisfaction of the commissioner, how the technician
will provide supervision to each temporary technician in accordance with section 146B.01,
subdivision 28.
new text end
new text begin
(c) The commissioner may refuse to approve as a supervisor a technician who has been
disciplined in Minnesota or in another jurisdiction.
new text end
Sec. 63.
Minnesota Statutes 2016, section 146B.02, subdivision 8, is amended to read:
Subd. 8.
Temporary deleted text begin eventsdeleted text end new text begin eventnew text end permit.
(a) An deleted text begin owner or operator of adeleted text end new text begin applicant for
a permit to hold anew text end temporary body art deleted text begin establishmentdeleted text end new text begin eventnew text end shall submit an application deleted text begin for a
temporary events permitdeleted text end to the commissionernew text begin . The application must be receivednew text end at least 14
days before the start of the event. The application must include the specific days and hours
of operation. deleted text begin The owner or operatordeleted text end new text begin An applicant issued a temporary event permitnew text end shall
comply with the requirements of this chapter.
(b) Applications received less than 14 days prior to the start of the event may be processed
if the commissioner determines it is possible to conduct deleted text begin thedeleted text end new text begin allnew text end required new text begin work, including an
new text end inspection.
(c) The temporary deleted text begin eventsdeleted text end new text begin eventnew text end permit must be prominently displayed in a public area
at the location.
(d) The temporary deleted text begin eventsdeleted text end new text begin eventnew text end permit, if approved, is valid for the specified dates and
hours listed on the application. No temporary events permit shall be issued for longer than
a 21-day period, and may not be extended.
new text begin
(e) No individual who does not hold a current body art establishment license may be
issued a temporary event permit more than four times within the same calendar year.
new text end
new text begin
(f) No individual who has been disciplined for a serious violation of this chapter within
three years preceding the intended start date of a temporary event may be issued a license
for a temporary event. Violations that preclude issuance of a temporary event permit include
unlicensed practice; practice in an unlicensed location; any of the conditions listed in section
146B.05, clauses (1) to (8), (12), or (13); 146B.08, subdivision 3, clauses (4), (5), and (10)
to (12); or any other violation that places the health or safety of a client at risk.
new text end
Sec. 64.
Minnesota Statutes 2016, section 146B.02, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Licensure precluded. new text end
new text begin
(a) The commissioner may choose to deny a body art
establishment license to an applicant who has been disciplined for a serious violation under
this chapter. Violations that constitute grounds for denial of license are any of the conditions
listed in section 146B.05, subdivision 1, clauses (1) to (8), (12), or (13); 146B.08, subdivision
3, clauses (4), (5), or (10) to (12); or any other violation that places the health or safety of
a client at risk.
new text end
new text begin
(b) In considering whether to grant a license to an applicant who has been disciplined
for a violation described in this subdivision, the commissioner shall consider evidence of
rehabilitation, including the nature and seriousness of the violation, circumstances relative
to the violation, the length of time elapsed since the violation, and evidence that demonstrates
that the applicant has maintained safe, ethical, and responsible body art practice since the
time of the most recent violation.
new text end
Sec. 65.
Minnesota Statutes 2016, section 146B.02, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Penalties. new text end
new text begin
Any person who violates the provisions of subdivision 1 or who
performs body art in an unlicensed location is guilty of a gross misdemeanor.
new text end
Sec. 66.
Minnesota Statutes 2016, section 146B.03, subdivision 6, is amended to read:
Subd. 6.
Licensure term; renewal.
(a) A technician's license is valid for two years from
the date of issuance and may be renewed upon payment of the renewal fee established under
section 146B.10.
(b) At renewal, a licensee must submit proof of continuing education approved by the
commissioner in the areas identified in subdivision 4.
(c) The commissioner shall notify the technician of the pending expiration of a technician
license at least 60 days prior to license expiration.
new text begin
(d) A technician previously licensed in Minnesota whose license has lapsed for less than
six years may apply to renew. A technician previously licensed in Minnesota whose license
has lapsed for less than ten years and who was licensed in another jurisdiction or jurisdictions
during the entire time of lapse may apply to renew, but must submit proof of licensure in
good standing in all other jurisdictions in which the technician was licensed as a body artist
during the time of lapse. A technician previously licensed in Minnesota whose license has
lapsed for more than six years and who was not continuously licensed in another jurisdiction
during the period of Minnesota lapse must reapply for licensure under subdivision 4.
new text end
Sec. 67.
Minnesota Statutes 2016, section 146B.03, subdivision 7, is amended to read:
Subd. 7.
Temporary licensure.
(a) The commissioner may issue a temporary license
to an applicant who submits to the commissioner on a form provided by the commissioner:
(1) proof that the applicant is over the age of 18;
(2) all fees required under section 148B.10; and
(3) a letter from a licensed technician who has agreed to provide the supervision to meet
the supervised experience requirement under subdivision 4.
(b) Upon completion of the required supervised experience, the temporary licensee shall
submit documentation of satisfactorily completing the requirements under subdivision 4,
and the applicable fee under section 146B.10. The commissioner shall issue a new license
in accordance with subdivision 4.
(c) A temporary license issued under this subdivision is valid for one year and may be
renewed deleted text begin for one additional yeardeleted text end new text begin twicenew text end .
Sec. 68.
Minnesota Statutes 2016, section 146B.07, subdivision 2, is amended to read:
Subd. 2.
Parent or legal guardian consent; prohibitions.
(a) A technician may perform
body piercings on an individual under the age of 18 if:
(1) the individual's parent or legal guardian is present;
(2) the individual's parent or legal guardian provides personal identification by using
one of the methods described in subdivision 1, paragraph (a), clauses (1) to (5), and provides
documentation that reasonably establishes that the individual is the parent or legal guardian
of the individual who is seeking the body piercing;
(3) the individual seeking the body piercing provides proof of identification by using
one of the methods described in subdivision 1, paragraph (a), clauses (1) to (5), a current
student identification, or another official source that includes the name and a photograph
of the individual;
(4) a consent form and the authorization form under subdivision 1, paragraph (b) is
signed by the parent or legal guardian in the presence of the technician; and
(5) the piercing is not prohibited under paragraph (c).
(b) deleted text begin No technician shall tattoo anydeleted text end new text begin Tattooing annew text end individual under the age of 18 new text begin is a gross
misdemeanor, new text end regardless of parental or guardian consent.
(c) No nipple or genital piercing, branding, scarification, suspension, subdermal
implantation, microdermal, or tongue bifurcation shall be performed by any technician on
any individual under the age of 18 regardless of parental or guardian consent.
(d) No technician shall perform body art procedures on any individual who appears to
be under the influence of alcohol, controlled substances as defined in section 152.01,
subdivision 4, or hazardous substances as defined in rules adopted under chapter 182.
(e) No technician shall perform body art procedures while under the influence of alcohol,
controlled substances as defined under section 152.01, subdivision 4, or hazardous substances
as defined in the rules adopted under chapter 182.
(f) No technician shall administer anesthetic injections or other medications.
Sec. 69.
Minnesota Statutes 2016, section 146B.07, subdivision 4, is amended to read:
Subd. 4.
Client record maintenance.
new text begin (a) new text end For each client, the body art establishment
operator shall maintain proper records of each procedure. The records of the procedure must
be kept for three years and must be available for inspection by the commissioner upon
request. The record must include the following:
(1) the date of the procedure;
(2) the information on the required picture identification showing the name, age, and
current address of the client;
(3) a copy of the authorization form signed and dated by the client required under
subdivision 1, paragraph (b);
(4) a description of the body art procedure performed;
(5) the name and license number of the technician performing the procedure;
(6) a copy of the consent form required under subdivision 3; and
(7) if the client is under the age of 18 years, a copy of the consent form signed by the
parent or legal guardian as required under subdivision 2.
new text begin
(b) Each body artist shall maintain a copy of the informed consent required under
subdivision 3 for three years.
new text end
Sec. 70.
Minnesota Statutes 2016, section 146B.10, subdivision 1, is amended to read:
Subdivision 1.
Licensing fees.
(a) The fee for the initial technician licensure and biennial
licensure renewal is deleted text begin $100deleted text end new text begin $420new text end .
(b) The fee for temporary technician licensure is deleted text begin $100deleted text end new text begin $240new text end .
(c) The fee for the temporary guest artist license is deleted text begin $50deleted text end new text begin $140new text end .
(d) The fee for a dual body art technician license is deleted text begin $100deleted text end new text begin $420new text end .
(e) The fee for a provisional establishment license is deleted text begin $1,000deleted text end new text begin $1,500new text end .
(f) The fee for an initial establishment license and the deleted text begin three-yeardeleted text end new text begin two-yearnew text end license renewal
period required in section 146B.02, subdivision 2, paragraph (b), is deleted text begin $1,000deleted text end new text begin $1,500new text end .
(g) The fee for a temporary body art establishmentnew text begin eventnew text end permit is deleted text begin $75deleted text end new text begin $200new text end .
(h) The commissioner shall prorate the initial two-year technician license fee deleted text begin and the
initial three-year body art establishment license feedeleted text end based on the number of months in the
initial licensure period.new text begin The commissioner shall prorate the first renewal fee for the
establishment license based on the number of months from issuance of the provisional
license to the first renewal.
new text end
new text begin
(i) The fee for verification of licensure to other states is $25.
new text end
new text begin
(j) The fee to reissue a provisional establishment license that relocates prior to inspection
and removal of provisional status is $350. The expiration date of the provisional license
does not change.
new text end
new text begin
(k) The fee to change an establishment name or establishment type, such as tattoo,
piercing, or dual, is $50.
new text end
Sec. 71.
Minnesota Statutes 2016, section 146B.10, subdivision 2, is amended to read:
Subd. 2.
deleted text begin Penalty fordeleted text end Late deleted text begin renewalsdeleted text end new text begin renewal feenew text end .
new text begin (a) new text end The deleted text begin penaltydeleted text end fee for late submission
deleted text begin fordeleted text end new text begin of a technician new text end renewal deleted text begin applicationsdeleted text end new text begin applicationnew text end is deleted text begin $75deleted text end new text begin $150new text end .
new text begin
(b) The fee for late submission of an establishment renewal application is $300.
new text end
Sec. 72.
Minnesota Statutes 2016, section 146B.10, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Technical violation fee for practice after lapse. new text end
new text begin
(a) The technical violation
fee for practicing body art after a body art license has expired and before it is renewed is
$200 for any part of the first month, plus $200 for any part of any subsequent month up to
one year. Continued practice or operation after one year becomes a disciplinary violation.
new text end
new text begin
(b) The technical violation fee for practicing body art after a temporary body art license
has expired and before it is renewed is $100 for any part of the first month, plus $100 for
any part of any subsequent month up to six months. Continued practice or operation after
six months becomes a disciplinary violation.
new text end
new text begin
(c) The technical violation fee for operating a body art establishment after the license
has expired and before it is renewed is $300 for any part of the first month, plus $300 for
any part of any subsequent month up to six months. Continued practice or operation after
six months becomes a disciplinary violation.
new text end
Sec. 73.
Minnesota Statutes 2016, section 148.514, subdivision 1, is amended to read:
Subdivision 1.
General licensure procedures.
An applicant for licensure must:
(1) submit an application as required under section 148.519, subdivision 1; deleted text begin and
deleted text end
(2) submit all fees required under section 148.5194deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) consent to a fingerprint-based background check as required under section 148.519.
new text end
Sec. 74.
Minnesota Statutes 2016, section 148.519, subdivision 1, is amended to read:
Subdivision 1.
Applications for licensure.
(a) An applicant for licensure must:
(1) submit a completed application for licensure on forms provided by the commissioner.
The application must include the applicant's name, certification number under chapter 153A,
if applicable, business address and telephone number, or home address and telephone number
if the applicant practices speech-language pathology or audiology out of the home, and a
description of the applicant's education, training, and experience, including previous work
history for the five years immediately preceding the date of application. The commissioner
may ask the applicant to provide additional information necessary to clarify information
submitted in the application; and
(2) submit documentation of the certificate of clinical competence issued by the American
Speech-Language-Hearing Association, board certification by the American Board of
Audiology, or satisfy the following requirements:
(i) submit a transcript showing the completion of a master's or doctoral degree or its
equivalent meeting the requirements of section 148.515, subdivision 2;
(ii) submit documentation of the required hours of supervised clinical training;
(iii) submit documentation of the postgraduate clinical or doctoral clinical experience
meeting the requirements of section 148.515, subdivision 4; and
(iv) submit documentation of receiving a qualifying score on an examination meeting
the requirements of section 148.515, subdivision 6.
(b) In addition, an applicant must:
(1) sign a statement that the information in the application is true and correct to the best
of the applicant's knowledge and belief;
(2) submit with the application all fees required by section 148.5194; deleted text begin and
deleted text end
(3) sign a waiver authorizing the commissioner to obtain access to the applicant's records
in this or any other state in which the applicant has engaged in the practice of speech-language
pathology or audiologydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) consent to a fingerprint-based criminal history background check as required under
section 144.0572, pay all required fees, and cooperate with all requests for information. An
applicant must complete a new criminal history background check if more than one year
has elapsed since the applicant last applied for a license.
new text end
Sec. 75.
Minnesota Statutes 2016, section 148.519, subdivision 2, is amended to read:
Subd. 2.
Action on applications for licensure.
(a) The commissioner shall act on an
application for licensure according to paragraphs (b) to deleted text begin (d)deleted text end new text begin (e)new text end .
(b) The commissioner shall determine if the applicant meets the requirements for
licensure. The commissioner or advisory council may investigate information provided by
an applicant to determine whether the information is accurate and complete.
new text begin
(c) The commissioner shall not issue a license to an applicant who refuses to consent to
a background study within 90 days after submission of an application or fails to submit
fingerprints to the Department of Human Services. Any fees paid by the applicant to the
Department of Health shall be forfeited if the applicant refuses to consent to the background
study.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The commissioner shall notify an applicant, via certified mail, of action taken on
the application and of the grounds for denying licensure if licensure is denied.
deleted text begin (d)deleted text end new text begin (e)new text end An applicant denied licensure may make a written request to the commissioner,
within 30 days of the date of notification to the applicant, for reconsideration of the denial.
Individuals requesting reconsideration may submit information that the applicant wants
considered in the reconsideration. After reconsideration of the commissioner's determination
to deny licensure, the commissioner shall determine whether the original determination
should be affirmed or modified. An applicant may make only one request in any one biennial
license period for reconsideration of the commissioner's determination to deny licensure.
Sec. 76.
Minnesota Statutes 2016, section 148.5194, subdivision 2, is amended to read:
Subd. 2.
Speech-language pathologist deleted text begin biennialdeleted text end licensure deleted text begin feedeleted text end new text begin feesnew text end .
new text begin (a) new text end The fee for initial
licensure deleted text begin and biennial licensure, clinical fellowship licensure, temporary licensure, or
renewaldeleted text end for a speech-language pathologist is deleted text begin $200deleted text end new text begin $210.50new text end .
new text begin
(b) The fee for clinical fellowship licensure, doctoral externship, temporary license, or
renewal for a speech-language pathologist is $200.
new text end
Sec. 77.
Minnesota Statutes 2016, section 148.5194, subdivision 3, is amended to read:
Subd. 3.
deleted text begin Biennialdeleted text end Licensure deleted text begin feedeleted text end new text begin feesnew text end for dual licensure as a speech-language
pathologist and audiologist.
new text begin (a) new text end The fee for initialnew text begin dualnew text end licensure deleted text begin and biennial licensure,
clinical fellowship licensure, doctoral externship, temporary license, or renewaldeleted text end new text begin as a
speech-language pathologist and audiologistnew text end is deleted text begin $435deleted text end new text begin $523new text end .
new text begin
(b) The fee for clinical fellowship licensure, doctoral externship, temporary license, or
renewal for dual licensure as a speech-language pathologist and audiologist is $510.
new text end
Sec. 78.
Minnesota Statutes 2016, section 148.5194, subdivision 4, is amended to read:
Subd. 4.
Penalty fee for late renewals.
The penalty fee for late submission of a renewal
application is deleted text begin $45deleted text end new text begin $60new text end .
Sec. 79.
Minnesota Statutes 2016, section 148.5194, subdivision 7, is amended to read:
Subd. 7.
Audiologist biennial licensure fee.
deleted text begin (a)deleted text end new text begin The licensure fee for initial applicants
is $523.new text end The biennial licensure fee for audiologists for clinical fellowship, doctoral externship,
temporary, deleted text begin initial applicants,deleted text end and renewal deleted text begin licenseesdeleted text end new text begin licensesnew text end is deleted text begin $435deleted text end new text begin $510new text end .
deleted text begin
(b) The audiologist fee is for practical examination costs greater than audiologist exam
fee receipts and for complaint investigation, enforcement action, and consumer information
and assistance expenditures related to hearing instrument dispensing.
deleted text end
Sec. 80.
Minnesota Statutes 2016, section 148.5194, is amended by adding a subdivision
to read:
new text begin Subd. 7a. new text end
new text begin Surcharge. new text end
new text begin
Speech-language pathologists who were licensed prior to January
1, 2018, shall pay a onetime surcharge of $10.50 to renew when their license first expires
after January 1, 2020. Audiologists who were licensed before January 1, 2018, shall pay a
onetime surcharge of $13 to renew when their license first expires after January 1, 2020.
The surcharge shall cover the commissioner's costs associated with criminal background
checks.
new text end
Sec. 81.
Minnesota Statutes 2016, section 148.5195, subdivision 2, is amended to read:
Subd. 2.
Rights of applicants and licensees.
The rights of an applicant denied licensure
are stated in section 148.519, subdivision 2, paragraph deleted text begin (d)deleted text end new text begin (e)new text end . A licensee shall not be
subjected to disciplinary action under this section without first having an opportunity for a
contested case hearing under chapter 14.
Sec. 82.
Minnesota Statutes 2016, section 148.6405, is amended to read:
148.6405 LICENSURE APPLICATION REQUIREMENTS: PROCEDURES AND
QUALIFICATIONS.
(a) An applicant for licensure must comply with the application requirements in section
148.6420. To qualify for licensure, an applicant must satisfy one of the requirements in
paragraphs (b) to (f) and not be subject to denial of licensure under section 148.6448.
(b) A person who applies for licensure as an occupational therapist and who has not
been credentialed by the National Board for Certification in Occupational Therapy or another
jurisdiction must meet the requirements in section 148.6408.
(c) A person who applies for licensure as an occupational therapy assistant and who has
not been credentialed by the National Board for Certification in Occupational Therapy or
another jurisdiction must meet the requirements in section 148.6410.
(d) A person who is certified by the National Board for Certification in Occupational
Therapy may apply for licensure by equivalency and must meet the requirements in section
148.6412.
(e) A person who is credentialed in another jurisdiction may apply for licensure by
reciprocity and must meet the requirements in section 148.6415.
(f) A person who applies for temporary licensure must meet the requirements in section
148.6418.
(g) A person who applies for licensure under paragraph (b), (c), or (f) more than two
and less than four years after meeting the requirements in section 148.6408 or 148.6410
must submit the following:
(1) a completed and signed application for licensure on forms provided by the
commissioner;
(2) the license application fee required under section 148.6445;
new text begin
(3) consent to a fingerprint-based criminal history records check required under section
148.6420;
new text end
deleted text begin (3)deleted text end new text begin (4)new text end if applying for occupational therapist licensure, proof of having met a minimum
of 24 contact hours of continuing education in the two years preceding licensure application,
or if applying for occupational therapy assistant licensure, proof of having met a minimum
of 18 contact hours of continuing education in the two years preceding licensure application;
deleted text begin (4)deleted text end new text begin (5)new text end verified documentation of successful completion of 160 hours of supervised
practice approved by the commissioner under a limited license specified in section 148.6425,
subdivision 3, paragraph (c); and
deleted text begin (5)deleted text end new text begin (6)new text end additional information as requested by the commissioner to clarify information
in the application, including information to determine whether the individual has engaged
in conduct warranting disciplinary action under section 148.6448. The information must be
submitted within 30 days after the commissioner's request.
(h) A person who applied for licensure under paragraph (b), (c), or (f) four years or more
after meeting the requirements in section 148.6408 or 148.6410 must meet all the
requirements in paragraph (g) except clauses deleted text begin (3)deleted text end new text begin (4)new text end and deleted text begin (4)deleted text end new text begin (5)new text end , submit documentation of
having retaken and passed the credentialing examination for occupational therapist or
occupational therapy assistant, or of having completed an occupational therapy refresher
program that contains both a theoretical and clinical component approved by the
commissioner, and verified documentation of successful completion of 480 hours of
supervised practice approved by the commissioner under a limited license specified in
section 148.6425, subdivision 3, paragraph (c). The 480 hours of supervised practice must
be completed in six months and may be completed at the applicant's place of work. Only
refresher courses completed within one year prior to the date of application qualify for
approval.
Sec. 83.
Minnesota Statutes 2016, section 148.6420, subdivision 1, is amended to read:
Subdivision 1.
Applications for licensure.
An applicant for licensure must:
(1) submit a completed application for licensure on forms provided by the commissioner
and must supply the information requested on the application, including:
(i) the applicant's name, business address and business telephone number, business
setting, and daytime telephone number;
(ii) the name and location of the occupational therapy program the applicant completed;
(iii) a description of the applicant's education and training, including a list of degrees
received from educational institutions;
(iv) the applicant's work history for the six years preceding the application, including
the number of hours worked;
(v) a list of all credentials currently and previously held in Minnesota and other
jurisdictions;
(vi) a description of any jurisdiction's refusal to credential the applicant;
(vii) a description of all professional disciplinary actions initiated against the applicant
in any jurisdiction;
(viii) information on any physical or mental condition or chemical dependency that
impairs the person's ability to engage in the practice of occupational therapy with reasonable
judgment or safety;
(ix) a description of any misdemeanor or felony conviction that relates to honesty or to
the practice of occupational therapy;
(x) a description of any state or federal court order, including a conciliation court
judgment or a disciplinary order, related to the individual's occupational therapy practice;
and
(xi) a statement indicating the physical agent modalities the applicant will use and
whether the applicant will use the modalities as an occupational therapist or an occupational
therapy assistant under direct supervision;
(2) submit with the application all fees required by section 148.6445;
(3) sign a statement that the information in the application is true and correct to the best
of the applicant's knowledge and belief;
(4) sign a waiver authorizing the commissioner to obtain access to the applicant's records
in this or any other state in which the applicant holds or previously held a credential for the
practice of an occupation, has completed an accredited occupational therapy education
program, or engaged in the practice of occupational therapy;
(5) deleted text begin submit additional information as requested by the commissionerdeleted text end new text begin consent to a
fingerprint-based criminal background records check required under section 144.0572, pay
all required fees, and cooperate with all requests for information. An applicant must complete
a new criminal background check if more than one year has elapsed since the applicant last
applied for a licensenew text end ; and
(6) submit the additional information required for licensure by equivalency, licensure
by reciprocity, and temporary licensure as specified in sections 148.6408 to 148.6418.
Sec. 84.
Minnesota Statutes 2016, section 148.6420, subdivision 5, is amended to read:
Subd. 5.
Action on applications for licensure.
(a) The commissioner shall approve,
approve with conditions, or deny licensure. The commissioner shall act on an application
for licensure according to paragraphs (b) to (d).
(b) The commissioner shall determine if the applicant meets the requirements for
licensure. The commissioner, or the advisory council at the commissioner's request, may
investigate information provided by an applicant to determine whether the information is
accurate and complete.
(c) The commissioner shall notify an applicant of action taken on the application and,
if licensure is denied or approved with conditions, the grounds for the commissioner's
determination.
(d) An applicant denied licensure or granted licensure with conditions may make a
written request to the commissioner, within 30 days of the date of the commissioner's
determination, for reconsideration of the commissioner's determination. Individuals
requesting reconsideration may submit information which the applicant wants considered
in the reconsideration. After reconsideration of the commissioner's determination to deny
licensure or grant licensure with conditions, the commissioner shall determine whether the
original determination should be affirmed or modified. An applicant is allowed no more
than one request in any one biennial licensure period for reconsideration of the
commissioner's determination to deny licensure or approve licensure with conditions.
new text begin
(e) The commissioner shall not issue a license to an applicant who refuses to consent to
a background study within 90 days after submission of an application or fails to submit
fingerprints to the Department of Human Services. Any fees paid by the applicant to the
Department of Health shall be forfeited if the applicant refuses to consent to the background
study.
new text end
Sec. 85.
Minnesota Statutes 2016, section 148.6445, subdivision 1, is amended to read:
Subdivision 1.
Initial licensure fee.
The initial licensure fee for occupational therapists
is deleted text begin $145deleted text end new text begin $188.50new text end . The initial licensure fee for occupational therapy assistants is deleted text begin $80deleted text end new text begin $112.50new text end .
The commissioner shall prorate fees based on the number of quarters remaining in the
biennial licensure period.
Sec. 86.
Minnesota Statutes 2016, section 148.6445, subdivision 2, is amended to read:
Subd. 2.
Licensure renewal fee.
The biennial licensure renewal fee for occupational
therapists is deleted text begin $145deleted text end new text begin $173new text end . The biennial licensure renewal fee for occupational therapy assistants
is deleted text begin $80deleted text end new text begin $96new text end .
Sec. 87.
Minnesota Statutes 2016, section 148.6445, subdivision 3, is amended to read:
Subd. 3.
Late fee.
The fee for late submission of a renewal application is deleted text begin $25deleted text end new text begin $32new text end .
Sec. 88.
Minnesota Statutes 2016, section 148.6445, is amended by adding a subdivision
to read:
new text begin Subd. 10a. new text end
new text begin Surcharge. new text end
new text begin
Practitioners who were licensed before January 1, 2018, shall
pay a onetime surcharge of $16.50 to renew when their license first expires after January
1, 2020. The surcharge shall cover the commissioner's costs associated with criminal
background checks.
new text end
Sec. 89.
Minnesota Statutes 2016, section 148.997, subdivision 1, is amended to read:
Subdivision 1.
Fees.
(a) The application fee is deleted text begin $130deleted text end new text begin $185new text end .
(b) The criminal background check fee is deleted text begin $6deleted text end new text begin $15new text end .
Sec. 90.
Minnesota Statutes 2016, section 153A.14, subdivision 1, is amended to read:
Subdivision 1.
Application for certificate.
An applicant must:
(1) be 21 years of age or older;
(2) apply to the commissioner for a certificate to dispense hearing instruments on
application forms provided by the commissioner;
(3) at a minimum, provide the applicant's name, Social Security number, business address
and phone number, employer, and information about the applicant's education, training,
and experience in testing human hearing and fitting hearing instruments;
(4) include with the application a statement that the statements in the application are
true and correct to the best of the applicant's knowledge and belief;
(5) include with the application a written and signed authorization that authorizes the
commissioner to make inquiries to appropriate regulatory agencies in this or any other state
where the applicant has sold hearing instruments;
(6) submit certification to the commissioner that the applicant's audiometric equipment
has been calibrated to meet current ANSI standards within 12 months of the date of the
application;
(7) submit evidence of continuing education credits, if required; deleted text begin and
deleted text end
(8) submit all fees as required under section 153A.17deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(9) consent to a fingerprint-based criminal history records check required under section
144.0572, pay all required fees, and cooperate with all requests for information. An applicant
must complete a new criminal background check if more than one year has elapsed since
the applicant last applied for a license.
new text end
Sec. 91.
Minnesota Statutes 2016, section 153A.14, subdivision 2, is amended to read:
Subd. 2.
Issuance of certificate.
new text begin (a) new text end The commissioner shall issue a certificate to each
dispenser of hearing instruments who applies under subdivision 1 if the commissioner
determines that the applicant is in compliance with this chapter, has passed an examination
administered by the commissioner, has met the continuing education requirements, if
required, and has paid the fee set by the commissioner. The commissioner may reject or
deny an application for a certificate if there is evidence of a violation or failure to comply
with this chapter.
new text begin
(b) The commissioner shall not issue a certificate to an applicant who refuses to consent
to a criminal history background check as required by section 144.0572 within 90 days after
submission of an application or fails to submit fingerprints to the Department of Human
Services. Any fees paid by the applicant to the Department of Health shall be forfeited if
the applicant refuses to consent to the background study.
new text end
Sec. 92.
Minnesota Statutes 2016, section 153A.17, is amended to read:
153A.17 EXPENSES; FEES.
(a) The expenses for administering the certification requirements, including the complaint
handling system for hearing aid dispensers in sections 153A.14 and 153A.15, and the
Consumer Information Center under section 153A.18, must be paid from initial application
and examination fees, renewal fees, penalties, and fines. The commissioner shall only use
fees collected under this section for the purposes of administering this chapter. The legislature
must not transfer money generated by these fees from the state government special revenue
fund to the general fund. Surcharges collected by the commissioner of health under section
16E.22 are not subject to this paragraph.
(b) The fees are as follows:
(1) the initial deleted text begin and annual renewaldeleted text end certification application fee is deleted text begin $600deleted text end new text begin $772.50new text end ;
(2) deleted text begin the initial examination fee for the written portion is $500, and for each time it is
taken, thereafterdeleted text end new text begin the annual renewal certification application fee is $750new text end ;
(3) the initial examination fee for the practical portion is $1,200, and $600 for each time
it is taken, thereafter; for individuals meeting the requirements of section 148.515, subdivision
2, the fee for the practical portion of the hearing instrument dispensing examination is deleted text begin $250deleted text end new text begin
$600new text end each time it is taken;
(4) the trainee application fee is deleted text begin $200deleted text end new text begin $230new text end ;
(5) the penalty fee for late submission of a renewal application is deleted text begin $200deleted text end new text begin $260new text end ; and
(6) the fee for verification of certification to other jurisdictions or entities is $25.
(c) The commissioner may prorate the certification fee for new applicants based on the
number of quarters remaining in the annual certification period.
(d) All fees are nonrefundable. All fees, penalties, and fines received must be deposited
in the state government special revenue fund.
(e) deleted text begin Beginning July 1, 2009, until June 30, 2016, a surcharge of $100 shall be paid at the
time of initial certification application or renewal to recover the commissioner's accumulated
direct expenditures for administering the requirements of this chapter.deleted text end new text begin Hearing instrument
dispensers who were certified before January 1, 2018, shall pay a onetime surcharge of
$22.50 to renew their certification when it expires after October 31, 2020. The surcharge
shall cover the commissioner's costs associated with criminal background checks.
new text end
Sec. 93.
Minnesota Statutes 2016, section 157.16, subdivision 1, is amended to read:
Subdivision 1.
License required annually.
A license is required annually for every
person, firm, or corporation engaged in the business of conducting a food and beverage
service establishment, youth camp, hotel, motel, lodging establishment, public pool, or
resort. Any person wishing to operate a place of business licensed in this section shall first
make application, pay the required fee specified in this section, and receive approval for
operation, including plan review approval. Special event food stands are not required to
submit plans. Nonprofit organizations operating a special event food stand with multiple
locations at an annual one-day event shall be issued only one license. Application shall be
made on forms provided by the commissioner and shall require the applicant to state the
full name and address of the owner of the building, structure, or enclosure, the lessee and
manager of the food and beverage service establishment, hotel, motel, lodging establishment,
public pool, or resort; the name under which the business is to be conducted; and any other
information as may be required by the commissioner to complete the application for license.new text begin
All fees collected under this section shall be deposited in the state government special
revenue fund.
new text end
Sec. 94.
Minnesota Statutes 2016, section 157.16, subdivision 3, is amended to read:
Subd. 3.
Establishment fees; definitions.
(a) The following fees are required for food
and beverage service establishments, youth camps, hotels, motels, lodging establishments,
public pools, and resorts licensed under this chapter. Food and beverage service
establishments must pay the highest applicable fee under paragraph (d), clause (1), (2), (3),
or (4)deleted text begin , and establishments serving alcohol must pay the highest applicable fee under paragraph
(d), clause (6) or (7)deleted text end . The license fee for new operators previously licensed under this chapter
for the same calendar year is one-half of the appropriate annual license fee, plus any penalty
that may be required. The license fee for operators opening on or after October 1 is one-half
of the appropriate annual license fee, plus any penalty that may be required.
(b) All food and beverage service establishments, except special event food stands, and
all hotels, motels, lodging establishments, public pools, and resorts shall pay an annual base
fee of deleted text begin $150deleted text end new text begin $165new text end .
(c) A special event food stand shall pay a flat fee of deleted text begin $50deleted text end new text begin $55new text end annually. "Special event
food stand" means a fee category where food is prepared or served in conjunction with
celebrations, county fairs, or special events from a special event food stand as defined in
section 157.15.
(d) In addition to the base fee in paragraph (b), each food and beverage service
establishment, other than a special event food stand and a school concession stand, and each
hotel, motel, lodging establishment, public pool, and resort shall pay an additional annual
fee for each fee category, additional food service, or required additional inspection specified
in this paragraph:
(1) deleted text begin Limited food menu selection, $60. "Limited food menu selection"deleted text end new text begin Category 1
establishment, $110. "Category 1 establishment"new text end means a fee category that provides one or
more of the followingnew text begin items or is one of the listed establishments or facilitiesnew text end :
(i) new text begin serves new text end prepackaged food that deleted text begin receives heat treatment anddeleted text end is served in the package;
(ii) deleted text begin frozen pizza that is heated and served;
deleted text end
deleted text begin (iii)deleted text end new text begin servesnew text end a continental breakfast such as rolls, coffee, juice, milk, and cold cereal;
deleted text begin (iv)deleted text end new text begin (iii) servesnew text end soft drinks, coffee, or nonalcoholic beverages; deleted text begin or
deleted text end
deleted text begin (v)deleted text end new text begin (iv) providesnew text end cleaning for eating, drinking, or cooking utensils, when the only food
served is prepared off sitedeleted text begin .deleted text end new text begin ;
new text end
new text begin
(v) a food establishment where the method of food preparation meets the definition of
a low-risk establishment in section 157.20; or
new text end
new text begin
(vi) operates as a child care facility licensed under section 245A.03 and Minnesota Rules,
chapter 9503.
new text end
deleted text begin
(2) Small establishment, including boarding establishments, $120. "Small establishment"
means a fee category that has no salad bar and meets one or more of the following:
deleted text end
deleted text begin
(i) possesses food service equipment that consists of no more than a deep fat fryer, a
grill, two hot holding containers, and one or more microwave ovens;
deleted text end
deleted text begin
(ii) serves dipped ice cream or soft serve frozen desserts;
deleted text end
deleted text begin
(iii) serves breakfast in an owner-occupied bed and breakfast establishment;
deleted text end
deleted text begin
(iv) is a boarding establishment; or
deleted text end
deleted text begin
(v) meets the equipment criteria in clause (3), item (i) or (ii), and has a maximum patron
seating capacity of not more than 50.
deleted text end
deleted text begin (3) Medium establishment, $310. "Medium establishment"deleted text end new text begin (2) Category 2 establishment,
$245. "Category 2 establishment"new text end means deleted text begin a fee category that meets one or more of the
followingdeleted text end new text begin an establishment that is not a Category 1 establishment and is eithernew text end :
(i) deleted text begin possesses food service equipment that includes a range, oven, steam table, salad bar,
or salad preparation area;deleted text end new text begin a food establishment where the method of food preparation meets
the definition of a medium-risk establishment in section 157.20; or
new text end
(ii) deleted text begin possesses food service equipment that includes more than one deep fat fryer, one
grill, or two hot holding containers; ordeleted text end new text begin an elementary or secondary school as defined in
section 120A.05.
new text end
deleted text begin
(iii) is an establishment where food is prepared at one location and served at one or more
separate locations.
deleted text end
deleted text begin
Establishments meeting criteria in clause (2), item (v), are not included in this fee
category.
deleted text end
deleted text begin (4) Large establishment, $540. "Large establishment"deleted text end new text begin (3) Category 3 establishment,
$385. "Category 3 establishment"new text end means new text begin an establishment that is not a Category 1 or Category
2 establishment and is new text end either:
(i) deleted text begin a fee category that (A) meets the criteria in clause (3), items (i) or (ii), for a medium
establishment, (B) seats more than 175 people, and (C) offers the full menu selection an
average of five or more days a week during the weeks of operationdeleted text end new text begin a food establishment
where the method of food preparation meets the definition of a high-risk establishment in
section 157.20new text end ; or
(ii) deleted text begin a fee category that (A) meets the criteria in clause (3), item (iii), for a medium
establishment, and (B) prepares and serves 500 or more meals per day.deleted text end new text begin an establishment
where 500 or more meals are prepared per day and served at one or more separate locations.
new text end
deleted text begin (5)deleted text end new text begin (4)new text end Other food and beverage service, including food carts, mobile food units, seasonal
temporary food stands, and seasonal permanent food stands, deleted text begin $60deleted text end new text begin $85new text end .
deleted text begin
(6) Beer or wine table service, $60. "Beer or wine table service" means a fee category
where the only alcoholic beverage service is beer or wine, served to customers seated at
tables.
deleted text end
deleted text begin
(7) Alcoholic beverage service, other than beer or wine table service, $165.
deleted text end
deleted text begin
"Alcohol beverage service, other than beer or wine table service" means a fee category
where alcoholic mixed drinks are served or where beer or wine are served from a bar.
deleted text end
deleted text begin (8)deleted text end new text begin (5)new text end Lodging per sleeping accommodation unit, deleted text begin $10deleted text end new text begin $11new text end , including hotels, motels,
lodging establishments, and resorts, up to a maximum of deleted text begin $1,000deleted text end new text begin $1,100new text end . "Lodging per
sleeping accommodation unit" means a fee category including the number of guest rooms,
cottages, or other rental units of a hotel, motel, lodging establishment, or resort; or the
number of beds in a dormitory.
deleted text begin (9)deleted text end new text begin (6)new text end First public pool, deleted text begin $325deleted text end new text begin $355new text end ; each additional public pool, deleted text begin $175deleted text end new text begin $200new text end . "Public
pool" means a fee category that has the meaning given in section 144.1222, subdivision 4.
deleted text begin (10)deleted text end new text begin (7)new text end First spa, deleted text begin $175deleted text end new text begin $200new text end ; each additional spa, deleted text begin $100deleted text end new text begin $110new text end . "Spa pool" means a fee
category that has the meaning given in Minnesota Rules, part 4717.0250, subpart 9.
deleted text begin (11)deleted text end new text begin (8)new text end Private sewer or water, $60. "Individual private water" means a fee category
with a water supply other than a community public water supply as defined in Minnesota
Rules, chapter 4720. "Individual private sewer" means a fee category with an individual
sewage treatment system which uses subsurface treatment and disposal.
deleted text begin (12)deleted text end new text begin (9)new text end Additional food service, deleted text begin $150deleted text end new text begin $175new text end . "Additional food service" means a location
at a food service establishment, other than the primary food preparation and service area,
used to prepare or serve new text begin beverages or new text end food to the public. Additional food service does not
apply to school concession stands.
deleted text begin (13)deleted text end new text begin (10)new text end Additional inspection fee, deleted text begin $360deleted text end new text begin $250new text end . "Additional inspection fee" means a fee
to conduct the second inspection each year for elementary and secondary education facility
school lunch programs when required by the Richard B. Russell National School Lunch
Act.
new text begin
(11) HACCP verification, $175. "HACCP verification" means an annual fee category
for a business that performs one or more specialized process that requires an HACCP plan
as required in chapter 31 and Minnesota Rules, chapter 4626.
new text end
(e) A fee for review of construction plans must accompany the initial license application
for restaurants, hotels, motels, lodging establishments, resorts, seasonal food stands, and
mobile food units. new text begin A fee for review of an HACCP plan for specialized processing must be
submitted and approved prior to preparing and serving the specialized processed food for
human consumption. new text end The deleted text begin feedeleted text end new text begin feesnew text end for deleted text begin thisdeleted text end construction plan deleted text begin review isdeleted text end new text begin reviews and HACCP
plan reviews arenew text end as follows:
|
Service Area |
Type |
Fee |
| Food |
deleted text begin
limited food menu deleted text end |
deleted text begin
$275 deleted text end |
| deleted text begin smalldeleted text end new text begin category 1new text end establishment |
$400 |
|
| deleted text begin mediumdeleted text end new text begin category 2new text end establishment |
$450 |
|
| deleted text begin largedeleted text end new text begin category 3new text end food establishment |
$500 |
|
| additional food service |
deleted text begin
$150 deleted text end new text begin $250 new text end |
|
|
new text begin
HACCP Plan Review new text end |
new text begin
$500 new text end |
|
| Transient food service |
food cart |
$250 |
| seasonal permanent food stand |
$250 |
|
| seasonal temporary food stand |
$250 |
|
| mobile food unit |
$350 |
|
|
deleted text begin
Alcohol deleted text end |
deleted text begin
beer or wine table service deleted text end |
deleted text begin
$150 deleted text end |
|
deleted text begin
alcohol service from bar deleted text end |
deleted text begin
$250 deleted text end |
|
| Lodging |
less than 25 rooms |
$375 |
| 25 to less than 100 rooms |
$400 |
|
| 100 rooms or more |
$500 |
|
| less than five cabins |
$350 |
|
| five to less than ten cabins |
$400 |
|
| ten cabins or more |
$450 |
(f) When existing food and beverage service establishments, hotels, motels, lodging
establishments, resorts, seasonal food stands, and mobile food units are extensively
remodeled, a fee must be submitted with the remodeling plans. The fee for this construction
plan review is as follows:
|
Service Area |
Type |
Fee |
| Food |
deleted text begin
limited food menu deleted text end |
deleted text begin
$250 deleted text end |
| deleted text begin smalldeleted text end new text begin category 1new text end establishment |
$300 |
|
| deleted text begin mediumdeleted text end new text begin category 2new text end establishment |
$350 |
|
| deleted text begin large fooddeleted text end new text begin category 3new text end establishment |
$400 |
|
| additional food service |
deleted text begin
$150 deleted text end new text begin $250 new text end |
|
| Transient food service |
food cart |
$250 |
| seasonal permanent food stand |
$250 |
|
| seasonal temporary food stand |
$250 |
|
| mobile food unit |
$250 |
|
|
deleted text begin
Alcohol deleted text end |
deleted text begin
beer or wine table service deleted text end |
deleted text begin
$150 deleted text end |
|
deleted text begin
alcohol service from bar deleted text end |
deleted text begin
$250 deleted text end |
|
| Lodging |
less than 25 rooms |
$250 |
| 25 to less than 100 rooms |
$300 |
|
| 100 rooms or more |
$450 |
|
| less than five cabins |
$250 |
|
| five to less than ten cabins |
$350 |
|
| ten cabins or more |
$400 |
(g) Special event food stands are not required to submit construction or remodeling plans
for review.
(h) Youth camps shall pay an annual single fee for food and lodging as follows:
(1) camps with up to 99 campers, $325;
(2) camps with 100 to 199 campers, $550; and
(3) camps with 200 or more campers, $750.
(i) A youth camp which pays fees under paragraph (d) is not required to pay fees under
paragraph (h).
Sec. 95.
Minnesota Statutes 2016, section 157.16, subdivision 3a, is amended to read:
Subd. 3a.
Statewide hospitality fee.
Every person, firm, or corporation that operates a
licensed boarding establishment, food and beverage service establishment, seasonal temporary
or permanent food stand, special event food stand, mobile food unit, food cart, resort, hotel,
motel, or lodging establishment in Minnesota must submit to the commissioner a deleted text begin $35deleted text end new text begin $40new text end
annual statewide hospitality fee for each licensed activity. The fee for establishments licensed
by the Department of Health is required at the same time the licensure fee is due. For
establishments licensed by local governments, the fee is due by July 1 of each year.
Sec. 96.
Minnesota Statutes 2016, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Occupations regulated by commissioner of health. new text end
new text begin
The commissioner shall
set fees to recover the cost of combined background studies and criminal background checks
initiated by applicants, licensees, and certified practitioners regulated under sections 148.511
to 148.5198 and 148.6401 to 148.6450 and chapter 153A. The fees collected under this
subdivision shall be deposited in the special revenue fund and are appropriated to the
commissioner for the purpose of conducting background studies and criminal background
checks.
new text end
Sec. 97.
Minnesota Statutes 2016, section 327.15, subdivision 3, is amended to read:
Subd. 3.
Fees, manufactured home parks and recreational camping areas.
(a) The
following fees are required for manufactured home parks and recreational camping areas
licensed under this chapter. new text begin Fees collected under this section shall be deposited in the state
government special revenue fund. new text end Recreational camping areas and manufactured home
parks shall pay the highest applicable base fee under paragraph (b). The license fee for new
operators of a manufactured home park or recreational camping area previously licensed
under this chapter for the same calendar year is one-half of the appropriate annual license
fee, plus any penalty that may be required. The license fee for operators opening on or after
October 1 is one-half of the appropriate annual license fee, plus any penalty that may be
required.
(b) All manufactured home parks and recreational camping areas shall pay the following
annual base fee:
(1) a manufactured home park, deleted text begin $150deleted text end new text begin $165new text end ; and
(2) a recreational camping area with:
(i) 24 or less sites, deleted text begin $50deleted text end new text begin $55new text end ;
(ii) 25 to 99 sites, deleted text begin $212deleted text end new text begin $230new text end ; and
(iii) 100 or more sites, deleted text begin $300deleted text end new text begin $330new text end .
In addition to the base fee, manufactured home parks and recreational camping areas shall
pay deleted text begin $4deleted text end new text begin $5new text end for each licensed site. This paragraph does not apply to special event recreational
camping areas. Operators of a manufactured home park or a recreational camping area also
licensed under section 157.16 for the same location shall pay only one base fee, whichever
is the highest of the base fees found in this section or section 157.16.
(c) In addition to the fee in paragraph (b), each manufactured home park or recreational
camping area shall pay an additional annual fee for each fee category specified in this
paragraph:
(1) Manufactured home parks and recreational camping areas with public swimming
pools and spas shall pay the appropriate fees specified in section 157.16.
(2) Individual private sewer or water, $60. "Individual private water" means a fee category
with a water supply other than a community public water supply as defined in Minnesota
Rules, chapter 4720. "Individual private sewer" means a fee category with a subsurface
sewage treatment system which uses subsurface treatment and disposal.
(d) The following fees must accompany a plan review application for initial construction
of a manufactured home park or recreational camping area:
(1) for initial construction of less than 25 sites, $375;
(2) for initial construction of 25 to 99 sites, $400; and
(3) for initial construction of 100 or more sites, $500.
(e) The following fees must accompany a plan review application when an existing
manufactured home park or recreational camping area is expanded:
(1) for expansion of less than 25 sites, $250;
(2) for expansion of 25 to 99 sites, $300; and
(3) for expansion of 100 or more sites, $450.
Sec. 98.
Minnesota Statutes 2016, section 364.09, is amended to read:
364.09 EXCEPTIONS.
(a) This chapter does not apply to the licensing process for peace officers; to law
enforcement agencies as defined in section 626.84, subdivision 1, paragraph (f); to fire
protection agencies; to eligibility for a private detective or protective agent license; to the
licensing and background study process under chapters 245A and 245C; to the licensing
and background investigation process under chapter 240; to eligibility for school bus driver
endorsements; to eligibility for special transportation service endorsements; to eligibility
for a commercial driver training instructor license, which is governed by section 171.35
and rules adopted under that section; to emergency medical services personnel, or to the
licensing by political subdivisions of taxicab drivers, if the applicant for the license has
been discharged from sentence for a conviction within the ten years immediately preceding
application of a violation of any of the following:
(1) sections 609.185 to 609.2114, 609.221 to 609.223, 609.342 to 609.3451, or 617.23,
subdivision 2 or 3; or Minnesota Statutes 2012, section 609.21;
(2) any provision of chapter 152 that is punishable by a maximum sentence of 15 years
or more; or
(3) a violation of chapter 169 or 169A involving driving under the influence, leaving
the scene of an accident, or reckless or careless driving.
This chapter also shall not apply to eligibility for juvenile corrections employment, where
the offense involved child physical or sexual abuse or criminal sexual conduct.
(b) This chapter does not apply to a school district or to eligibility for a license issued
or renewed by the Board of Teaching or the commissioner of education.
(c) Nothing in this section precludes the Minnesota Police and Peace Officers Training
Board or the state fire marshal from recommending policies set forth in this chapter to the
attorney general for adoption in the attorney general's discretion to apply to law enforcement
or fire protection agencies.
(d) This chapter does not apply to a license to practice medicine that has been denied or
revoked by the Board of Medical Practice pursuant to section 147.091, subdivision 1a.
(e) This chapter does not apply to any person who has been denied a license to practice
chiropractic or whose license to practice chiropractic has been revoked by the board in
accordance with section 148.10, subdivision 7.
(f) This chapter does not apply to any license, registration, or permit that has been denied
or revoked by the Board of Nursing in accordance with section 148.261, subdivision 1a.
new text begin
(g) This chapter does not apply to any license, registration, permit, or certificate that has
been denied or revoked by the commissioner of health according to section 148.5195,
subdivision 5; 148.6448, subdivision 3; or 153A.15, subdivision 2.
new text end
deleted text begin (g)deleted text end new text begin (h) new text end This chapter does not supersede a requirement under law to conduct a criminal
history background investigation or consider criminal history records in hiring for particular
types of employment.
Sec. 99. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2016, sections 103I.005, subdivisions 8, 14, and 15; 103I.451; and
144.0571,
new text end
new text begin
are repealed.
new text end
ARTICLE 11
HEALTH LICENSING BOARDS
Section 1.
Minnesota Statutes 2016, section 144E.35, subdivision 1, is amended to read:
Subdivision 1.
Repayment for volunteer education.
A licensed ambulance service
shall be reimbursed by the board for the necessary expense of the initial education of a
volunteer ambulance attendant upon successful completion by the attendant of an EMT
education course, or deleted text begin a continuingdeleted text end new text begin renewalnew text end education deleted text begin coursedeleted text end for EMT care, or both, which
has been approved by the board, pursuant to section 144E.285. Reimbursement may include
tuition, transportation, food, lodging, hourly payment for the time spent deleted text begin indeleted text end new text begin atnew text end the education
deleted text begin coursedeleted text end , and other necessary expenditures, except that in no instance shall a volunteer
ambulance attendant be reimbursed more than deleted text begin $600deleted text end new text begin $900new text end for successful completion of an
initial education course, and deleted text begin $275deleted text end new text begin $350new text end for successful completion of deleted text begin a continuingdeleted text end new text begin renewalnew text end
education deleted text begin coursedeleted text end .
Sec. 2.
Minnesota Statutes 2016, section 147.01, subdivision 7, is amended to read:
Subd. 7.
Physician application deleted text begin feedeleted text end new text begin and license feesnew text end .
new text begin (a) new text end The board may charge deleted text begin adeleted text end new text begin the
following nonrefundable application and license fees processed pursuant to sections 147.02,
147.03, 147.037, 147.0375, and 147.38:
new text end
new text begin (1) new text end physician application fee deleted text begin ofdeleted text end new text begin ,new text end $200deleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) physician annual registration renewal fee, $192;
new text end
new text begin
(3) physician endorsement to other states, $40;
new text end
new text begin
(4) physician emeritus license, $50;
new text end
new text begin
(5) physician temporary licenses, $60;
new text end
new text begin
(6) physician late fee, $60;
new text end
new text begin
(7) duplicate license fee, $20;
new text end
new text begin
(8) certification letter fee, $25;
new text end
new text begin
(9) education or training program approval fee, $100;
new text end
new text begin
(10) report creation and generation fee, $60;
new text end
new text begin
(11) examination administration fee (half day), $50;
new text end
new text begin
(12) examination administration fee (full day), $80; and
new text end
new text begin
(13) fees developed by the Interstate Commission for determining physician qualification
to register and participate in the interstate medical licensure compact, as established in rules
authorized in and pursuant to section 147.38, not to exceed $1,000.
new text end
new text begin (b) The board may prorate the initial annual license fee. All licensees are required to
pay the full fee upon license renewal. new text end The revenue generated from the fee must be deposited
in an account in the state government special revenue fund.
Sec. 3.
Minnesota Statutes 2016, section 147.02, subdivision 1, is amended to read:
Subdivision 1.
United States or Canadian medical school graduates.
The board shall
issue a license to practice medicine to a person not currently licensed in another state or
Canada and who meets the requirements in paragraphs (a) to (i).
(a) An applicant for a license shall file a written application on forms provided by the
board, showing to the board's satisfaction that the applicant is of good moral character and
satisfies the requirements of this section.
(b) The applicant shall present evidence satisfactory to the board of being a graduate of
a medical or osteopathic medical school located in the United States, its territories or Canada,
and approved by the board based upon its faculty, curriculum, facilities, accreditation by a
recognized national accrediting organization approved by the board, and other relevant data,
or is currently enrolled in the final year of study at the school.
(c) The applicant must have passed an examination as described in clause (1) or (2).
(1) The applicant must have passed a comprehensive examination for initial licensure
prepared and graded by the National Board of Medical Examiners, the Federation of State
Medical Boards, the Medical Council of Canada, the National Board of Osteopathic
Examiners, or the appropriate state board that the board determines acceptable. The board
shall by rule determine what constitutes a passing score in the examination.
(2) The applicant taking the United States Medical Licensing Examination (USMLE)
or Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) must
have passed steps or levels one, two, and three. Step or level three must be passed within
five years of passing step or level two, or before the end of residency training. The applicant
must pass each of steps or levels one, two, and three with passing scores as recommended
by the USMLE program or National Board of Osteopathic Medical Examiners within three
attempts. The applicant taking combinations of Federation of State Medical Boards, National
Board of Medical Examiners, and USMLE may be accepted only if the combination is
approved by the board as comparable to existing comparable examination sequences and
all examinations are completed prior to the year 2000.
(d) The applicant shall present evidence satisfactory to the board of the completion of
one year of graduate, clinical medical training in a program accredited by a national
accrediting organization approved by the board or other graduate training approved in
advance by the board as meeting standards similar to those of a national accrediting
organization.
(e) The applicant may make arrangements with the executive director to appear in person
before the board or its designated representative to show that the applicant satisfies the
requirements of this section. The board may establish as internal operating procedures the
procedures or requirements for the applicant's personal presentation.
(f) The applicant shall pay a new text begin nonrefundable new text end fee established by the board deleted text begin by ruledeleted text end . deleted text begin The
fee may not be refunded.deleted text end Upon application or notice of license renewal, the board must
provide notice to the applicant and to the person whose license is scheduled to be issued or
renewed of any additional fees, surcharges, or other costs which the person is obligated to
pay as a condition of licensure. The notice must:
(1) state the dollar amount of the additional costs; and
(2) clearly identify to the applicant the payment schedule of additional costs.
(g) The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or revocation
occurred.
(h) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee, or have been subject to disciplinary action other than as specified in
paragraph (g). If the applicant does not satisfy the requirements stated in this paragraph,
the board may issue a license only on the applicant's showing that the public will be protected
through issuance of a license with conditions and limitations the board considers appropriate.
(i) If the examination in paragraph (c) was passed more than ten years ago, the applicant
must either:
(1) pass the special purpose examination of the Federation of State Medical Boards with
a score of 75 or better within three attempts; or
(2) have a current certification by a specialty board of the American Board of Medical
Specialties, of the American Osteopathic Association, the Royal College of Physicians and
Surgeons of Canada, or of the College of Family Physicians of Canada.
Sec. 4.
Minnesota Statutes 2016, section 147.03, subdivision 1, is amended to read:
Subdivision 1.
Endorsement; reciprocity.
(a) The board may issue a license to practice
medicine to any person who satisfies the requirements in paragraphs (b) to (f).
(b) The applicant shall satisfy all the requirements established in section 147.02,
subdivision 1, paragraphs (a), (b), (d), (e), and (f).
(c) The applicant shall:
(1) have passed an examination prepared and graded by the Federation of State Medical
Boards, the National Board of Medical Examiners, or the United States Medical Licensing
Examination (USMLE) program in accordance with section 147.02, subdivision 1, paragraph
(c), clause (2); the National Board of Osteopathic Medical Examiners; or the Medical Council
of Canada; and
(2) have a current license from the equivalent licensing agency in another state or Canada
and, if the examination in clause (1) was passed more than ten years ago, either:
(i) pass the Special Purpose Examination of the Federation of State Medical Boards with
a score of 75 or better within three attempts; or
(ii) have a current certification by a specialty board of the American Board of Medical
Specialties, of the American Osteopathic Association, the Royal College of Physicians and
Surgeons of Canada, or of the College of Family Physicians of Canada; or
(3) if the applicant fails to meet the requirement established in section 147.02, subdivision
1, paragraph (c), clause (2), because the applicant failed to pass each of steps one, two, and
three of the USMLE within the required three attempts, the applicant may be granted a
license provided the applicant:
(i) has passed each of steps one, two, and three with passing scores as recommended by
the USMLE program within no more than four attempts for any of the three steps;
(ii) is currently licensed in another state; and
(iii) has current certification by a specialty board of the American Board of Medical
Specialties, the American Osteopathic Association Bureau of Professional Education, the
Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians
of Canada.
deleted text begin
(d) The applicant shall pay a fee established by the board by rule. The fee may not be
refunded.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or revocation
occurred.
deleted text begin (f)deleted text end new text begin (e)new text end The applicant must not have engaged in conduct warranting disciplinary action
against a licensee, or have been subject to disciplinary action other than as specified in
paragraph (e). If an applicant does not satisfy the requirements stated in this paragraph, the
board may issue a license only on the applicant's showing that the public will be protected
through issuance of a license with conditions or limitations the board considers appropriate.
deleted text begin (g)deleted text end new text begin (f)new text end Upon the request of an applicant, the board may conduct the final interview of
the applicant by teleconference.
Sec. 5.
new text begin
[147A.28] PHYSICIAN ASSISTANT APPLICATION AND LICENSE FEES.
new text end
new text begin
(a) The board may charge the following nonrefundable fees:
new text end
new text begin
(1) physician assistant application fee, $120;
new text end
new text begin
(2) physician assistant annual registration renewal fee (prescribing authority), $135;
new text end
new text begin
(3) physician assistant annual registration renewal fee (no prescribing authority), $115;
new text end
new text begin
(4) physician assistant temporary registration, $115;
new text end
new text begin
(5) physician assistant temporary permit, $60;
new text end
new text begin
(6) physician assistant locum tenens permit, $25;
new text end
new text begin
(7) physician assistant late fee, $50;
new text end
new text begin
(8) duplicate license fee, $20;
new text end
new text begin
(9) certification letter fee, $25;
new text end
new text begin
(10) education or training program approval fee, $100; and
new text end
new text begin
(11) report creation and generation fee, $60.
new text end
new text begin
(b) The board may prorate the initial annual license fee. All licensees are required to
pay the full fee upon license renewal. The revenue generated from the fees must be deposited
in an account in the state government special revenue fund.
new text end
Sec. 6.
Minnesota Statutes 2016, section 147B.08, is amended by adding a subdivision to
read:
new text begin Subd. 4. new text end
new text begin Acupuncturist application and license fees. new text end
new text begin
(a) The board may charge the
following nonrefundable fees:
new text end
new text begin
(1) acupuncturist application fee, $150;
new text end
new text begin
(2) acupuncturist annual registration renewal fee, $150;
new text end
new text begin
(3) acupuncturist temporary registration fee, $60;
new text end
new text begin
(4) acupuncturist inactive status fee, $50;
new text end
new text begin
(5) acupuncturist late fee, $50;
new text end
new text begin
(6) duplicate license fee, $20;
new text end
new text begin
(7) certification letter fee, $25;
new text end
new text begin
(8) education or training program approval fee, $100; and
new text end
new text begin
(9) report creation and generation fee, $60.
new text end
new text begin
(b) The board may prorate the initial annual license fee. All licensees are required to
pay the full fee upon license renewal. The revenue generated from the fees must be deposited
in an account in the state government special revenue fund.
new text end
Sec. 7.
Minnesota Statutes 2016, section 147C.40, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Respiratory therapist application and license fees. new text end
new text begin
(a) The board may charge
the following nonrefundable fees:
new text end
new text begin
(1) respiratory therapist application fee, $100;
new text end
new text begin
(2) respiratory therapist annual registration renewal fee, $90;
new text end
new text begin
(3) respiratory therapist inactive status fee, $50;
new text end
new text begin
(4) respiratory therapist temporary registration fee, $90;
new text end
new text begin
(5) respiratory therapist temporary permit, $60;
new text end
new text begin
(6) respiratory therapist late fee, $50;
new text end
new text begin
(7) duplicate license fee, $20;
new text end
new text begin
(8) certification letter fee, $25;
new text end
new text begin
(9) education or training program approval fee, $100; and
new text end
new text begin
(10) report creation and generation fee, $60.
new text end
new text begin
(b) The board may prorate the initial annual license fee. All licensees are required to
pay the full fee upon license renewal. The revenue generated from the fees must be deposited
in an account in the state government special revenue fund.
new text end
Sec. 8.
Minnesota Statutes 2016, section 148.59, is amended to read:
148.59 LICENSE RENEWAL; LICENSE AND REGISTRATION FEES.
A licensed optometrist shall pay to the state Board of Optometry a fee as set by the board
in order to renew a license as provided by board rule. No fees shall be refunded. Fees may
not exceed the following amounts but may be adjusted lower by board direction and are for
the exclusive use of the board:
(1) optometry licensure application, $160;
(2) optometry annual licensure renewal, deleted text begin $135deleted text end new text begin $170new text end ;
(3) optometry late penalty fee, $75;
(4) annual license renewal card, $10;
(5) continuing education provider application, $45;
(6) emeritus registration, $10;
(7) endorsement/reciprocity application, $160;
(8) replacement of initial license, $12; deleted text begin and
deleted text end
(9) license verification, $50deleted text begin .deleted text end new text begin ;
new text end
new text begin
(10) jurisprudence state examination, $75;
new text end
new text begin
(11) Optometric Education Continuing Education data bank registration, $20; and
new text end
new text begin
(12) data requests and labels, $50.
new text end
Sec. 9.
Minnesota Statutes 2016, section 148E.180, is amended to read:
148E.180 FEE AMOUNTS.
Subdivision 1.
Application fees.
new text begin Nonrefundable new text end application fees for licensure deleted text begin are as
followsdeleted text end new text begin may not exceed the following amounts but may be adjusted lower by board actionnew text end :
(1) for a licensed social worker, deleted text begin $45deleted text end new text begin $75new text end ;
(2) for a licensed graduate social worker, deleted text begin $45deleted text end new text begin $75new text end ;
(3) for a licensed independent social worker, deleted text begin $45deleted text end new text begin $75new text end ;
(4) for a licensed independent clinical social worker, deleted text begin $45deleted text end new text begin $75new text end ;
(5) for a temporary license, $50; and
(6) for a deleted text begin licensuredeleted text end new text begin licensenew text end by endorsement, deleted text begin $85deleted text end new text begin $115new text end .
The fee for criminal background checks is the fee charged by the Bureau of Criminal
Apprehension. The criminal background check fee must be included with the application
fee as required according to section 148E.055.
Subd. 2.
License fees.
new text begin Nonrefundable new text end license fees deleted text begin are as followsdeleted text end new text begin may not exceed the
following amounts but may be adjusted lower by board actionnew text end :
(1) for a licensed social worker, deleted text begin $81deleted text end new text begin $115new text end ;
(2) for a licensed graduate social worker, deleted text begin $144deleted text end new text begin $210new text end ;
(3) for a licensed independent social worker, deleted text begin $216deleted text end new text begin $305new text end ;
(4) for a licensed independent clinical social worker, deleted text begin $238.50deleted text end new text begin $335new text end ;
(5) for an emeritus inactive license, deleted text begin $43.20deleted text end new text begin $65new text end ;
(6) for an emeritus active license, one-half of the renewal fee specified in subdivision
3; and
(7) for a temporary leave fee, the same as the renewal fee specified in subdivision 3.
If the licensee's initial license term is less or more than 24 months, the required license
fees must be prorated proportionately.
Subd. 3.
Renewal fees.
new text begin Nonrefundable new text end renewal fees for deleted text begin licensure are as followsdeleted text end new text begin the
two-year renewal term may not exceed the following amounts but may be adjusted lower
by board actionnew text end :
(1) for a licensed social worker, deleted text begin $81deleted text end new text begin $115new text end ;
(2) for a licensed graduate social worker, deleted text begin $144deleted text end new text begin $210new text end ;
(3) for a licensed independent social worker, deleted text begin $216deleted text end new text begin $305new text end ; and
(4) for a licensed independent clinical social worker, deleted text begin $238.50deleted text end new text begin $335new text end .
Subd. 4.
Continuing education provider fees.
Continuing education provider fees are
deleted text begin as followsdeleted text end new text begin the following nonrefundable amountsnew text end :
(1) for a provider who offers programs totaling one to eight clock hours in a one-year
period according to section 148E.145, $50;
(2) for a provider who offers programs totaling nine to 16 clock hours in a one-year
period according to section 148E.145, $100;
(3) for a provider who offers programs totaling 17 to 32 clock hours in a one-year period
according to section 148E.145, $200;
(4) for a provider who offers programs totaling 33 to 48 clock hours in a one-year period
according to section 148E.145, $400; and
(5) for a provider who offers programs totaling 49 or more clock hours in a one-year
period according to section 148E.145, $600.
Subd. 5.
Late fees.
Late fees are deleted text begin as followsdeleted text end new text begin the following nonrefundable amountsnew text end :
(1) renewal late fee, one-fourth of the renewal fee specified in subdivision 3;
(2) supervision plan late fee, $40; and
(3) license late fee, $100 plus the prorated share of the license fee specified in subdivision
2 for the number of months during which the individual practiced social work without a
license.
Subd. 6.
License cards and wall certificates.
(a) The fee for a license card as specified
in section 148E.095 is $10.
(b) The fee for a license wall certificate as specified in section 148E.095 is $30.
Subd. 7.
Reactivation fees.
Reactivation fees are deleted text begin as followsdeleted text end new text begin the following nonrefundable
amountsnew text end :
(1) reactivation from a temporary leave or emeritus status, the prorated share of the
renewal fee specified in subdivision 3; and
(2) reactivation of an expired license, 1-1/2 times the renewal fees specified in subdivision
3.
Sec. 10. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2016, sections 147A.21; 147B.08, subdivisions 1, 2, and 3; and
147C.40, subdivisions 1, 2, 3, and 4,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, part 5600.2500,
new text end
new text begin
is repealed.
new text end
ARTICLE 12
APPROPRIATIONS
Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
|
new text begin
The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2018" and "2019" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2018, or June 30, 2019, respectively.
"The first year" is fiscal year 2018. "The second year" is fiscal year 2019. "The biennium"
is fiscal years 2018 and 2019.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2018 new text end |
new text begin
2019 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
7,591,115,000 new text end |
new text begin
$ new text end |
new text begin
7,941,222,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2018 new text end |
new text begin
2019 new text end |
|
|
new text begin
General new text end |
new text begin
6,663,399,000 new text end |
new text begin
7,027,393,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
8,194,000 new text end |
new text begin
7,994,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
639,575,000 new text end |
new text begin
643,442,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
278,051,000 new text end |
new text begin
260,497,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
1,896,000 new text end |
new text begin
1,896,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
TANF Maintenance of Effort
|
||||||
new text begin
(a) The commissioner shall ensure that
sufficient qualified nonfederal expenditures
are made each year to meet the state's
maintenance of effort (MOE) requirements of
the TANF block grant specified under Code
of Federal Regulations, title 45, section 263.1.
In order to meet these basic TANF/MOE
requirements, the commissioner may report
as TANF/MOE expenditures only nonfederal
money expended for allowable activities listed
in the following clauses:
new text end
new text begin
(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
new text end
new text begin
(2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
new text end
new text begin
(3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
new text end
new text begin
(4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;
new text end
new text begin
(5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
new text end
new text begin
(6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;
new text end
new text begin
(7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
new text end
new text begin
(8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
new text end
new text begin
(b) For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
new text end
new text begin
(c) The commissioner shall ensure that the
MOE used by the commissioner of
management and budget for the February and
November forecasts required under Minnesota
Statutes, section 16A.103, contains
expenditures under paragraph (a), clause (1),
equal to at least 16 percent of the total required
under Code of Federal Regulations, title 45,
section 263.1.
new text end
new text begin
(d) The commissioner may not claim an
amount of TANF/MOE in excess of the 75
percent standard in Code of Federal
Regulations, title 45, section 263.1(a)(2),
except:
new text end
new text begin
(1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
new text end
new text begin
(2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
new text end
new text begin
(3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section 261.43
(a)(2).
new text end
new text begin
(e) For the purposes of paragraph (d), the
commissioner may supplement the MOE claim
with working family credit expenditures or
other qualified expenditures to the extent such
expenditures are otherwise available after
considering the expenditures allowed in this
subdivision.
new text end
new text begin
(f) The requirement in Minnesota Statutes,
section 256.011, subdivision 3, that federal
grants or aids secured or obtained under that
subdivision be used to reduce any direct
appropriations provided by law, does not apply
if the grants or aids are federal TANF funds.
new text end
new text begin
(g) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
new text end
new text begin
(h) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for computer
projects approved by the commissioner of the
Office of MN.IT Services, funded by the
legislature, and approved by the commissioner
of management and budget may be transferred
from one project to another and from
development to operations as the
commissioner of human services considers
necessary. Any unexpended balance in the
appropriation for these projects does not
cancel and is available for ongoing
development and operations.
new text end
new text begin Subd. 3. new text end
new text begin
Central Office; Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
133,248,000 new text end |
new text begin
133,652,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
8,069,000 new text end |
new text begin
7,869,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
23,618,000 new text end |
new text begin
21,516,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
100,000 new text end |
new text begin
100,000 new text end |
new text begin
(a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
new text end
new text begin
(1) Minnesota Statutes, section 125A.744,
subdivision 3;
new text end
new text begin
(2) Minnesota Statutes, section 245.495,
paragraph (b);
new text end
new text begin
(3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
new text end
new text begin
(4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
new text end
new text begin
(5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and
new text end
new text begin
(6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
new text end
new text begin
(b) Base Level Adjustments. The general
fund base is $139,064,000 in fiscal year 2020
and $139,010,000 in fiscal year 2021.
new text end
new text begin Subd. 4. new text end
new text begin
Central Office; Children and Families
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
10,520,000 new text end |
new text begin
10,331,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
2,582,000 new text end |
new text begin
2,582,000 new text end |
new text begin
(a) Financial Institution Data Match and
Payment of Fees. The commissioner is
authorized to allocate up to $310,000 each
year in fiscal year 2018 and fiscal year 2019
from the systems special revenue account to
make payments to financial institutions in
exchange for performing data matches
between account information held by financial
institutions and the public authority's database
of child support obligors as authorized by
Minnesota Statutes, section 13B.06,
subdivision 7.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $11,129,000 in fiscal year 2020 and
$11,042,000 in fiscal year 2021.
new text end
new text begin Subd. 5. new text end
new text begin
Central Office; Health Care
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
21,709,000 new text end |
new text begin
21,714,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
33,931,000 new text end |
new text begin
23,984,000 new text end |
new text begin
Rates Study. $350,000 in fiscal year 2018 is
for the medical assistance payment rate study
required under article 4, section 64. This is a
onetime appropriation.
new text end
new text begin
new text begin Trust Guide. new text end $200,000 in fiscal year 2018
and $150,000 in fiscal year 2019 are for the
development of a special needs trust guide that
directs the state medical assistance program's
trust recovery process and establishes
guidelines for the public. This is a onetime
appropriation.
new text end
new text begin
new text begin Base Level Adjustments.new text end The general fund
base is $21,470,000 in fiscal year 2020 and
$21,515,000 in fiscal year 2021. The health
care access fund base is $24,000,000 in fiscal
year 2020 and $24,000,000 in fiscal year 2021.
new text end
new text begin Subd. 6. new text end
new text begin
Central Office; Continuing Care for
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
17,652,000 new text end |
new text begin
18,089,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
125,000 new text end |
new text begin
125,000 new text end |
new text begin
new text begin Base Level Adjustment.new text end The general fund
base is $21,352,000 in fiscal year 2020 and
$17,045,000 in fiscal year 2021.
new text end
new text begin
new text begin Assisted Living Report Card. new text end Of these
amounts, $4,402,000 in fiscal year 2020 is to
collect data from residents of housing with
services establishments with an assisted living
designation on quality of life and quality of
care to produce a report card under Minnesota
Statutes, section 144G.02, subdivision 2.
$4,402,000 is the base in each even year
starting in fiscal year 2022.
new text end
new text begin Subd. 7. new text end
new text begin
Central Office; Community Supports
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
31,028,000 new text end |
new text begin
28,675,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
163,000 new text end |
new text begin
163,000 new text end |
new text begin
new text begin Transportation Study. new text end $250,000 in fiscal
year 2018 and $250,000 in fiscal year 2019
are for the transportation study required under
article 1, section 36. This is a onetime
appropriation.
new text end
new text begin
new text begin Waiver Consolidation Study. new text end $110,000 in
fiscal year 2018 and $140,000 in fiscal year
2019 are to conduct a study on consolidating
the four disability home and community-based
services waivers into one program. The
commissioner of human services shall submit
recommendations to the chairs and ranking
minority members of the legislative
committees with oversight over health and
human services by January 15, 2019. This is
a onetime appropriation.
new text end
new text begin
new text begin Children's Mental Health Study. new text end $125,000
in fiscal year 2018 and $125,000 in fiscal year
2019 are for children's mental health study
under article 8, section 60. This is a onetime
appropriation.
new text end
new text begin
new text begin Substance Use Disorder System Study.
new text end $150,000 in fiscal year 2018 and $150,000 in
fiscal year 2019 are for the substance use
disorder system study required under article
8, section 59. This is a onetime appropriation.
new text end
new text begin
new text begin Base Level Adjustment. new text end The general fund
base is $28,381,000 in fiscal year 2020 and
$27,705,000 in fiscal year 2021. Of these
amounts, $500,000 in fiscal year 2020 is to
study and develop an individual budgeting
model for disability waiver recipients and
those accessing services through
consumer-directed community supports. The
commissioner shall submit recommendations
to the chairs and ranking minority members
of the legislative committees with jurisdiction
over these programs by January 15, 2021. This
is a onetime appropriation.
new text end
new text begin Subd. 8. new text end
new text begin
Forecasted Programs; MFIP/DWP
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
88,930,000 new text end |
new text begin
106,340,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
92,732,000 new text end |
new text begin
75,025,000 new text end |
new text begin Subd. 9. new text end
new text begin
Forecasted Programs; MFIP Child Care
|
new text begin
115,067,000 new text end |
new text begin
142,287,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Forecasted Programs; General
|
new text begin
56,650,000 new text end |
new text begin
58,365,000 new text end |
||||
new text begin
(a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.
new text end
new text begin
(b) Emergency General Assistance. The
amount appropriated for emergency general
assistance is limited to no more than
$6,729,812 in fiscal year 2018 and $6,729,812
in fiscal year 2019. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.
new text end
new text begin Subd. 11. new text end
new text begin
Forecasted Programs; Minnesota
|
new text begin
40,484,000 new text end |
new text begin
41,634,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Forecasted Programs; Group
|
new text begin
167,426,000 new text end |
new text begin
177,460,000 new text end |
||||
new text begin Subd. 13. new text end
new text begin
Forecasted Programs; Northstar Care
|
new text begin
83,622,000 new text end |
new text begin
111,432,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
new text begin
9,652,000 new text end |
new text begin
10,798,000 new text end |
||||
new text begin
This appropriation is from the health care
access fund.
new text end
new text begin Subd. 15. new text end
new text begin
Forecasted Programs; Medical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
4,988,270,000 new text end |
new text begin
5,221,647,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
568,159,000 new text end |
new text begin
582,929,000 new text end |
new text begin
(a) Behavioral Health Services. $1,000,000
each fiscal year is for behavioral health
services provided by hospitals identified under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (a), clause (4). The
increase in payments shall be made by
increasing the adjustment under Minnesota
Statutes, section 256.969, subdivision 2b,
paragraph (e), clause (2).
new text end
new text begin
(b) Base Level Adjustment. The health care
access fund base for medical assistance is
$798,429,000 in fiscal year 2020 and
$798,429,000 in fiscal year 2021.
new text end
new text begin Subd. 16. new text end
new text begin
Forecasted Programs; Alternative
|
new text begin
44,442,000 new text end |
new text begin
45,123,000 new text end |
||||
new text begin
new text begin Alternative Care Transfer.new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
new text end
new text begin Subd. 17. new text end
new text begin
Forecasted Programs; Chemical
|
new text begin
111,844,000 new text end |
new text begin
131,445,000 new text end |
||||
new text begin Subd. 18. new text end
new text begin
Grant Programs; Support Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
8,715,000 new text end |
new text begin
8,715,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
96,311,000 new text end |
new text begin
96,311,000 new text end |
new text begin Subd. 19. new text end
new text begin
Grant Programs; Basic Sliding Fee
|
new text begin
55,879,000 new text end |
new text begin
68,609,000 new text end |
||||
new text begin
new text begin Base Level Adjustment.new text end The general fund
base is $63,813,000 in fiscal year 2020 and
$63,943,000 in fiscal year 2021.
new text end
new text begin Subd. 20. new text end
new text begin
Grant Programs; Child Care
|
new text begin
1,737,000 new text end |
new text begin
1,737,000 new text end |
||||
new text begin Subd. 21. new text end
new text begin
Grant Programs; Child Support
|
new text begin
50,000 new text end |
new text begin
50,000 new text end |
||||
new text begin Subd. 22. new text end
new text begin
Grant Programs; Children's Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
39,965,000 new text end |
new text begin
39,165,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
140,000 new text end |
new text begin
140,000 new text end |
new text begin
(a) Title IV-E Adoption Assistance.
Additional federal reimbursement to the state
as a result of the Fostering Connections to
Success and Increasing Adoptions Act's
expanded eligibility for title IV-E adoption
assistance is appropriated to the commissioner
for postadoption services, including a
parent-to-parent support network.
new text end
new text begin
(b) Adoption Assistance Incentive Grants.
Federal funds available during fiscal years
2018 and 2019 for adoption incentive grants
are appropriated to the commissioner for
postadoption services, including a
parent-to-parent support network.
new text end
new text begin
(c) new text begin American Indian Child Welfare
Initiative. new text end $800,000 in fiscal year 2018 is for
planning efforts to expand the American
Indian Child Welfare Initiative under
Minnesota Statutes, section 256.01,
subdivision 14b. Of this amount, $400,000 is
for a grant to the Mille Lacs Band of Ojibwe
and $400,000 is for a grant to the Red Lake
Nation. This is a onetime appropriation.
new text end
new text begin Subd. 23. new text end
new text begin
Grant Programs; Children and
|
new text begin
58,201,000 new text end |
new text begin
58,201,000 new text end |
||||
new text begin Subd. 24. new text end
new text begin
Grant Programs; Children and
|
new text begin
32,430,000 new text end |
new text begin
32,640,000 new text end |
||||
new text begin
(a) Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2018 do not
cancel but are available for this purpose in
fiscal year 2019.
new text end
new text begin
(b) new text begin Community Living Infrastructure.
new text end $1,400,000 in fiscal year 2018 and $1,400,000
in fiscal year 2019 are for community living
infrastructure grant allocations under article
2, section 17.
new text end
new text begin
(c) new text begin Housing Web Site Grant. new text end $150,000 in
fiscal year 2018 and $150,000 in fiscal year
2019 are for a grant to a public or private
entity to create and maintain a Web site and
application to track real-time housing openings
for people with disabilities.
new text end
new text begin
(d) new text begin Housing Benefit Web Site. new text end $130,000 in
fiscal year 2018 and $130,000 in fiscal year
2019 are to operate the housing benefit 101
Web site to help people who need affordable
housing, and supports to maintain that
housing, understand the range of housing
options and support services available.
new text end
new text begin
(e) new text begin Child Care Inspections. new text end $2,400,000 in
fiscal year 2018 and $2,400,000 in fiscal year
2019 are for grants to counties to conduct
annual inspections of family child care
providers licensed under Minnesota Statutes,
chapter 245A, and Minnesota Rules, chapter
9502.
new text end
new text begin
(f) Base Level Adjustment. The general fund
base is $32,740,000 in fiscal year 2020 and
$33,840,000 in fiscal year 2021.
new text end
new text begin Subd. 25. new text end
new text begin
Grant Programs; Health Care Grants
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
4,244,000 new text end |
new text begin
3,961,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
3,465,000 new text end |
new text begin
3,465,000 new text end |
new text begin
new text begin Health Information Exchanges. new text end $125,000
in fiscal year 2018 and $250,000 in fiscal year
2019 are for the nonfederal share of health
information exchange grants to eligible health
care providers.
new text end
new text begin
new text begin Navigator Payments. new text end The health care access
fund base for navigator grants is decreased by
$1,000,000 in fiscal year 2018 and $1,000,000
in fiscal year 2019. The health care access
fund base for navigator grants is increased by
$1,000,000 in fiscal year 2018 and $1,000,000
in fiscal year 2019 for increased navigator
payments as required under article 4, section
5.
new text end
new text begin Subd. 26. new text end
new text begin
Grant Programs; Other Long-Term
|
new text begin
1,500,000 new text end |
new text begin
1,925,000 new text end |
||||
new text begin Subd. 27. new text end
new text begin
Grant Programs; Aging and Adult
|
new text begin
31,339,000 new text end |
new text begin
32,594,000 new text end |
||||
new text begin
new text begin Individual Provider Registry. new text end $375,000 in
fiscal year 2018 and $375,000 in fiscal year
2019 are for the registry of individual
providers of direct support services as defined
in Minnesota Statutes, section 256B.0711,
subdivision 1.
new text end
new text begin
new text begin Base Level Adjustment. new text end The general fund
base is $33,403,000 in fiscal year 2020 and
$33,152,000 in fiscal year 2021. Of these
amounts, $334,000 in fiscal year 2020 and
$477,000 in fiscal year 2021 are appropriated
to the Minnesota Board on Aging for
self-directed caregiver grants under article 3,
section 7.
new text end
new text begin Subd. 28. new text end
new text begin
Grant Programs; Deaf and
|
new text begin
2,675,000 new text end |
new text begin
2,675,000 new text end |
||||
new text begin
new text begin Expanded Services Grants. new text end $800,000 in
fiscal year 2018 and $800,000 in fiscal year
2019 are for deaf and hard-of-hearing grants.
The funds must be used to:
new text end
new text begin
(1) provide linguistically and culturally
appropriate mental health services for children
who are deaf, children who are deafblind, and
children who are hard-of-hearing in
northwestern and northeastern Minnesota;
new text end
new text begin
(2) provide psychiatric services statewide for
people who are deaf, people who are
deafblind, and people who are hard-of-hearing;
and
new text end
new text begin
(3) provide services and assistive technology
for people who are deafblind throughout
Minnesota.
new text end
new text begin Subd. 29. new text end
new text begin
Grant Programs; Disabilities Grants
|
new text begin
21,372,000 new text end |
new text begin
24,122,000 new text end |
||||
new text begin
new text begin Training of Direct Support Services
Providers. new text end $400,000 in fiscal year 2018 and
$400,000 in fiscal year 2019 are for training
and orientation of individual providers of
direct support services as defined in Minnesota
Statutes, section 256B.0711, subdivision 1.
This is a onetime appropriation. This
appropriation is not available until the labor
agreement between the state of Minnesota and
the Service Employees International Union
Healthcare Minnesota under Minnesota
Statutes, section 179A.54, is implemented
under Minnesota Statutes, sections 3.855 and
179A.22. The funding is available in either
year of the biennium and is available until
June 30, 2021.
new text end
new text begin
new text begin Stipends for Direct Support Services
Providers. new text end $2,750,000 in fiscal year 2019 is
for training of individual providers of direct
support services as defined in Minnesota
Statutes, section 256B.0711, subdivision 1.
Of this amount, $2,500,000 shall only be used
for stipends of $500 for up to 5,000 individual
providers who have completed designated,
voluntary trainings. Up to $250,000 may be
used by the grantee for grant administration.
This appropriation is not available until the
labor agreement between the state of
Minnesota and the Service Employees
International Union Healthcare Minnesota
under Minnesota Statutes, section 179A.54,
is implemented under Minnesota Statutes,
sections 3.855 and 179A.22. If made available,
this appropriation is onetime and is available
until June 30, 2021.
new text end
new text begin
new text begin Base Level Adjustment. new text end The general fund
base is $20,972,000 in fiscal year 2020 and
$20,972,000 in fiscal year 2021.
new text end
new text begin Subd. 30. new text end
new text begin
Grant Programs; Adult Mental Health
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
82,622,000 new text end |
new text begin
82,622,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
750,000 new text end |
new text begin
750,000 new text end |
new text begin
new text begin Community Mental Health Grants.
new text end $2,820,000 in fiscal year 2018 and $2,820,000
in fiscal year 2019 are for grants to counties
to build and expand community-based mental
health infrastructure under Minnesota Statutes,
section 245.4661, subdivision 9.
new text end
new text begin Subd. 31. new text end
new text begin
Grant Programs; Child Mental Health
|
new text begin
20,761,000 new text end |
new text begin
20,826,000 new text end |
||||
new text begin Subd. 32. new text end
new text begin
Grant Programs; Chemical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
2,136,000 new text end |
new text begin
2,136,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
1,733,000 new text end |
new text begin
1,733,000 new text end |
new text begin
new text begin Problem Gambling.new text end $225,000 in fiscal year
2018 and $225,000 in fiscal year 2019 are
from the lottery prize fund for a grant to the
state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
and training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
new text end
new text begin Subd. 33. new text end
new text begin
Direct Care and Treatment - Generally
|
||||||
new text begin
(a) new text begin Transfer Authority. new text end Money appropriated
to budget activities under subdivisions 34, 35,
36, 37, and 38 may be transferred between
budget activities and between years of the
biennium with the approval of the
commissioner of management and budget.
new text end
new text begin
(b) Dedicated Receipts Available. Of the
revenue received under Minnesota Statutes,
section 246.18, subdivision 8, paragraph (a),
up to $1,000,000 each year is available for the
purposes of Minnesota Statutes, section
246.18, subdivision 8, paragraph (b), clause
(1); and up to $2,713,000 each year is
available for the purposes of Minnesota
Statutes, section 246.18, subdivision 8,
paragraph (b), clause (2).
new text end
new text begin Subd. 34. new text end
new text begin
Direct Care and Treatment - Mental
|
new text begin
119,711,000 new text end |
new text begin
123,004,000 new text end |
||||
new text begin
new text begin DCT Operating Adjustment (CARE).
new text end $431,000 in fiscal year 2018 and $835,000 in
fiscal year 2019 are from the general fund for
Community Addiction Recover Enterprise
(CARE) operating adjustments. The
commissioner must transfer $431,000 in fiscal
year 2018 and $835,000 in fiscal year 2019 to
the enterprise fund for CARE.
new text end
new text begin
new text begin Base Level Adjustment. new text end The general fund
base is $128,143,000 in fiscal year 2020 and
$128,143,000 in fiscal year 2021.
new text end
new text begin Subd. 35. new text end
new text begin
Direct Care and Treatment -
|
new text begin
25,806,000 new text end |
new text begin
23,099,000 new text end |
||||
new text begin
new text begin DCT Operating Adjustment (MSOCS).
new text end $2,284,000 in fiscal year 2018 and $4,448,000
in fiscal year 2019 are from the general fund
for Minnesota State Operated Community
Services (MSOCS) operating adjustments.
The commissioner must transfer $2,284,000
in fiscal year 2018 and $4,448,000 in fiscal
year 2019 to the enterprise fund for MSOCS.
new text end
new text begin
new text begin MSOCS Sustainability. new text end $7,697,000 in fiscal
year 2018 and $2,588,000 in fiscal year 2019
are from the general fund for the Minnesota
State Operated Community Services program.
Of this amount, the commissioner must
transfer $6,697,000 in fiscal year 2018 and
$1,588,000 in fiscal year 2019 to the enterprise
fund for Minnesota State Operated Community
Services. $1,000,000 is available each year of
the biennium for start-up expenses for new
residential homes to be operated by Minnesota
State Operated Community Services.
new text end
new text begin
new text begin Base Level Adjustment.new text end The general fund
base is $23,099,000 in fiscal year 2020 and
$21,511,000 in fiscal year 2021.
new text end
new text begin Subd. 36. new text end
new text begin
Direct Care and Treatment - Forensic
|
new text begin
103,080,000 new text end |
new text begin
109,567,000 new text end |
||||
new text begin
new text begin Base Level Adjustment.new text end The general fund
base is $112,437,000 in fiscal year 2020 and
$115,046,000 in fiscal year 2021.
new text end
new text begin Subd. 37. new text end
new text begin
Direct Care and Treatment - Sex
|
new text begin
91,283,000 new text end |
new text begin
93,137,000 new text end |
||||
new text begin
Transfer Authority. Money appropriated for
the Minnesota sex offender program may be
transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.
new text end
new text begin
new text begin Minnesota State Industries Enterprise
Fund.new text end Funds remaining in the Minnesota state
industries enterprise fund on September 30,
2017, shall be transferred to the Minnesota
sex offender program vocational work
program established under Minnesota Statutes,
section 246B.05.
new text end
new text begin Subd. 38. new text end
new text begin
Direct Care and Treatment -
|
new text begin
49,001,000 new text end |
new text begin
50,415,000 new text end |
||||
new text begin
new text begin Base Level Adjustment.new text end The general fund
base is $51,202,000 in fiscal year 2020 and
$51,463,000 in fiscal year 2021.
new text end
new text begin Subd. 39. new text end
new text begin
Technical Activities
|
new text begin
86,186,000 new text end |
new text begin
86,339,000 new text end |
||||
new text begin
(a) This appropriation is from the federal
TANF fund.
new text end
new text begin
(b) Base Level Adjustment. The TANF fund
appropriation is $86,346,000 in fiscal year
2020 and $86,355,000 in fiscal year 2021.
new text end
Sec. 3. new text begin COMMISSIONER OF HEALTH
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
216,850,000 new text end |
new text begin
$ new text end |
new text begin
220,396,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2018 new text end |
new text begin
2019 new text end |
|
|
new text begin
General new text end |
new text begin
112,229,000 new text end |
new text begin
114,430,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
56,265,000 new text end |
new text begin
57,995,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
36,643,000 new text end |
new text begin
36,258,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Health Improvement
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
87,066,000 new text end |
new text begin
88,388,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
6,319,000 new text end |
new text begin
6,286,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
36,643,000 new text end |
new text begin
36,258,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
(a) Home Visiting for Pregnant and
Parenting Teens. $12,478,000 in fiscal year
2018 and $18,522,000 in fiscal year 2019 are
from the general fund for home visiting
services to pregnant and parenting teens.
new text end
new text begin
(b) Opioid Overdose Prevention. $4,000,000
in fiscal year 2018 is from the general fund
for a root-cause approach to reduce opioid
misuse in American Indian communities. This
is a onetime appropriation.
new text end
new text begin
(c) Community-Driven Data. $1,000,000 in
fiscal year 2018 is from the general fund to
align public health data with community
needs. This is a onetime appropriation.
new text end
new text begin
(d) Medical Cannabis. $150,000 in fiscal year
2018 and $150,000 in fiscal year 2019 are
added to the general fund appropriation for
the medical cannabis program.
new text end
new text begin
(e) TANF Appropriations. (1) $1,156,000
of the TANF fund is appropriated each year
of the biennium to the commissioner for
family planning grants under Minnesota
Statutes, section 145.925.
new text end
new text begin
(2) $3,579,000 of the TANF fund is
appropriated each year of the biennium to the
commissioner for home visiting and nutritional
services listed under Minnesota Statutes,
section 145.882, subdivision 7, clauses (6) and
(7). Funds must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1.
new text end
new text begin
(3) $2,000,000 of the TANF fund is
appropriated each year of the biennium to the
commissioner for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7.
new text end
new text begin
(4) $4,978,000 of the TANF fund is
appropriated each year of the biennium to the
commissioner for the family home visiting
grant program according to Minnesota
Statutes, section 145A.17. $4,000,000 of the
funding must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1. $978,000 of
the funding must be distributed to tribal
governments as provided in Minnesota
Statutes, section 145A.14, subdivision 2a.
new text end
new text begin
(5) The commissioner may use up to 6.23
percent of the funds appropriated each fiscal
year to conduct the ongoing evaluations
required under Minnesota Statutes, section
145A.17, subdivision 7, and training and
technical assistance as required under
Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
new text end
new text begin
(f) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
new text end
new text begin
(g) Base Level Adjustments. The general
fund base is $95,316,000 in fiscal year 2020
and $95,366,000 in fiscal year 2021. The
health care access fund base is $36,858,000
in fiscal year 2020 and $36,258,000 in fiscal
year 2021.
new text end
new text begin Subd. 3. new text end
new text begin
Health Protection
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
15,700,000 new text end |
new text begin
16,207,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
49,946,000 new text end |
new text begin
51,709,000 new text end |
new text begin
(a) Water Infrastructure Review. $230,000
in fiscal year 2018 and $230,000 in fiscal year
2019 are from the general fund for reviewing
and inspecting drinking water improvement
projects.
new text end
new text begin
(b) Vulnerable Adults in Health Care
Settings. $633,000 in fiscal year 2018 and
$559,000 in fiscal year 2019 are added to the
appropriation from the general fund for
regulating health care and home care settings.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is $16,596,000 in fiscal year 2020 and
$16,506,000 in fiscal year 2021. The state
government special revenue fund base is
$52,083,000 in fiscal year 2020 and
$52,119,000 in fiscal year 2021.
new text end
new text begin Subd. 4. new text end
new text begin
Health Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
9,463,000 new text end |
new text begin
9,835,000 new text end |
Sec. 4. new text begin HEALTH-RELATED BOARDS
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
25,126,000 new text end |
new text begin
$ new text end |
new text begin
23,319,000 new text end |
||
new text begin
This appropriation is from the state
government special revenue fund. The
amounts that may be spent for each purpose
are specified in the following subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Board of Chiropractic Examiners
|
new text begin
565,000 new text end |
new text begin
571,000 new text end |
||||
new text begin
Base Level Adjustment. The base is $576,000
in fiscal year 2020 and $576,000 in fiscal year
2021.
new text end
new text begin Subd. 3. new text end
new text begin
Board of Dentistry
|
new text begin
1,396,000 new text end |
new text begin
1,408,000 new text end |
||||
new text begin Subd. 4. new text end
new text begin
Board of Dietetics and Nutrition
|
new text begin
130,000 new text end |
new text begin
132,000 new text end |
||||
new text begin Subd. 5. new text end
new text begin
Board of Marriage and Family Therapy
|
new text begin
360,000 new text end |
new text begin
357,000 new text end |
||||
new text begin
Base Level Adjustment. The base is $360,000
in fiscal year 2020 and $361,000 in fiscal year
2021.
new text end
new text begin Subd. 6. new text end
new text begin
Board of Medical Practice
|
new text begin
5,207,000 new text end |
new text begin
5,243,000 new text end |
||||
new text begin
This appropriation includes $955,000 in fiscal
year 2018 and $964,000 in fiscal year 2019
for the health professional services program.
The base for this program is $924,000 in fiscal
year 2020 and $924,000 in fiscal year 2021.
new text end
new text begin
Base Level Adjustment. The base is
$5,205,000 in fiscal year 2020 and $5,205,000
in fiscal year 2021.
new text end
new text begin Subd. 7. new text end
new text begin
Board of Nursing
|
new text begin
6,380,000 new text end |
new text begin
4,783,000 new text end |
||||
new text begin Subd. 8. new text end
new text begin
Board of Nursing Home Administrators
|
new text begin
3,397,000 new text end |
new text begin
3,202,000 new text end |
||||
new text begin
(a) Administrative Services Unit - Operating
Costs. Of this appropriation, $2,260,000 in
fiscal year 2018 and $2,287,000 in fiscal year
2019 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.
new text end
new text begin
(b) Administrative Services Unit - Volunteer
Health Care Provider Program. Of this
appropriation, $150,000 in fiscal year 2018
and $150,000 in fiscal year 2019 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
new text end
new text begin
(c) Administrative Services Unit -
Retirement Costs. Of this appropriation,
$378,000 in fiscal year 2019 is a onetime
appropriation to the administrative services
unit to pay for the retirement costs of
health-related board employees. This funding
may be transferred to the health board
incurring retirement costs. Any board that has
an unexpended balance for an amount
transferred under this paragraph shall transfer
the unexpended amount to the administrative
services unit. These funds are available either
year of the biennium.
new text end
new text begin
(d) Administrative Services Unit -
Health-Related Licensing Boards Operating
Costs. Of this appropriation, $194,000 in
fiscal year 2018 and $350,000 in fiscal year
2019 shall be transferred to the health-related
boards funded under this section for operating
costs. The administrative services unit shall
determine transfer amounts in consultation
with the health-related boards funded under
this section.
new text end
new text begin
(e) Administrative Services Unit - Contested
Cases and Other Legal Proceedings. Of this
appropriation, $200,000 in fiscal year 2018
and $200,000 in fiscal year 2019 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval of
the commissioner of management and budget.
The commissioner of management and budget
must require any board that has an unexpended
balance for an amount transferred under this
paragraph to transfer the unexpended amount
to the administrative services unit to be
deposited in the state government special
revenue fund.
new text end
new text begin Subd. 9. new text end
new text begin
Board of Optometry
|
new text begin
173,000 new text end |
new text begin
174,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Board of Pharmacy
|
new text begin
3,254,000 new text end |
new text begin
3,294,000 new text end |
||||
new text begin
Base Level Adjustment. The base is
$3,319,000 in fiscal year 2020 and $3,356,000
in fiscal year 2021.
new text end
new text begin Subd. 11. new text end
new text begin
Board of Physical Therapy
|
new text begin
507,000 new text end |
new text begin
508,000 new text end |
||||
new text begin
Base Level Adjustment. The base is $510,000
in fiscal year 2020 and $512,000 in fiscal year
2021.
new text end
new text begin Subd. 12. new text end
new text begin
Board of Podiatric Medicine
|
new text begin
198,000 new text end |
new text begin
198,000 new text end |
||||
new text begin Subd. 13. new text end
new text begin
Board of Psychology
|
new text begin
1,220,000 new text end |
new text begin
1,240,000 new text end |
||||
new text begin
Base Level Adjustment. The base is
$1,247,000 in fiscal year 2020 and $1,247,000
in fiscal year 2021.
new text end
new text begin Subd. 14. new text end
new text begin
Board of Social Work
|
new text begin
1,254,000 new text end |
new text begin
1,246,000 new text end |
||||
new text begin
Base Level Adjustment. The base is
$1,248,000 in fiscal year 2020 and $1,250,000
in fiscal year 2021.
new text end
new text begin Subd. 15. new text end
new text begin
Board of Veterinary Medicine
|
new text begin
314,000 new text end |
new text begin
320,000 new text end |
||||
new text begin
Base Level Adjustment. The base is $327,000
in fiscal year 2020 and $333,000 in fiscal year
2021.
new text end
new text begin Subd. 16. new text end
new text begin
Board of Behavioral Health and
|
new text begin
771,000 new text end |
new text begin
643,000 new text end |
||||
Sec. 5. new text begin EMERGENCY MEDICAL SERVICES
|
new text begin
$ new text end |
new text begin
4,159,000 new text end |
new text begin
$ new text end |
new text begin
4,088,000 new text end |
||
new text begin
(a) Cooper/Sams Volunteer Ambulance
Program. $950,000 in fiscal year 2018 and
$950,000 in fiscal year 2019 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
new text end
new text begin
(1) Of this amount, $861,000 in fiscal year
2018 and $861,000 in fiscal year 2019 are for
the ambulance service personnel longevity
award and incentive program under Minnesota
Statutes, section 144E.40.
new text end
new text begin
(2) Of this amount, $89,000 in fiscal year 2018
and $89,000 in fiscal year 2019 are for the
operations of the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.
new text end
new text begin
(b) EMSRB Board Operations. $1,954,000
in fiscal year 2018 and $1,883,000 in fiscal
year 2019 are for board operations. The base
for this program is $1,885,000 in fiscal year
2020 and $1,885,000 in fiscal year 2021.
new text end
new text begin
(c) Base Level Adjustment. The base is
$4,090,000 in fiscal year 2020 and $4,090,000
in fiscal year 2021.
new text end
new text begin
(d) Regional Grants. $785,000 in fiscal year
2018 and $785,000 in fiscal year 2019 are for
regional emergency medical services
programs, to be distributed equally to the eight
emergency medical service regions under
Minnesota Statutes, section 144E.52.
new text end
new text begin
(e) Ambulance Training Grant. $470,000
in fiscal year 2018 and $470,000 in fiscal year
2019 are for training grants under Minnesota
Statutes, section 144E.35.
new text end
Sec. 6. new text begin COUNCIL ON DISABILITY
|
new text begin
$ new text end |
new text begin
1,002,000 new text end |
new text begin
$ new text end |
new text begin
1,002,000 new text end |
||
new text begin
Base Level Adjustment. The base is $966,000
in fiscal year 2020 and $968,000 in fiscal year
2021.
new text end
Sec. 7. new text begin OMBUDSMAN FOR MENTAL
|
new text begin
$ new text end |
new text begin
2,307,000 new text end |
new text begin
$ new text end |
new text begin
2,327,000 new text end |
||
Sec. 8. new text begin OMBUDSPERSONS FOR FAMILIES
|
new text begin
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Sec. 9. new text begin TRANSFERS.
new text end
new text begin Subdivision 1. new text end
new text begin Grants. new text end
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The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2019, within fiscal years among the MFIP, general
assistance, medical assistance, MinnesotaCare, MFIP child care assistance under Minnesota
Statutes, section 119B.05, Minnesota supplemental aid, and group residential housing
programs, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance Division
and the house of representatives Health and Human Services Finance Committee quarterly
about transfers made under this subdivision.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
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Positions, salary money, and nonsalary administrative money
may be transferred within the Departments of Health and Human Services as the
commissioners consider necessary, with the advance approval of the commissioner of
management and budget. The commissioner shall inform the chairs and ranking minority
members of the senate Health and Human Services Finance Division and the house of
representatives Health and Human Services Finance Committee quarterly about transfers
made under this subdivision.
new text end
Sec. 10. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end
new text begin
The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.
new text end
Sec. 11. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2019, unless a
different expiration date is explicit.
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Sec. 12. new text begin EFFECTIVE DATE.
new text end
new text begin This article is effective July 1, 2017, unless a different effective date is specifiednew text end .
APPENDIX
Repealed Minnesota Statutes: 17-2331
103I.005 DEFINITIONS.
Subd. 8.
Environmental bore hole.
"Environmental bore hole" means a hole or excavation in the ground that penetrates a confining layer or is greater than 25 feet in depth and enters or goes through a water bearing layer and is used to monitor or measure physical, chemical, radiological, or biological parameters without extracting water. An environmental bore hole also includes bore holes constructed for vapor recovery or venting systems. An environmental bore hole does not include a well, elevator shaft, exploratory boring, or monitoring well.
Subd. 14.
Monitoring well.
"Monitoring well" means an excavation that is drilled, cored, bored, washed, driven, dug, jetted, or otherwise constructed to extract groundwater for physical, chemical, or biological testing. "Monitoring well" includes a groundwater quality sampling well.
Subd. 15.
Monitoring well contractor.
"Monitoring well contractor" means a person who is registered by the commissioner to construct monitoring wells.
103I.451 ENVIRONMENTAL BORE HOLES.
An environmental bore hole must be constructed, sealed, and reported as prescribed by rule of the commissioner by a well contractor or a monitoring well contractor.
119B.07 USE OF MONEY.
(a) Money for persons listed in sections 119B.03, subdivision 3, and 119B.05, subdivision 1, shall be used to reduce the costs of child care for students, including the costs of child care for students while employed if enrolled in an eligible education program at the same time and making satisfactory progress towards completion of the program. Counties may not limit the duration of child care subsidies for a person in an employment or educational program, except when the person is found to be ineligible under the child care fund eligibility standards. Any limitation must be based on a person's employment plan in the case of an MFIP participant, and county policies included in the child care fund plan. The maximum length of time a student is eligible for child care assistance under the child care fund for education and training is no more than the time necessary to complete the credit requirements for an associate or baccalaureate degree as determined by the educational institution, excluding basic or remedial education programs needed to prepare for postsecondary education or employment.
(b) To be eligible, the student must be in good standing and be making satisfactory progress toward the degree. Time limitations for child care assistance do not apply to basic or remedial educational programs needed to prepare for postsecondary education or employment. These programs include: high school, general equivalency diploma, and English as a second language. Programs exempt from this time limit must not run concurrently with a postsecondary program. If an MFIP participant who is receiving MFIP child care assistance under this chapter moves to another county, continues to participate in educational or training programs authorized in their employment plans, and continues to be eligible for MFIP child care assistance under this chapter, the MFIP participant must receive continued child care assistance from the county responsible for their current employment plan, under section 256G.07.
119B.125 PROVIDER REQUIREMENTS.
Subd. 5.
Provisional payment.
After a county receives a completed application from a provider, the county may issue provisional authorization and payment to the provider during the time needed to determine whether to give final authorization to the provider.
119B.16 FAIR HEARING PROCESS.
Subd. 2.
Informal conference.
The county agency shall offer an informal conference to applicants and recipients adversely affected by an agency action to attempt to resolve the dispute. The county agency shall offer an informal conference to providers to whom the county agency has assigned responsibility for an overpayment in an attempt to resolve the dispute. The county agency or the provider may ask the family in whose case the overpayment arose to participate in the informal conference, but the family may refuse to do so. The county agency shall advise adversely affected applicants, recipients, and providers that a request for a conference with the agency is optional and does not delay or replace the right to a fair hearing.
144.0571 INCLUSION OF OTHER HEALTH-RELATED OCCUPATIONS TO CRIMINAL BACKGROUND CHECKS.
(a) If the Department of Health is not reviewed by the Sunset Advisory Commission according to the schedule in section 3D.21, the commissioner of health, as the regulator for occupational therapy practitioners, speech-language pathologists, audiologists, and hearing instrument dispensers, shall require applicants for licensure or renewal to submit to a criminal history records check as required under section 214.075 for other health-related licensed occupations regulated by the health-related licensing boards.
(b) Any statutory changes necessary to include the commissioner of health to section 214.075 shall be included in the plan required in section 214.075, subdivision 8.
147A.21 RULEMAKING AUTHORITY.
The board shall adopt rules:
(1) setting license fees;
(2) setting renewal fees;
(3) setting fees for temporary licenses; and
(4) establishing renewal dates.
147B.08 FEES.
Subdivision 1.
Annual registration fee.
The board shall establish the fee of $150 for initial licensure and $150 annual licensure renewal. The board may prorate the initial licensure fee.
Subd. 2.
Penalty fee for late renewals.
The penalty fee for late submission for renewal application is $50.
Subd. 3.
Deposit.
Fees collected by the board under this section must be deposited in the state government special revenue fund.
147C.40 FEES.
Subdivision 1.
Fees.
The board shall adopt rules setting:
(1) licensure fees;
(2) renewal fees;
(3) late fees;
(4) inactive status fees; and
(5) fees for temporary permits.
Subd. 2.
Proration of fees.
The board may prorate the initial annual license fee. All licensees are required to pay the full fee upon license renewal.
Subd. 3.
Penalty fee for late renewals.
An application for license renewal submitted after the deadline must be accompanied by a late fee in addition to the required fees.
Subd. 4.
Nonrefundable fees.
All of the fees in subdivision 1 are nonrefundable.
245A.1915 OPIOID ADDICTION TREATMENT EDUCATION REQUIREMENT FOR PROVIDERS LICENSED TO PROVIDE CHEMICAL DEPENDENCY TREATMENT SERVICES.
All programs serving persons with substance use issues licensed by the commissioner must provide educational information concerning: treatment options for opioid addiction, including the use of a medication for the use of opioid addiction; and recognition of and response to opioid overdose and the use and administration of naloxone, to clients identified as having or seeking treatment for opioid addiction. The commissioner shall develop educational materials that are supported by research and updated periodically that must be used by programs to comply with this requirement.
245A.192 PROVIDERS LICENSED TO PROVIDE TREATMENT OF OPIOID ADDICTION.
Subdivision 1.
Scope.
(a) This section applies to services licensed under this chapter to provide treatment for opioid addiction. In addition to the requirements under Minnesota Rules, parts 9530.6405 to 9530.6505, a program licensed to provide treatment of opioid addiction must meet the requirements in this section.
(b) Where a standard in this section differs from a standard in an otherwise applicable administrative rule, the standards of this section apply.
(c) When federal guidance or interpretations have been issued on federal standards or requirements also required under this section, the federal guidance or interpretations shall apply.
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision have the meanings given them.
(b) "Diversion" means the use of a medication for the treatment of opioid addiction being diverted from its intended use.
(c) "Guest dose or dosing" means the practice of administering a medication used for the treatment of opioid addiction to a person who is not a client of the program that is administering or dispensing the medication.
(d) "Medical director" means a physician, licensed to practice medicine in the jurisdiction in which the opioid treatment program is located, who assumes responsibility for administering all medical services performed by the program, either by performing them directly or by delegating specific responsibility to authorized program physicians and health care professionals functioning under the medical director's direct supervision.
(e) "Medication used for the treatment of opioid addiction" means a medication approved by the Food and Drug Administration for the treatment of opioid addiction.
(f) "Opioid treatment program" has the meaning given in Code of Federal Regulations, title 42, section 8.12, and includes programs licensed under Minnesota Rules, part 9530.6500.
(g) "Program" means an entity that is licensed under Minnesota Rules, part 9530.6500.
(h) "Unsupervised use" means the use of a medication for the treatment of opioid addiction dispensed for use by a client outside of the program setting. This is also referred to as a "take-home" dose.
(i) "Placing authority" has the meaning given in Minnesota Rules, part 9530.6605, subpart 21a.
(j) "Minnesota health care programs" has the meaning given in section 256B.0636.
Subd. 3.
Medication orders.
Prior to the program administering or dispensing a medication used for the treatment of opioid addiction:
(1) a client-specific order must be received from an appropriately credentialed physician who is enrolled as a Minnesota health care programs provider and meets all applicable provider standards;
(2) the signed order must be documented in the client's record; and
(3) if the physician that issued the order is not able to sign the order when issued, the unsigned order must be entered in the client record at the time it was received, and the physician must review the documentation and sign the order in the client's record within 72 hours of the medication being ordered. The license holder must report to the commissioner any medication error that endangers a patient's health, as determined by the medical director.
Subd. 3a.
High dose requirements.
A client being administered or dispensed a dose beyond that set forth in subdivision 5, paragraph (a), clause (1), that exceeds 150 milligrams of methadone or 24 milligrams of buprenorphine daily, and for each subsequent increase, must meet face-to-face with a prescribing physician. The meeting must occur before the administering or dispensing of the increased dose.
Subd. 4.
Drug testing.
Each client enrolled in the program must receive a minimum of eight random drug abuse tests per 12 months of treatment. These tests must be reasonably disbursed over the 12-month period. A license holder may elect to conduct more drug abuse tests.
Subd. 5.
Criteria for unsupervised use.
(a) To limit the potential for diversion of medication used for the treatment of opioid addiction to the illicit market, any such medications dispensed to patients for unsupervised use shall be subject to the following requirements:
(1) any patient in an opioid treatment program may receive a single take-home dose for a day that the clinic is closed for business, including Sundays and state and federal holidays; and
(2) treatment program decisions on dispensing medications used to treat opioid addiction to patients for unsupervised use beyond that set forth in clause (1) shall be determined by the medical director.
(b) A physician with authority to prescribe must consider the criteria in this subdivision in determining whether a client may be permitted unsupervised or take-home use of such medications. The criteria must also be considered when determining whether dispensing medication for a client's unsupervised use is appropriate to increase or to extend the amount of time between visits to the program. The criteria include:
(1) absence of recent abuse of drugs including but not limited to opioids, nonnarcotics, and alcohol;
(2) regularity of program attendance;
(3) absence of serious behavioral problems at the program;
(4) absence of known recent criminal activity such as drug dealing;
(5) stability of the client's home environment and social relationships;
(6) length of time in comprehensive maintenance treatment;
(7) reasonable assurance that take-home medication will be safely stored within the client's home; and
(8) whether the rehabilitative benefit the client derived from decreasing the frequency of program attendance outweighs the potential risks of diversion or unsupervised use.
(c) The determination, including the basis of the determination, must be consistent with the criteria in this subdivision and must be documented in the client's medical record.
Subd. 6.
Restrictions for unsupervised or take-home use of methadone hydrochloride.
(a) In cases where it is determined that a client meets the criteria in subdivision 5 and may be dispensed a medication used for the treatment of opioid addiction, the restrictions in paragraphs (b) to (g) must be followed when the medication to be dispensed is methadone hydrochloride.
(b) During the first 90 days of treatment, the take-home supply must be limited to a maximum of a single dose each week and the client shall ingest all other doses under direct supervision.
(c) In the second 90 days of treatment, the take-home supply must be limited to two doses per week.
(d) In the third 90 days of treatment, the take-home supply must not exceed three doses per week.
(e) In the remaining months of the first year, a client may be given a maximum six-day supply of take-home medication.
(f) After one year of continuous treatment, a client may be given a maximum two-week supply of take-home medication.
(g) After two years of continuous treatment, a client may be given a maximum one-month supply of take-home medication, but must make monthly visits.
Subd. 7.
Restriction exceptions.
When a license holder has reason to accelerate the number of unsupervised or take-home doses of methadone hydrochloride, the license holder must comply with the requirements of Code of Federal Regulations, title 42, section 8.12, the criteria for unsupervised use in subdivision 5, and must use the exception process provided by the federal Center for Substance Abuse Treatment Division of Pharmacologic Therapies. For the purposes of enforcement of this subdivision, the commissioner has the authority to monitor for compliance with these federal regulations and may issue licensing actions according to sections 245A.05, 245A.06, and 245A.07 based on the commissioner's determination of noncompliance.
Subd. 8.
Guest dosing.
In order to receive a guest dose, the client must be enrolled in an opioid treatment program elsewhere in the state or country and be receiving the medication on a temporary basis because the client is not able to receive the medication at the program in which the client is enrolled. Such arrangements shall not exceed 30 consecutive days in any one program and must not be for the convenience or benefit of either program. Guest dosing may also occur when the client's primary clinic is not open and the client is not receiving take-home doses.
Subd. 9.
Data and reporting.
The license holder must submit data concerning medication used for the treatment of opioid addiction to a central registry. The data must be submitted in a method determined by the commissioner and must be submitted for each client at the time of admission and discharge. The program must document the date the information was submitted. This requirement is effective upon implementation of changes to the Drug and Alcohol Abuse Normative Evaluation System (DAANES) or development of an electronic system by which to submit the data.
Subd. 10.
Nonmedication treatment services; documentation.
(a) The program must offer at least 50 consecutive minutes of individual or group therapy treatment services as defined in Minnesota Rules, part 9530.6430, subpart 1, item A, subitem (1), per week, for the first ten weeks following admission, and at least 50 consecutive minutes per month thereafter. As clinically appropriate, the program may offer these services cumulatively and not consecutively in increments of no less than 15 minutes over the required time period, and for a total of 60 minutes of treatment services over the time period, and must document the reason for providing services cumulatively in the client's record. The program may offer additional levels of service when deemed clinically necessary.
(b) Notwithstanding the requirements of comprehensive assessments in Minnesota Rules, part 9530.6422, the assessment must be completed within 21 days of service initiation.
(c) Notwithstanding the requirements of individual treatment plans set forth in Minnesota Rules, part 9530.6425:
(1) treatment plan contents for maintenance clients are not required to include goals the client must reach to complete treatment and have services terminated;
(2) treatment plans for clients in a taper or detox status must include goals the client must reach to complete treatment and have services terminated;
(3) for the initial ten weeks after admission for all new admissions, readmissions, and transfers, progress notes must be entered in a client's file at least weekly and be recorded in each of the six dimensions upon the development of the treatment plan and thereafter. Subsequently, the counselor must document progress no less than one time monthly, recorded in the six dimensions or when clinical need warrants more frequent notations; and
(4) upon the development of the treatment plan and thereafter, treatment plan reviews must occur weekly, or after each treatment service, whichever is less frequent, for the first ten weeks after the treatment plan is developed. Following the first ten weeks of treatment plan reviews, reviews may occur monthly, unless the client has needs that warrant more frequent revisions or documentation.
Subd. 11.
Prescription monitoring program.
(a) The program must develop and maintain a policy and procedure that requires the ongoing monitoring of the data from the prescription monitoring program for each client. The policy and procedure must include how the program will meet the requirements in paragraph (b).
(b) If a medication used for the treatment of opioid addiction is administered or dispensed to a client, the license holder shall be subject to the following requirements:
(1) upon admission to a methadone clinic outpatient treatment program, clients must be notified in writing that the commissioner of human services and the medical director will monitor the prescription monitoring program to review the prescribed controlled drugs the clients have received;
(2) the medical director or the medical director's delegate must review the data from the Minnesota Board of Pharmacy prescription monitoring program (PMP) established under section 152.126 prior to the client being ordered any controlled substance, as defined under section 152.126, subdivision 1, paragraph (c), including medications used for the treatment of opioid addiction, and subsequent reviews of the PMP data must occur at least every 90 days;
(3) a copy of the PMP data reviewed must be maintained in the client file;
(4) when the PMP data contains a recent history of multiple prescribers or multiple prescriptions for controlled substances, the physician's review of the data and subsequent actions must be documented in the client's individual file within 72 hours and must contain the medical director's determination of whether or not the prescriptions place the client at risk of harm and the actions to be taken in response to the PMP findings. In addition, the provider must conduct subsequent reviews of the PMP on a monthly basis; and
(5) if at any time the medical director believes the use of the controlled substances places the client at risk of harm, the program must seek the client's consent to discuss the client's opioid treatment with other prescribers and must seek consent for the other prescriber to disclose to the opioid treatment program's medical director the client's condition that formed the basis of the other prescriptions. If the information is not obtained within seven days, the medical director must document whether or not changes to the client's medication dose or number of take-home doses are necessary until the information is obtained.
(c) The commissioner shall collaborate with the Minnesota Board of Pharmacy to develop and implement an electronic system through which the commissioner shall routinely access the data from the Minnesota Board of Pharmacy prescription monitoring program established under section 152.126 for the purpose of determining whether any client enrolled in an opioid addiction treatment program licensed according to this section has also been prescribed or dispensed a controlled substance in addition to that administered or dispensed by the opioid addiction treatment program. When the commissioner determines there have been multiple prescribers or multiple prescriptions of controlled substances, the commissioner shall:
(1) inform the medical director of the opioid treatment program only that the commissioner determined the existence of multiple prescribers or multiple prescriptions of controlled substances; and
(2) direct the medical director of the opioid treatment program to access the data directly, review the effect of the multiple prescribers or multiple prescriptions, and document the review.
(d) If determined necessary, the commissioner shall seek a federal waiver of, or exception to, any applicable provision of Code of Federal Regulations, title 42, section 2.34(c), prior to implementing this subdivision.
Subd. 12.
Policies and procedures.
(a) License holders must develop and maintain the policies and procedures required in this subdivision.
(b) For programs that are not open every day of the year, the license holder must maintain a policy and procedure that permits clients to receive a single unsupervised use of medication used for the treatment of opioid addiction for days that the program is closed for business, including, but not limited to, Sundays and state and federal holidays as required under subdivision 5, paragraph (a), clause (1).
(c) The license holder must maintain a policy and procedure that includes specific measures to reduce the possibility of medication used for the treatment of opioid addiction being diverted from its intended treatment use. The policy and procedure must:
(1) specifically identify and define the responsibilities of the medical and administrative staff for carrying out diversion control measures; and
(2) include a process for contacting no less than five percent of clients who have unsupervised use of medication used for the treatment of opioid addiction, excluding those approved solely under subdivision 5, paragraph (a), clause (1), to require them to physically return to the program each month. The system must require clients to return to the program within a stipulated time frame and turn in all unused medication containers related to opioid addiction treatment. The license holder must document all related contacts on a central log and the outcome of the contact for each client in the individual client's record.
(d) Medications used for the treatment of opioid addictions must be ordered, administered, and dispensed according to applicable state and federal regulations and the standards set by applicable accreditation entities. In addition, when an order requires assessment by the person administering or dispensing the medication to determine the amount to be administered or dispensed, the assessment must be completed by an individual whose professional scope of practice permits such assessment. For the purposes of enforcement of this paragraph, the commissioner has the authority to monitor for compliance with these state and federal regulations and the relevant standards of the license holder's accreditation agency and may issue licensing actions according to sections 245A.05, 245A.06, and 245A.07 based on the commissioner's determination of noncompliance.
Subd. 13.
Quality improvement plan.
The license holder must develop and maintain a quality improvement process and plan. The plan must:
(1) include evaluation of the services provided to clients with the goal of identifying issues that may improve service delivery and client outcomes;
(2) include goals for the program to accomplish based on the evaluation;
(3) be reviewed annually by the management of the program to determine whether the goals were met and, if not, whether additional action is required;
(4) be updated at least annually to include new or continued goals based on an updated evaluation of services; and
(5) identify two specific goal areas, in addition to others identified by the program, including:
(i) a goal concerning oversight and monitoring of the premises around and near the exterior of the program to reduce the possibility of medication used for the treatment of opioid addiction being inappropriately used by clients, including but not limited to the sale or transfer of the medication to others; and
(ii) a goal concerning community outreach, including but not limited to communications with local law enforcement and county human services agencies, with the goal of increasing coordination of services and identification of areas of concern to be addressed in the plan.
Subd. 14.
Placing authorities.
Programs must provide certain notification and client-specific updates to placing authorities for clients who are enrolled in Minnesota health care programs. At the request of the placing authority, the program must provide client-specific updates, including but not limited to informing the placing authority of positive drug screenings and changes in medications used for the treatment of opioid addiction ordered for the client.
Subd. 15.
A program's duty to report suspected drug diversion.
(a) To the fullest extent permitted under Code of Federal Regulations, title 42, sections 2.1 to 2.67, a program shall report to law enforcement any credible evidence that the program or its personnel knows, or reasonably should know, that is directly related to a diversion crime on the premises of the program, or a threat to commit a diversion crime.
(b) "Diversion crime," for the purposes of this section, means diverting, attempting to divert, or conspiring to divert Schedule I, II, III, or IV drugs, as defined in section 152.02, on the program's premises.
(c) The program must document its compliance with the requirement in paragraph (a) in either a client's record or an incident report.
(d) Failure to comply with the duty in paragraph (a) may result in sanctions as provided in sections 245A.06 and 245A.07.
Subd. 16.
Variance.
The commissioner may grant a variance to the requirements of this section.
245C.11 BACKGROUND STUDY; COUNTY AGENCIES.
Subd. 4.
Background study.
A county agency may accept a background study completed by the commissioner under this chapter in place of the background study required under section 245A.16, subdivision 3, for educational programs that train individuals by providing direct contact services in licensed programs.
245C.16 DISQUALIFIED INDIVIDUAL'S RISK OF HARM.
Subd. 3.
County agency.
(a) County licensing agencies performing duties under this section may develop an alternative system for determining the subject's immediate risk of harm to persons served by the program, providing the notices under subdivision 2, paragraph (b), and documenting the action taken by the county licensing agency.
(b) Each county licensing agency's implementation of the alternative system is subject to approval by the commissioner.
(c) Notwithstanding this alternative system, county licensing agencies shall complete the requirements of section 245C.17.
245C.17 NOTICE OF BACKGROUND STUDY RESULTS.
Subd. 4.
Disqualification notice to family child care or foster care provider.
For studies on individuals pertaining to a license to provide family child care or group family child care, foster care for children in the provider's own home, or foster care or day care services for adults in the provider's own home, the commissioner is not required to provide a separate notice of the background study results to the individual who is the subject of the study unless the study results in a disqualification of the individual.
245E.03 DUTY TO PROVIDE ACCESS.
Subd. 3.
Notice of denial or termination.
When a provider fails to provide access, a 15-day notice of denial or termination must be issued to the provider, which prohibits the provider from participating in the child care assistance program. Notice must be sent to recipients whose children are under the provider's care pursuant to Minnesota Rules, part 3400.0185.
245E.06 ADMINISTRATIVE SANCTIONS.
Subd. 4.
Consolidated hearings with licensing sanction.
If a financial misconduct sanction has an appeal hearing right and it is timely appealed, and a licensing sanction exists for which there is an appeal hearing right and the sanction is timely appealed, and the overpayment recovery action and licensing sanction involve the same set of facts, the overpayment recovery action and licensing sanction must be consolidated in the contested case hearing related to the licensing sanction.
Subd. 5.
Effect of department's administrative determination or sanction.
Unless a timely and proper appeal is received by the department, the department's administrative determination or sanction shall be considered a final department determination.
246B.06 VOCATIONAL WORK PROGRAM.
Subdivision 1.
Establishment; purpose.
(a) The commissioner of human services may establish, equip, maintain, and operate a vocational work program at any Minnesota sex offender program facility under this chapter. The commissioner may establish vocational activities for sex offender treatment for civilly committed sex offenders as the commissioner deems necessary and suitable to the meaningful work skills training, educational training, and development of proper work habits and extended treatment services for civilly committed sex offenders consistent with the requirements in section 246B.05. The industrial and commercial activities authorized by this section are designated Minnesota State Industries and must be for the primary purpose of sustaining and ensuring Minnesota State Industries' self-sufficiency, providing educational training, meaningful employment, and the teaching of proper work habits to the individuals in the Minnesota sex offender program under this chapter, and not solely as competitive business ventures.
(b) The net profits from the vocational work program must be used for the benefit of the civilly committed sex offenders as it relates to building education and self-sufficiency skills. Prior to the establishment of any vocational activity, the commissioner of human services shall consult with stakeholders including representatives of business, industry, organized labor, the commissioner of education, the state Apprenticeship Council, the commissioner of labor and industry, the commissioner of employment and economic development, the commissioner of administration, and other stakeholders the commissioner deems qualified. The purpose of the stakeholder consultation is to determine the quantity and nature of the goods, wares, merchandise, and services to be made or provided, and the types of processes to be used in their manufacture, processing, repair, and production consistent with the greatest opportunity for the reform and educational training of the civilly committed sex offenders, and with the best interests of the state, business, industry, and labor.
(c) The commissioner of human services shall, at all times in the conduct of any vocational activity authorized by this section, utilize civilly committed sex offender labor to the greatest extent feasible, provided that the commissioner may employ all administrative, supervisory, and other skilled workers necessary to the proper instruction of the civilly committed sex offenders and the efficient operation of the vocational activities authorized by this section.
(d) The commissioner of human services may authorize the director of any Minnesota sex offender treatment facility under the commissioner's control to accept work projects from outside sources for processing, fabrication, or repair, provided that preference is given to the performance of work projects for state departments and agencies.
Subd. 2.
Revolving fund.
As described in section 246B.05, subdivision 2, there is established a vocational work program revolving fund under the control of the commissioner of human services. The revolving fund must be used for the vocational work program authorized under this section, including, but not limited to, the purchase of equipment and raw materials, the payment of salaries and wages, and other necessary expenses as determined by the commissioner of human services. The purchase of services, materials, and commodities used in and held for resale are not subject to the competitive bidding procedures of section 16C.06, but are subject to all other provisions of chapters 16B and 16C. When practical, purchases must be made from small targeted group businesses designated under section 16C.16. Additionally, the expenses of client educational training and self-sufficiency skills may be financed from the revolving fund in an amount to be determined by the commissioner or designee. The proceeds and income from all vocational work program activities conducted at the Minnesota sex offender treatment facilities must be deposited in the revolving fund subject to disbursement under subdivision 3. The commissioner of human services may request that money in the fund be invested pursuant to section 11A.25. Proceeds from the investment not currently needed must be accounted for separately and credited to the revolving fund.
Subd. 3.
Disbursement from fund.
The vocational work program revolving fund must be deposited in the state treasury and paid out only on proper vouchers as authorized and approved by the commissioner of human services, and in the same manner and under the same restrictions as are now provided by law for the disbursement of funds by the commissioner. An amount deposited in the state treasury equal to six months of net operating cash as determined by the prior 12 months of revenue and cash flow statements must be restricted for use only by the vocational work program as described under subdivision 2. For purposes of this subdivision, "net operating cash" means net income, minus sales, plus cost of goods sold. Cost of goods sold include all direct costs of products attributable to the goods' production.
Subd. 4.
Revolving fund; borrowing.
The commissioner of human services is authorized to borrow sums of money as the commissioner deems necessary to meet current demands on the vocational work program revolving fund. The sums borrowed must not exceed, in any calendar year, six months of net operating cash as determined by the previous 12 months of the vocational program's revenue and cash flow statements. If the commissioner of human services determines that borrowing of funds is necessary, the commissioner of human services shall certify this need to the commissioner of management and budget. Funds may be borrowed from general fund appropriations to the Minnesota sex offender program with the authorization of the commissioner of management and budget. Upon authorization of the commissioner of management and budget, the transfer must be made and credited to the vocational work program revolving fund. The sum transferred to the vocational work program revolving fund must be repaid by the commissioner of human services from the revolving fund to the fund from which it was transferred in a time period specified by the commissioner of management and budget, but by no later than the end of the biennium, as defined in section 16A.011, in which the loan is made. When any transfer is made to the vocational work program revolving fund, the commissioner of management and budget shall notify the commissioner of human services of the amount transferred to the fund and the date the transfer is to be repaid.
Subd. 5.
Federal grant fund transfers.
Grants received by the commissioner of human services from the federal government for any vocational training program or for administration by the commissioner of human services must (1) be credited to a federal grant fund and then (2) be transferred from the federal grant fund to the credit of the commissioner of human services in the appropriate account upon certification by the commissioner of human services that the amounts requested to be transferred have been earned or are required for the purposes of this section. Funds received by the federal grant fund need not be budgeted as such, provided transfers from the fund are budgeted for allotment purposes in the appropriate appropriation.
Subd. 6.
Wages.
Notwithstanding section 177.24 or any other law to the contrary, the commissioner of human services has the discretion to set the pay rate for individuals participating in the vocational work program. The commissioner has the authority to retain up to 50 percent of any payments made to an individual participating in the vocational work program for the purpose of reducing state costs associated with operating the Minnesota sex offender program.
Subd. 7.
Status of civilly committed sex offenders.
Civilly committed sex offenders participating in the vocational work program are not employees of the Minnesota sex offender program, the Department of Human Services, or the state, and are not subject to fair labor standards under sections 177.21 to 177.35; workers compensation under sections 176.011 to 176.862; the Minnesota Human Rights Act under sections 363A.01 to 363A.41; laws governing state employees under chapter 43A; labor relations under chapter 179A; or the successors to any of these sections and any other laws pertaining to employees and employment.
Subd. 8.
Claims.
Claims and demands arising out of injury to or death of a civilly committed sex offender while that individual is participating in the vocational work program or performing a work assignment maintaining the facility must be presented to, heard by, and determined exclusively by the legislature as provided in section 3.738.
252.41 DEFINITIONS.
Subd. 8.
Supported employment.
"Supported employment" means employment of a person with a disability so severe that the person needs ongoing training and support to get and keep a job in which:
(1) the person engages in paid work at a work site where individuals without disabilities who do not require public subsidies also may be employed;
(2) public funds are necessary to provide ongoing training and support services throughout the period of the person's employment; and
(3) the person has the opportunity for social interaction with individuals who do not have disabilities and who are not paid caregivers.
252.451 BUSINESS AGREEMENTS; SUPPORT AND SUPERVISION OF DISABLED PERSONS.
Subdivision 1.
Definition.
For the purposes of this section, "qualified business" means a business that employs primarily nondisabled persons and will employ persons with developmental disabilities. For purposes of this section, licensed providers of residential services for persons with developmental disabilities are not a qualified business. A qualified business and its employees are exempt from Minnesota Rules, parts 9525.1800 to 9525.1930.
Subd. 2.
Vendor participation and reimbursement.
Notwithstanding requirements in chapters 245A and 245D, and sections 252.28, 252.41 to 252.46, and 256B.501, vendors of day training and habilitation services may enter into written agreements with qualified businesses to provide additional training and supervision needed by individuals to maintain their employment.
Subd. 3.
Agreement specifications.
Agreements must include the following:
(1) the type and amount of supervision and support to be provided by the business to the individual in accordance with their needs as identified in their individual service plan;
(2) the methods used to periodically assess the individual's satisfaction with their work, training, and support;
(3) the measures taken by the qualified business and the vendor to ensure the health, safety, and protection of the individual during working hours, including the reporting of abuse and neglect under state law and rules;
(4) the training and support services the vendor will provide to the qualified business, including the frequency of on-site supervision and support; and
(5) any payment to be made to the qualified business by the vendor. Payment to the business must be limited to:
(i) additional costs of training coworkers and managers that exceed ordinary and customary training costs and are a direct result of employing a person with a developmental disability; and
(ii) additional costs for training, supervising, and assisting the person with a developmental disability that exceed normal and customary costs required for performing similar tasks or duties.
Payments made to a qualified business under this section must not include incentive payments to the qualified business or salary supplementation for the person with a developmental disability.
Subd. 4.
Client protection.
Persons receiving training and support under this section may not be denied their rights or procedural protections under section 256.045, subdivision 4a, or 256B.092, including the county agency's responsibility to arrange for appropriate services, as necessary, in the event that persons lose their job or the contract with the qualified business is terminated.
Subd. 5.
Vendor payment.
(a) For purposes of this section, the vendor shall bill and the commissioner shall reimburse the vendor for full-day or partial-day services to a client that would otherwise have been paid to the vendor for providing direct services, provided that both of the following criteria are met:
(1) the vendor provides services and payments to the qualified business that enable the business to perform support and supervision services for the client that the vendor would otherwise need to perform; and
(2) the client for whom a rate will be billed will receive full-day or partial-day services from the vendor and the rate to be paid the vendor will allow the client to work with this support and supervision at the qualified business instead of receiving these services from the vendor.
(b) Medical assistance reimbursement of services provided to persons receiving day training and habilitation services under this section is subject to the limitations on reimbursement for vocational services under federal law and regulation.
254A.02 DEFINITIONS.
Subd. 4.
Drug abuse or abuse of drugs.
"Drug abuse or abuse of drugs" is the use of any psychoactive or mood altering chemical substance, without compelling medical reason, in such a manner as to induce mental, emotional or physical impairment and cause socially dysfunctional or socially disordering behavior and which results in psychological or physiological dependency as a function of continued use.
256.9692 EFFECT OF INTEGRATION AGREEMENT ON DIVISION OF COST.
Beginning in the first calendar month after there is a definitive integration agreement affecting the University of Minnesota hospital and clinics and Fairview hospital and health care services, Fairview hospital and health care services shall pay the University of Minnesota $505,000 on the 15th of each month, after receiving the state payment, provided that the University of Minnesota has fulfilled the requirements of section 256B.19, subdivision 1c.
256B.0625 COVERED SERVICES.
Subd. 25a.
Prior authorization of diagnostic imaging services.
(a) Effective January 1, 2010, the commissioner shall require prior authorization or decision support for the ordering providers at the time the service is ordered for the following outpatient diagnostic imaging services: computerized tomography (CT), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), positive emission tomography (PET), cardiac imaging, and ultrasound diagnostic imaging.
(b) Prior authorization under this subdivision is not required for diagnostic imaging services performed as part of a hospital emergency room visit, inpatient hospitalization, or if concurrent with or on the same day as an urgent care facility visit.
(c) This subdivision does not apply to services provided to recipients who are enrolled in Medicare, the prepaid medical assistance program, or the MinnesotaCare program.
(d) The commissioner may contract with a private entity to provide the prior authorization or decision support required under this subdivision. The contracting entity must incorporate clinical guidelines that are based on evidence-based medical literature, if available. By January 1, 2012, the contracting entity shall report to the commissioner the results of prior authorization or decision support.
256B.0659 PERSONAL CARE ASSISTANCE PROGRAM.
Subd. 22.
Annual review for personal care providers.
(a) All personal care assistance provider agencies shall resubmit, on an annual basis, the information specified in subdivision 21, in a format determined by the commissioner, and provide a copy of the personal care assistance provider agency's most current version of its grievance policies and procedures along with a written record of grievances and resolutions of the grievances that the personal care assistance provider agency has received in the previous year and any other information requested by the commissioner.
(b) The commissioner shall send annual review notification to personal care assistance provider agencies 30 days prior to renewal. The notification must:
(1) list the materials and information the personal care assistance provider agency is required to submit;
(2) provide instructions on submitting information to the commissioner; and
(3) provide a due date by which the commissioner must receive the requested information.
Personal care assistance provider agencies shall submit required documentation for annual review within 30 days of notification from the commissioner. If no documentation is submitted, the personal care assistance provider agency enrollment number must be terminated or suspended.
(c) Personal care assistance provider agencies also currently licensed under section 144A.471, subdivision 6 or 7, or currently certified for participation in Medicare as a home health agency are deemed in compliance with the personal care assistance requirements for enrollment, annual review process, and documentation.
256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE SETTING.
Subd. 16.
Budget neutrality adjustments.
(a) The commissioner shall use the following adjustments to the rate generated by the framework to assure budget neutrality until the rate information is available to implement paragraph (b). The rate generated by the framework shall be multiplied by the appropriate factor, as designated below:
(1) for residential services: 1.003;
(2) for day services: 1.000;
(3) for unit-based services with programming: 0.941; and
(4) for unit-based services without programming: 0.796.
(b) Within 12 months of January 1, 2014, the commissioner shall compare estimated spending for all home and community-based waiver services under the new payment rates defined in subdivisions 6 to 9 with estimated spending for the same recipients and services under the rates in effect on July 1, 2013. This comparison must distinguish spending under each of subdivisions 6, 7, 8, and 9. The comparison must be based on actual recipients and services for one or more service months after the new rates have gone into effect. The commissioner shall consult with the commissioner of management and budget on this analysis to ensure budget neutrality. If estimated spending under the new rates for services under one or more subdivisions differs in this comparison by 0.3 percent or more, the commissioner shall assure aggregate budget neutrality across all service areas by adjusting the budget neutrality factor in paragraph (a) in each subdivision so that total estimated spending for each subdivision under the new rates matches estimated spending under the rates in effect on July 1, 2013.
256B.64 ATTENDANTS TO VENTILATOR-DEPENDENT RECIPIENTS.
A ventilator-dependent recipient of medical assistance who has been receiving the services of a home care nurse or personal care assistant in the recipient's home may continue to have a home care nurse or personal care assistant present upon admission to a hospital licensed under chapter 144. The personal care assistant or home care nurse shall perform only the services of communicator or interpreter for the ventilator-dependent patient during a transition period of up to 120 hours to assure adequate training of the hospital staff to communicate with the patient and to understand the unique comfort, safety, and personal care needs of the patient. The personal care assistant or home care nurse may offer nonbinding advice to the health care professionals in charge of the ventilator-dependent patient's care and treatment on matters pertaining to the comfort and safety of the patient. Within 36 hours of the end of the 120-hour transition period, an assessment may be made by the ventilator-dependent recipient, the attending physician, and the hospital staff caring for the recipient. If the persons making the assessment determine that additional communicator or interpreter services are medically necessary, the hospital must contact the commissioner 24 hours prior to the end of the 120-hour transition period and submit the assessment information to the commissioner. The commissioner shall review the request and determine if it is medically necessary to continue the interpreter services or if the hospital staff has had sufficient opportunity to adequately determine the needs of the patient. The commissioner shall determine if continued service is necessary and appropriate and whether or not payments shall continue. The commissioner may not authorize services beyond the limits of the available appropriations for this section. The commissioner may adopt rules necessary to implement this section. Reimbursement under this section must be at the payment rate and in a manner consistent with the payment rate and manner used in reimbursing these providers for home care services for the ventilator-dependent recipient under the medical assistance program.
256B.69 PREPAID HEALTH PLANS.
Subdivision 1.
Purpose.
The commissioner of human services shall establish a medical assistance demonstration project to determine whether prepayment combined with better management of health care services is an effective mechanism to ensure that all eligible individuals receive necessary health care in a coordinated fashion while containing costs. For the purposes of this project, waiver of certain statutory provisions is necessary in accordance with this section.
Subd. 2.
Definitions.
For the purposes of this section, the following terms have the meanings given.
(a) "Commissioner" means the commissioner of human services. For the remainder of this section, the commissioner's responsibilities for methods and policies for implementing the project will be proposed by the project advisory committees and approved by the commissioner.
(b) "Demonstration provider" means a health maintenance organization, community integrated service network, or accountable provider network authorized and operating under chapter 62D, 62N, or 62T that participates in the demonstration project according to criteria, standards, methods, and other requirements established for the project and approved by the commissioner. For purposes of this section, a county board, or group of county boards operating under a joint powers agreement, is considered a demonstration provider if the county or group of county boards meets the requirements of section 256B.692.
(c) "Eligible individuals" means those persons eligible for medical assistance benefits as defined in sections 256B.055, 256B.056, and 256B.06.
(d) "Limitation of choice" means suspending freedom of choice while allowing eligible individuals to choose among the demonstration providers.
Subd. 3.
Geographic area.
The commissioner shall designate the geographic areas in which eligible individuals may be included in the medical assistance prepayment programs.
Subd. 3a.
County authority.
(a) The commissioner, when implementing the medical assistance prepayment program within a county, must include the county board in the process of development, approval, and issuance of the request for proposals to provide services to eligible individuals within the proposed county. County boards must be given reasonable opportunity to make recommendations regarding the development, issuance, review of responses, and changes needed in the request for proposals. The commissioner must provide county boards the opportunity to review each proposal based on the identification of community needs under chapters 145A and 256E and county advocacy activities. If a county board finds that a proposal does not address certain community needs, the county board and commissioner shall continue efforts for improving the proposal and network prior to the approval of the contract. The county board shall make recommendations regarding the approval of local networks and their operations to ensure adequate availability and access to covered services. The provider or health plan must respond directly to county advocates and the state prepaid medical assistance ombudsperson regarding service delivery and must be accountable to the state regarding contracts with medical assistance funds. The county board may recommend a maximum number of participating health plans after considering the size of the enrolling population; ensuring adequate access and capacity; considering the client and county administrative complexity; and considering the need to promote the viability of locally developed health plans. The county board or a single entity representing a group of county boards and the commissioner shall mutually select health plans for participation at the time of initial implementation of the prepaid medical assistance program in that county or group of counties and at the time of contract renewal. The commissioner shall also seek input for contract requirements from the county or single entity representing a group of county boards at each contract renewal and incorporate those recommendations into the contract negotiation process.
(b) At the option of the county board, the board may develop contract requirements related to the achievement of local public health goals to meet the health needs of medical assistance enrollees. These requirements must be reasonably related to the performance of health plan functions and within the scope of the medical assistance benefit set. If the county board and the commissioner mutually agree to such requirements, the department shall include such requirements in all health plan contracts governing the prepaid medical assistance program in that county at initial implementation of the program in that county and at the time of contract renewal. The county board may participate in the enforcement of the contract provisions related to local public health goals.
(c) For counties in which a prepaid medical assistance program has not been established, the commissioner shall not implement that program if a county board submits an acceptable and timely preliminary and final proposal under section 256B.692, until county-based purchasing is no longer operational in that county. For counties in which a prepaid medical assistance program is in existence on or after September 1, 1997, the commissioner must terminate contracts with health plans according to section 256B.692, subdivision 5, if the county board submits and the commissioner accepts a preliminary and final proposal according to that subdivision. The commissioner is not required to terminate contracts that begin on or after September 1, 1997, according to section 256B.692 until two years have elapsed from the date of initial enrollment.
(d) In the event that a county board or a single entity representing a group of county boards and the commissioner cannot reach agreement regarding: (i) the selection of participating health plans in that county; (ii) contract requirements; or (iii) implementation and enforcement of county requirements including provisions regarding local public health goals, the commissioner shall resolve all disputes after taking into account the recommendations of a three-person mediation panel. The panel shall be composed of one designee of the president of the association of Minnesota counties, one designee of the commissioner of human services, and one person selected jointly by the designee of the commissioner of human services and the designee of the Association of Minnesota Counties. Within a reasonable period of time before the hearing, the panelists must be provided all documents and information relevant to the mediation. The parties to the mediation must be given 30 days' notice of a hearing before the mediation panel.
(e) If a county which elects to implement county-based purchasing ceases to implement county-based purchasing, it is prohibited from assuming the responsibility of county-based purchasing for a period of five years from the date it discontinues purchasing.
(f) The commissioner shall not require that contractual disputes between county-based purchasing entities and the commissioner be mediated by a panel that includes a representative of the Minnesota Council of Health Plans.
(g) At the request of a county-purchasing entity, the commissioner shall adopt a contract reprocurement or renewal schedule under which all counties included in the entity's service area are reprocured or renewed at the same time.
(h) The commissioner shall provide a written report under section 3.195 to the chairs of the legislative committees having jurisdiction over human services in the senate and the house of representatives describing in detail the activities undertaken by the commissioner to ensure full compliance with this section. The report must also provide an explanation for any decisions of the commissioner not to accept the recommendations of a county or group of counties required to be consulted under this section. The report must be provided at least 30 days prior to the effective date of a new or renewed prepaid or managed care contract in a county.
Subd. 3b.
Provision of data to county boards.
The commissioner, in consultation with representatives of county boards of commissioners shall identify program information and data necessary on an ongoing basis for county boards to: (1) make recommendations to the commissioner related to state purchasing under the prepaid medical assistance program; and (2) effectively administer county-based purchasing. This information and data must include, but is not limited to, county-specific, individual-level fee-for-service and prepaid health plan claims information.
Subd. 4.
Limitation of choice.
(a) The commissioner shall develop criteria to determine when limitation of choice may be implemented in the experimental counties. The criteria shall ensure that all eligible individuals in the county have continuing access to the full range of medical assistance services as specified in subdivision 6.
(b) The commissioner shall exempt the following persons from participation in the project, in addition to those who do not meet the criteria for limitation of choice:
(1) persons eligible for medical assistance according to section 256B.055, subdivision 1;
(2) persons eligible for medical assistance due to blindness or disability as determined by the Social Security Administration or the state medical review team, unless:
(i) they are 65 years of age or older; or
(ii) they reside in Itasca County or they reside in a county in which the commissioner conducts a pilot project under a waiver granted pursuant to section 1115 of the Social Security Act;
(3) recipients who currently have private coverage through a health maintenance organization;
(4) recipients who are eligible for medical assistance by spending down excess income for medical expenses other than the nursing facility per diem expense;
(5) recipients who receive benefits under the Refugee Assistance Program, established under United States Code, title 8, section 1522(e);
(6) children who are both determined to be severely emotionally disturbed and receiving case management services according to section 256B.0625, subdivision 20, except children who are eligible for and who decline enrollment in an approved preferred integrated network under section 245.4682;
(7) adults who are both determined to be seriously and persistently mentally ill and received case management services according to section 256B.0625, subdivision 20;
(8) persons eligible for medical assistance according to section 256B.057, subdivision 10; and
(9) persons with access to cost-effective employer-sponsored private health insurance or persons enrolled in a non-Medicare individual health plan determined to be cost-effective according to section 256B.0625, subdivision 15.
Children under age 21 who are in foster placement may enroll in the project on an elective basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an elective basis. The commissioner may enroll recipients in the prepaid medical assistance program for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by spending down excess income.
(c) The commissioner may allow persons with a one-month spenddown who are otherwise eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay their monthly spenddown to the state.
(d) The commissioner may require those individuals to enroll in the prepaid medical assistance program who otherwise would have been excluded under paragraph (b), clauses (1), (3), and (8), and under Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.
(e) Before limitation of choice is implemented, eligible individuals shall be notified and after notification, shall be allowed to choose only among demonstration providers. The commissioner may assign an individual with private coverage through a health maintenance organization, to the same health maintenance organization for medical assistance coverage, if the health maintenance organization is under contract for medical assistance in the individual's county of residence. After initially choosing a provider, the recipient is allowed to change that choice only at specified times as allowed by the commissioner. If a demonstration provider ends participation in the project for any reason, a recipient enrolled with that provider must select a new provider but may change providers without cause once more within the first 60 days after enrollment with the second provider.
(f) An infant born to a woman who is eligible for and receiving medical assistance and who is enrolled in the prepaid medical assistance program shall be retroactively enrolled to the month of birth in the same managed care plan as the mother once the child is enrolled in medical assistance unless the child is determined to be excluded from enrollment in a prepaid plan under this section.
Subd. 4b.
Individualized education program and individualized family service plan services.
The commissioner shall amend the federal waiver allowing the state to separate out individualized education program and individualized family service plan services for children enrolled in the prepaid medical assistance program and the MinnesotaCare program. Medical assistance coverage of eligible individualized education program and individualized family service plan services shall not be included in the capitated services for children enrolled in health plans through the prepaid medical assistance program and the MinnesotaCare program. Local school districts shall bill the commissioner for these services, and claims shall be paid on a fee-for-service basis.
Subd. 5.
Prospective per capita payment.
The commissioner shall establish the method and amount of payments for services. The commissioner shall annually contract with demonstration providers to provide services consistent with these established methods and amounts for payment.
If allowed by the commissioner, a demonstration provider may contract with an insurer, health care provider, nonprofit health service plan corporation, or the commissioner, to provide insurance or similar protection against the cost of care provided by the demonstration provider or to provide coverage against the risks incurred by demonstration providers under this section. The recipients enrolled with a demonstration provider are a permissible group under group insurance laws and chapter 62C, the Nonprofit Health Service Plan Corporations Act. Under this type of contract, the insurer or corporation may make benefit payments to a demonstration provider for services rendered or to be rendered to a recipient. Any insurer or nonprofit health service plan corporation licensed to do business in this state is authorized to provide this insurance or similar protection.
The commissioner shall complete development of capitation rates for payments before delivery of services under this section is begun. The commissioner shall contract with an independent actuary to establish prepayment rates.
Beginning July 1, 2004, the commissioner may include payments for elderly waiver services and 180 days of nursing home care in capitation payments for the prepaid medical assistance program for recipients age 65 and older.
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner may issue separate contracts with requirements specific to services to medical assistance recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant to chapters 256B and 256L is responsible for complying with the terms of its contract with the commissioner. Requirements applicable to managed care programs under chapters 256B and 256L established after the effective date of a contract with the commissioner take effect when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program pending completion of performance targets. Each performance target must be quantifiable, objective, measurable, and reasonably attainable, except in the case of a performance target based on a federal or state law or rule. Criteria for assessment of each performance target must be outlined in writing prior to the contract effective date. Clinical or utilization performance targets and their related criteria must consider evidence-based research and reasonable interventions when available or applicable to the populations served, and must be developed with input from external clinical experts and stakeholders, including managed care plans, county-based purchasing plans, and providers. The managed care or county-based purchasing plan must demonstrate, to the commissioner's satisfaction, that the data submitted regarding attainment of the performance target is accurate. The commissioner shall periodically change the administrative measures used as performance targets in order to improve plan performance across a broader range of administrative services. The performance targets must include measurement of plan efforts to contain spending on health care services and administrative activities. The commissioner may adopt plan-specific performance targets that take into account factors affecting only one plan, including characteristics of the plan's enrollee population. The withheld funds must be returned no sooner than July of the following year if performance targets in the contract are achieved. The commissioner may exclude special demonstration projects under subdivision 23.
(d) The commissioner shall require that managed care plans use the assessment and authorization processes, forms, timelines, standards, documentation, and data reporting requirements, protocols, billing processes, and policies consistent with medical assistance fee-for-service or the Department of Human Services contract requirements consistent with medical assistance fee-for-service or the Department of Human Services contract requirements for all personal care assistance services under section 256B.0659.
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the health plan's emergency department utilization rate for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. For 2012, the reduction shall be based on the health plan's utilization in 2009. To earn the return of the withhold each subsequent year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of no less than ten percent of the plan's emergency department utilization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, compared to the previous measurement year until the final performance target is reached. When measuring performance, the commissioner must consider the difference in health risk in a managed care or county-based purchasing plan's membership in the baseline year compared to the measurement year, and work with the managed care or county-based purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract period until the plan's emergency room utilization rate for state health care program enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the health plans in meeting this performance target and shall accept payment withholds that may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the plan's hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of no less than five percent of the plan's hospital admission rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, compared to the previous calendar year until the final performance target is reached. When measuring performance, the commissioner must consider the difference in health risk in a managed care or county-based purchasing plan's membership in the baseline year compared to the measurement year, and work with the managed care or county-based purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent reduction in the hospital admission rate compared to the hospital admission rates in calendar year 2011, as determined by the commissioner. The hospital admissions in this performance target do not include the admissions applicable to the subsequent hospital admission performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting this performance target and shall accept payment withholds that may be returned to the hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the plan's hospitalization admission rates for subsequent hospitalizations within 30 days of a previous hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, of no less than five percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in the subsequent hospitalization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract period until the plan's subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this performance target and shall accept payment withholds that must be returned to the hospitals if the performance target is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year. The commissioner may exclude special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall withhold three percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year. The commissioner may exclude special demonstration projects under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may include as admitted assets under section 62D.044 any amount withheld under this section that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and 7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and fully executed agreements for all subcontractors, including bargaining groups, for administrative services that are expensed to the state's public health care programs. Subcontractor agreements determined to be material, as defined by the commissioner after taking into account state contracting and relevant statutory requirements, must be in the form of a written instrument or electronic document containing the elements of offer, acceptance, consideration, payment terms, scope, duration of the contract, and how the subcontractor services relate to state public health care programs. Upon request, the commissioner shall have access to all subcontractor documentation under this paragraph. Nothing in this paragraph shall allow release of information that is nonpublic data pursuant to section 13.02.
Subd. 5b.
Prospective reimbursement rates.
(a) For prepaid medical assistance program contract rates set by the commissioner under subdivision 5, capitation rates for nonmetropolitan counties shall on a weighted average be no less than 87 percent of the capitation rates for metropolitan counties, excluding Hennepin County. The commissioner shall make a pro rata adjustment in capitation rates paid to counties other than nonmetropolitan counties in order to make this provision budget neutral. The commissioner, in consultation with a health care actuary, shall evaluate the regional rate relationships based on actual health plan costs for Minnesota health care programs. The commissioner may establish, based on the actuary's recommendation, new rate regions that recognize metropolitan areas outside of the seven-county metropolitan area.
(b) This subdivision shall not affect the nongeographically based risk adjusted rates established under section 62Q.03, subdivision 5a.
Subd. 5c.
Medical education and research fund.
(a) The commissioner of human services shall transfer each year to the medical education and research fund established under section 62J.692, an amount specified in this subdivision. The commissioner shall calculate the following:
(1) an amount equal to the reduction in the prepaid medical assistance payments as specified in this clause. After January 1, 2002, the county medical assistance capitation base rate prior to plan specific adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing facility and elderly waiver payments and demonstration project payments operating under subdivision 23 are excluded from this reduction. The amount calculated under this clause shall not be adjusted for periods already paid due to subsequent changes to the capitation payments;
(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this section;
(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates paid under this section; and
(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid under this section.
(b) This subdivision shall be effective upon approval of a federal waiver which allows federal financial participation in the medical education and research fund. The amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally reduce the amount specified under paragraph (a), clause (1).
(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner shall transfer $21,714,000 each fiscal year to the medical education and research fund.
(d) Beginning September 1, 2011, of the amount in paragraph (a), following the transfer under paragraph (c), the commissioner shall transfer to the medical education research fund $23,936,000 in fiscal years 2012 and 2013 and $49,552,000 in fiscal year 2014 and thereafter.
Subd. 5d.
Modification of payment dates effective January 1, 2001.
Effective for services rendered on or after January 1, 2001, capitation payments under this section for services provided in the month of June shall be made no earlier than the first day after the month of service.
Subd. 5f.
Capitation rates.
(a) Beginning July 1, 2002, the capitation rates paid under this section are increased by $12,700,000 per year. Beginning July 1, 2003, the capitation rates paid under this section are increased by $4,700,000 per year.
(b) Beginning July 1, 2009, the capitation rates paid under this section are increased each year by the lesser of $21,714,000 or an amount equal to the difference between the estimated value of the reductions described in subdivision 5c, paragraph (a), clause (1), and the amount of the limit described in subdivision 5c, paragraph (b).
Subd. 5g.
Payment for covered services.
For services rendered on or after January 1, 2003, the total payment made to managed care plans for providing covered services under the medical assistance program is reduced by .5 percent from their current statutory rates. This provision excludes payments for nursing home services, home and community-based waivers, payments to demonstration projects for persons with disabilities, and mental health services added as covered benefits after December 31, 2007.
Subd. 5h.
Payment reduction.
In addition to the reduction in subdivision 5g, the total payment made to managed care plans under the medical assistance program is reduced 1.0 percent for services provided on or after October 1, 2003, and an additional 1.0 percent for services provided on or after January 1, 2004. This provision excludes payments for nursing home services, home and community-based waivers, payments to demonstration projects for persons with disabilities, and mental health services added as covered benefits after December 31, 2007.
Subd. 5i.
Administrative expenses.
(a) Administrative costs paid to managed care plans and county-based purchasing plans under this section, section 256B.692, and section 256L.12 must not exceed 6.6 percent of total payments made to all managed care plans and county-based purchasing plans in aggregate across all state public health care programs, based on payments expected to be made at the beginning of each calendar year. The commissioner may reduce or eliminate administrative requirements to meet the administrative cost limit. For purposes of this paragraph, administrative costs do not include premium taxes paid under section 297I.05, subdivision 5, provider surcharges paid under section 256.9657, subdivision 3, and health insurance fees under section 9010 of the Affordable Care Act.
(b) The following expenses are not allowable administrative expenses for rate-setting purposes under this section:
(1) charitable contributions made by the managed care plan or the county-based purchasing plan;
(2) compensation of individuals within the organization in excess of $200,000 such that the allocation of compensation for an individual across all state public health care programs in total cannot exceed $200,000;
(3) any penalties or fines assessed against the managed care plan or county-based purchasing plan;
(4) any indirect marketing or advertising expenses of the managed care plan or county-based purchasing plan, including but not limited to costs to promote the managed care or county-based purchasing plan, costs of facilities used for special events, and costs of displays, demonstrations, donations, and promotional items such as memorabilia, models, gifts, and souvenirs. The commissioner may classify an item listed in this clause as an allowable administrative expense for rate-setting purposes, if the commissioner determines that the expense is incidental to an activity related to state public health care programs that is an allowable cost for purposes of rate setting;
(5) any lobbying and political activities, events, or contributions;
(6) administrative expenses related to the provision of services not covered under the state plan or waiver;
(7) alcoholic beverages and related costs;
(8) membership in any social, dining, or country club or organization; and
(9) entertainment, including amusement, diversion, and social activities, and any costs directly associated with these costs, including but not limited to tickets to shows or sporting events, meals, lodging, rentals, transportation, and gratuities.
For the purposes of this subdivision, compensation includes salaries, bonuses and incentives, other reportable compensation on an IRS 990 form, retirement and other deferred compensation, and nontaxable benefits. Charitable contributions under clause (1) include payments for or to any organization or entity selected by the managed care plan or county-based purchasing plan that is operated for charitable, educational, political, religious, or scientific purposes, that are not related to medical and administrative services covered under state public health care programs.
(c) Payments to a quality improvement organization are an allowable administrative expense for rate-setting purposes under this section, to the extent they are allocated to a state public health care program and approved by the commissioner.
(d) Where reasonably possible, expenses for an administrative item shall be directly allocated so as to assign costs for an item to an individual state public health care program when the cost can be specifically identified with and benefits the individual state public health care program. For administrative services expensed to the state's public health care programs, managed care plans and county-based purchasing plans must clearly identify and separately record expense items listed under paragraph (b) in their accounting systems in a manner that allows for independent verification of unallowable expenses for purposes of determining payment rates for state public health care programs.
(e) Notwithstanding paragraph (a), the commissioner shall reduce administrative expenses paid to managed care plans and county-based purchasing plans by .50 of a percentage point for contracts beginning January 1, 2016, and ending December 31, 2017. To meet the administrative reductions under this paragraph, the commissioner may reduce or eliminate administrative requirements, exclude additional unallowable administrative expenses identified under this section and resulting from the financial audits conducted under subdivision 9d, and utilize competitive bidding to gain efficiencies through economies of scale from increased enrollment. If the total reduction cannot be achieved through administrative reduction, the commissioner may limit total rate increases on payments to managed care plans and county-based purchasing plans.
Subd. 5j.
Treatment of investment earnings.
Capitation rates shall treat investment income and interest earnings as income to the same extent that investment-related expenses are treated as administrative expenditures.
Subd. 5k.
Actuarial soundness.
(a) Rates paid to managed care plans and county-based purchasing plans shall satisfy requirements for actuarial soundness. In order to comply with this subdivision, the rates must:
(1) be neither inadequate nor excessive;
(2) satisfy federal requirements;
(3) in the case of contracts with incentive arrangements, not exceed 105 percent of the approved capitation payments attributable to the enrollees or services covered by the incentive arrangement;
(4) be developed in accordance with generally accepted actuarial principles and practices;
(5) be appropriate for the populations to be covered and the services to be furnished under the contract; and
(6) be certified as meeting the requirements of federal regulations by actuaries who meet the qualification standards established by the American Academy of Actuaries and follow the practice standards established by the Actuarial Standards Board.
(b) Each year within 30 days of the establishment of plan rates the commissioner shall report to the chairs and ranking minority members of the senate Health and Human Services Budget Division and the house of representatives Health Care and Human Services Finance Division to certify how each of these conditions have been met by the new payment rates.
Subd. 6.
Service delivery.
(a) Each demonstration provider shall be responsible for the health care coordination for eligible individuals. Demonstration providers:
(1) shall authorize and arrange for the provision of all needed health services including but not limited to the full range of services listed in sections 256B.02, subdivision 8, and 256B.0625 in order to ensure appropriate health care is delivered to enrollees. Notwithstanding section 256B.0621, demonstration providers that provide nursing home and community-based services under this section shall provide relocation service coordination to enrolled persons age 65 and over;
(2) shall accept the prospective, per capita payment from the commissioner in return for the provision of comprehensive and coordinated health care services for eligible individuals enrolled in the program;
(3) may contract with other health care and social service practitioners to provide services to enrollees; and
(4) shall institute recipient grievance procedures according to the method established by the project, utilizing applicable requirements of chapter 62D. Disputes not resolved through this process shall be appealable to the commissioner as provided in subdivision 11.
(b) Demonstration providers must comply with the standards for claims settlement under section 72A.201, subdivisions 4, 5, 7, and 8, when contracting with other health care and social service practitioners to provide services to enrollees. A demonstration provider must pay a clean claim, as defined in Code of Federal Regulations, title 42, section 447.45(b), within 30 business days of the date of acceptance of the claim.
Subd. 6a.
Nursing home services.
(a) Notwithstanding Minnesota Rules, part 9500.1457, subpart 1, item B, up to 180 days of nursing facility services as defined in section 256B.0625, subdivision 2, which are provided in a nursing facility certified by the Minnesota Department of Health for services provided and eligible for payment under Medicaid, shall be covered under the prepaid medical assistance program for individuals who are not residing in a nursing facility at the time of enrollment in the prepaid medical assistance program. The commissioner may develop a schedule to phase in implementation of the 180-day provision.
(b) For individuals enrolled in the Minnesota senior health options project or in other demonstrations authorized under subdivision 23, nursing facility services shall be covered according to the terms and conditions of the federal agreement governing that demonstration project.
(c) For individuals enrolled in demonstrations authorized under subdivision 23, services in an intermediate care facility for persons with developmental disabilities shall be covered according to the terms and conditions of the federal agreement governing the demonstration project.
Subd. 6b.
Home and community-based waiver services.
(a) For individuals enrolled in the Minnesota senior health options project authorized under subdivision 23, elderly waiver services shall be covered according to the terms and conditions of the federal agreement governing that demonstration project.
(b) For individuals under age 65 enrolled in demonstrations authorized under subdivision 23, home and community-based waiver services shall be covered according to the terms and conditions of the federal agreement governing that demonstration project.
(c) The commissioner of human services shall issue requests for proposals for collaborative service models between counties and managed care organizations to integrate the home and community-based elderly waiver services and additional nursing home services into the prepaid medical assistance program.
(d) Notwithstanding Minnesota Rules, part 9500.1457, subpart 1, item C, elderly waiver services shall be covered statewide under the prepaid medical assistance program for all individuals who are eligible according to section 256B.0915. The commissioner may develop a schedule to phase in implementation of these waiver services, including collaborative service models under paragraph (c). The commissioner shall phase in implementation beginning with those counties participating under section 256B.692, and those counties where a viable collaborative service model has been developed. In consultation with counties and all managed care organizations that have expressed an interest in participating in collaborative service models, the commissioner shall evaluate the models. The commissioner shall consider the evaluation in selecting the most appropriate models for statewide implementation.
Subd. 6d.
Prescription drugs.
The commissioner may exclude or modify coverage for prescription drugs from the prepaid managed care contracts entered into under this section in order to increase savings to the state by collecting additional prescription drug rebates. The contracts must maintain incentives for the managed care plan to manage drug costs and utilization and may require that the managed care plans maintain an open drug formulary. In order to manage drug costs and utilization, the contracts may authorize the managed care plans to use preferred drug lists and prior authorization. This subdivision is contingent on federal approval of the managed care contract changes and the collection of additional prescription drug rebates.
Subd. 7.
Enrollee benefits.
All eligible individuals enrolled by demonstration providers shall receive all needed health care services as defined in subdivision 6.
All enrolled individuals have the right to appeal if necessary services are not being authorized as defined in subdivision 11.
Subd. 8.
Preadmission screening waiver.
Except as applicable to the project's operation, the provisions of sections 256.975 and 256B.0911 are waived for the purposes of this section for recipients enrolled with demonstration providers or in the prepaid medical assistance program for seniors.
Subd. 9.
Reporting.
(a) Each demonstration provider shall submit information as required by the commissioner, including data required for assessing client satisfaction, quality of care, cost, and utilization of services for purposes of project evaluation. The commissioner shall also develop methods of data reporting and collection in order to provide aggregate enrollee information on encounters and outcomes to determine access and quality assurance. Required information shall be specified before the commissioner contracts with a demonstration provider.
(b) Aggregate nonpersonally identifiable health plan encounter data, aggregate spending data for major categories of service as reported to the commissioners of health and commerce under section 62D.08, subdivision 3, clause (a), and criteria for service authorization and service use are public data that the commissioner shall make available and use in public reports. The commissioner shall require each health plan and county-based purchasing plan to provide:
(1) encounter data for each service provided, using standard codes and unit of service definitions set by the commissioner, in a form that the commissioner can report by age, eligibility groups, and health plan; and
(2) criteria, written policies, and procedures required to be disclosed under section 62M.10, subdivision 7, and Code of Federal Regulations, title 42, part 438.210 (b)(1), used for each type of service for which authorization is required.
(c) Each demonstration provider shall report to the commissioner on the extent to which providers employed by or under contract with the demonstration provider use patient-centered decision-making tools or procedures designed to engage patients early in the decision-making process and the steps taken by the demonstration provider to encourage their use.
Subd. 9a.
Administrative expense reporting.
Within the limit of available appropriations, the commissioner shall work with the commissioner of health to identify and collect data on administrative spending for state health care programs reported to the commissioner of health by managed care plans under section 62D.08 and county-based purchasing plans under section 256B.692, provided that such data are consistent with guidelines and standards for administrative spending that are developed by the commissioner of health, and reported to the legislature under Laws 2008, chapter 364, section 12. Data provided to the commissioner under this subdivision are nonpublic data as defined under section 13.02.
Subd. 9c.
Managed care financial reporting.
(a) The commissioner shall collect detailed data regarding financials, provider payments, provider rate methodologies, and other data as determined by the commissioner. The commissioner, in consultation with the commissioners of health and commerce, and in consultation with managed care plans and county-based purchasing plans, shall set uniform criteria, definitions, and standards for the data to be submitted, and shall require managed care and county-based purchasing plans to comply with these criteria, definitions, and standards when submitting data under this section. In carrying out the responsibilities of this subdivision, the commissioner shall ensure that the data collection is implemented in an integrated and coordinated manner that avoids unnecessary duplication of effort. To the extent possible, the commissioner shall use existing data sources and streamline data collection in order to reduce public and private sector administrative costs. Nothing in this subdivision shall allow release of information that is nonpublic data pursuant to section 13.02.
(b) Effective January 1, 2014, each managed care and county-based purchasing plan must quarterly provide to the commissioner the following information on state public programs, in the form and manner specified by the commissioner, according to guidelines developed by the commissioner in consultation with managed care plans and county-based purchasing plans under contract:
(1) an income statement by program;
(2) financial statement footnotes;
(3) quarterly profitability by program and population group;
(4) a medical liability summary by program and population group;
(5) received but unpaid claims report by program;
(6) services versus payment lags by program for hospital services, outpatient services, physician services, other medical services, and pharmaceutical benefits;
(7) utilization reports that summarize utilization and unit cost information by program for hospitalization services, outpatient services, physician services, and other medical services;
(8) pharmaceutical statistics by program and population group for measures of price and utilization of pharmaceutical services;
(9) subcapitation expenses by population group;
(10) third-party payments by program;
(11) all new, active, and closed subrogation cases by program;
(12) all new, active, and closed fraud and abuse cases by program;
(13) medical loss ratios by program;
(14) administrative expenses by category and subcategory by program that reconcile to other state and federal regulatory agencies, including Minnesota Supplement Report #1A;
(15) revenues by program, including investment income;
(16) nonadministrative service payments, provider payments, and reimbursement rates by provider type or service category, by program, paid by the managed care plan under this section or the county-based purchasing plan under section 256B.692 to providers and vendors for administrative services under contract with the plan, including but not limited to:
(i) individual-level provider payment and reimbursement rate data;
(ii) provider reimbursement rate methodologies by provider type, by program, including a description of alternative payment arrangements and payments outside the claims process;
(iii) data on implementation of legislatively mandated provider rate changes; and
(iv) individual-level provider payment and reimbursement rate data and plan-specific provider reimbursement rate methodologies by provider type, by program, including alternative payment arrangements and payments outside the claims process, provided to the commissioner under this subdivision are nonpublic data as defined in section 13.02;
(17) data on the amount of reinsurance or transfer of risk by program; and
(18) contribution to reserve, by program.
(c) In the event a report is published or released based on data provided under this subdivision, the commissioner shall provide the report to managed care plans and county-based purchasing plans 15 days prior to the publication or release of the report. Managed care plans and county-based purchasing plans shall have 15 days to review the report and provide comment to the commissioner.
The quarterly reports shall be submitted to the commissioner no later than 60 days after the end of the previous quarter, except the fourth-quarter report, which shall be submitted by April 1 of each year. The fourth-quarter report shall include audited financial statements, parent company audited financial statements, an income statement reconciliation report, and any other documentation necessary to reconcile the detailed reports to the audited financial statements.
(d) Managed care plans and county-based purchasing plans shall certify to the commissioner for the purpose of financial reporting for state public health care programs under this subdivision that costs reported for state public health care programs include:
(1) only services covered under the state plan and waivers, and related allowable administrative expenses; and
(2) the dollar value of unallowable and nonstate plan services, including both medical and administrative expenditures, that have been excluded.
Subd. 9d.
Financial and quality assurance audits.
(a) The commissioner shall require, in the request for bids and resulting contracts with managed care plans and county-based purchasing plans under this section and section 256B.692, that each managed care plan and county-based purchasing plan submit to and fully cooperate with the independent third-party financial audits by the legislative auditor under subdivision 9e of the information required under subdivision 9c, paragraph (b). Each contract with a managed care plan or county-based purchasing plan under this section or section 256B.692 must provide the commissioner, the legislative auditor, and vendors contracting with the legislative auditor, access to all data required to complete audits under subdivision 9e.
(b) Each managed care plan and county-based purchasing plan providing services under this section shall provide to the commissioner biweekly encounter data and claims data for state public health care programs and shall participate in a quality assurance program that verifies the timeliness, completeness, accuracy, and consistency of the data provided. The commissioner shall develop written protocols for the quality assurance program and shall make the protocols publicly available. The commissioner shall contract for an independent third-party audit to evaluate the quality assurance protocols as to the capacity of the protocols to ensure complete and accurate data and to evaluate the commissioner's implementation of the protocols.
(c) Upon completion of the evaluation under paragraph (b), the commissioner shall provide copies of the report to the legislative auditor and the chairs and ranking minority members of the legislative committees with jurisdiction over health care policy and financing.
(d) Any actuary under contract with the commissioner to provide actuarial services must meet the independence requirements under the professional code for fellows in the Society of Actuaries and must not have provided actuarial services to a managed care plan or county-based purchasing plan that is under contract with the commissioner pursuant to this section and section 256B.692 during the period in which the actuarial services are being provided. An actuary or actuarial firm meeting the requirements of this paragraph must certify and attest to the rates paid to the managed care plans and county-based purchasing plans under this section and section 256B.692, and the certification and attestation must be auditable.
(e) The commissioner, to the extent of available funding, shall conduct ad hoc audits of state public health care program administrative and medical expenses reported by managed care plans and county-based purchasing plans. This includes: financial and encounter data reported to the commissioner under subdivision 9c, including payments to providers and subcontractors; supporting documentation for expenditures; categorization of administrative and medical expenses; and allocation methods used to attribute administrative expenses to state public health care programs. These audits also must monitor compliance with data and financial report certification requirements established by the commissioner for the purposes of managed care capitation payment rate-setting. The managed care plans and county-based purchasing plans shall fully cooperate with the audits in this subdivision. The commissioner shall report to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and finance by February 1, 2016, and each February 1 thereafter, the number of ad hoc audits conducted in the past calendar year and the results of these audits.
(f) Nothing in this subdivision shall allow the release of information that is nonpublic data pursuant to section 13.02.
Subd. 9e.
Financial audits.
(a) The legislative auditor shall conduct or contract with vendors to conduct independent third-party financial audits of the information required to be provided by managed care plans and county-based purchasing plans under subdivision 9c, paragraph (b). The audits by the vendors shall be conducted as vendor resources permit and in accordance with generally accepted government auditing standards issued by the United States Government Accountability Office. The contract with the vendors shall be designed and administered so as to render the independent third-party audits eligible for a federal subsidy, if available. The contract shall require the audits to include a determination of compliance with the federal Medicaid rate certification process.
(b) For purposes of this subdivision, "independent third-party" means a vendor that is independent in accordance with government auditing standards issued by the United States Government Accountability Office.
Subd. 10.
Information.
Notwithstanding any law or rule to the contrary, the commissioner may allow disclosure of the recipient's identity solely for the purposes of (a) allowing demonstration providers to provide the information to the recipient regarding services, access to services, and other provider characteristics, and (b) facilitating monitoring of recipient satisfaction and quality of care. The commissioner shall develop and implement measures to protect recipients from invasions of privacy and from harassment.
Subd. 11.
Appeals.
A recipient may appeal to the commissioner a demonstration provider's delay or refusal to provide services, according to section 256.045.
Subd. 16.
Project extension.
Minnesota Rules, parts 9500.1450; 9500.1451; 9500.1452; 9500.1453; 9500.1454; 9500.1455; 9500.1457; 9500.1458; 9500.1459; 9500.1460; 9500.1461; 9500.1462; 9500.1463; and 9500.1464, are extended.
Subd. 17.
Continuation of prepaid medical assistance.
The commissioner may continue the provisions of this section in any or all of the participating counties if necessary federal authority is granted. The commissioner may adopt permanent rules to continue prepaid medical assistance in these areas.
Subd. 18.
Services pending appeal.
If the recipient appeals in writing to the state agency on or before the tenth day after the decision of the prepaid health plan to reduce, suspend, or terminate services which the recipient had been receiving, and the treating physician or another plan physician orders the services to be continued at the previous level, the prepaid health plan must continue to provide services at a level equal to the level ordered by the plan's physician until the state agency renders its decision.
Subd. 19.
Limitation on reimbursement; providers not with prepaid health plan.
A prepaid health plan may limit any reimbursement it may be required to pay to providers not employed by or under contract with the prepaid health plan to the medical assistance rates for medical assistance enrollees paid by the commissioner of human services to providers for services to recipients not enrolled in a prepaid health plan.
Subd. 20.
Ombudsperson.
The commissioner shall designate an ombudsperson to advocate for persons required to enroll in prepaid health plans under this section. The ombudsperson shall advocate for recipients enrolled in prepaid health plans through complaint and appeal procedures and ensure that necessary medical services are provided either by the prepaid health plan directly or by referral to appropriate social services. At the time of enrollment in a prepaid health plan, the local agency shall inform recipients about the ombudsperson program and their right to a resolution of a complaint by the prepaid health plan if they experience a problem with the plan or its providers.
Subd. 21.
Prepayment coordinator.
The county board shall designate a prepayment coordinator to assist the state agency in implementing this section. Assistance must include educating recipients about available health care options, enrolling recipients under subdivision 5, providing necessary eligibility and enrollment information to health plans and the state agency, and coordinating complaints and appeals with the ombudsman established in subdivision 18.
Subd. 22.
Impact on public or teaching hospitals and community clinics.
(a) Before implementing prepaid programs in counties with a county operated or affiliated public teaching hospital or a hospital or clinic operated by the University of Minnesota, the commissioner shall consider the risks the prepaid program creates for the hospital and allow the county or hospital the opportunity to participate in the program, provided the terms of participation in the program are competitive with the terms of other participants.
(b) Prepaid health plans serving counties with a nonprofit community clinic or community health services agency must contract with the clinic or agency to provide services to clients who choose to receive services from the clinic or agency, if the clinic or agency agrees to payment rates that are competitive with rates paid to other health plan providers for the same or similar services.
(c) For purposes of this subdivision, "nonprofit community clinic" includes, but is not limited to, a community mental health center as defined in sections 245.62 and 256B.0625, subdivision 5.
Subd. 23.
Alternative services; elderly and disabled persons.
(a) The commissioner may implement demonstration projects to create alternative integrated delivery systems for acute and long-term care services to elderly persons and persons with disabilities as defined in section 256B.77, subdivision 7a, that provide increased coordination, improve access to quality services, and mitigate future cost increases. The commissioner may seek federal authority to combine Medicare and Medicaid capitation payments for the purpose of such demonstrations and may contract with Medicare-approved special needs plans that are offered by a demonstration provider or by an entity that is directly or indirectly wholly owned or controlled by a demonstration provider to provide Medicaid services. Medicare funds and services shall be administered according to the terms and conditions of the federal contract and demonstration provisions. For the purpose of administering medical assistance funds, demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations, with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1, items B and C, which do not apply to persons enrolling in demonstrations under this section. All enforcement and rulemaking powers available under chapters 62D, 62M, and 62Q are hereby granted to the commissioner of health with respect to Medicare-approved special needs plans with which the commissioner contracts to provide Medicaid services under this section. An initial open enrollment period may be provided. Persons who disenroll from demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is enrolled in a health plan under these demonstrations and the health plan's participation is subsequently terminated for any reason, the person shall be provided an opportunity to select a new health plan and shall have the right to change health plans within the first 60 days of enrollment in the second health plan. Persons required to participate in health plans under this section who fail to make a choice of health plan shall not be randomly assigned to health plans under these demonstrations. Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220, subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision, the commissioner may contract with managed care organizations, including counties, to serve only elderly persons eligible for medical assistance, elderly and disabled persons, or disabled persons only. For persons with a primary diagnosis of developmental disability, serious and persistent mental illness, or serious emotional disturbance, the commissioner must ensure that the county authority has approved the demonstration and contracting design. Enrollment in these projects for persons with disabilities shall be voluntary. The commissioner shall not implement any demonstration project under this subdivision for persons with a primary diagnosis of developmental disabilities, serious and persistent mental illness, or serious emotional disturbance, without approval of the county board of the county in which the demonstration is being implemented.
(b) MS 2009 Supplement [Expired, 2003 c 47 s 4; 2007 c 147 art 7 s 60]
(c) Before implementation of a demonstration project for disabled persons, the commissioner must provide information to appropriate committees of the house of representatives and senate and must involve representatives of affected disability groups in the design of the demonstration projects.
(d) A nursing facility reimbursed under the alternative reimbursement methodology in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity provide services under paragraph (a). The commissioner shall amend the state plan and seek any federal waivers necessary to implement this paragraph.
(e) The commissioner, in consultation with the commissioners of commerce and health, may approve and implement programs for all-inclusive care for the elderly (PACE) according to federal laws and regulations governing that program and state laws or rules applicable to participating providers. A PACE provider is not required to be licensed or certified as a health plan company as defined in section 62Q.01, subdivision 4. Persons age 55 and older who have been screened by the county and found to be eligible for services under the elderly waiver or community access for disability inclusion or who are already eligible for Medicaid but meet level of care criteria for receipt of waiver services may choose to enroll in the PACE program. Medicare and Medicaid services will be provided according to this subdivision and federal Medicare and Medicaid requirements governing PACE providers and programs. PACE enrollees will receive Medicaid home and community-based services through the PACE provider as an alternative to services for which they would otherwise be eligible through home and community-based waiver programs and Medicaid State Plan Services. The commissioner shall establish Medicaid rates for PACE providers that do not exceed costs that would have been incurred under fee-for-service or other relevant managed care programs operated by the state.
(f) The commissioner shall seek federal approval to expand the Minnesota disability health options (MnDHO) program established under this subdivision in stages, first to regional population centers outside the seven-county metro area and then to all areas of the state. Until July 1, 2009, expansion for MnDHO projects that include home and community-based services is limited to the two projects and service areas in effect on March 1, 2006. Enrollment in integrated MnDHO programs that include home and community-based services shall remain voluntary. Costs for home and community-based services included under MnDHO must not exceed costs that would have been incurred under the fee-for-service program. Notwithstanding whether expansion occurs under this paragraph, in determining MnDHO payment rates and risk adjustment methods, the commissioner must consider the methods used to determine county allocations for home and community-based program participants. If necessary to reduce MnDHO rates to comply with the provision regarding MnDHO costs for home and community-based services, the commissioner shall achieve the reduction by maintaining the base rate for contract year 2010 for services provided under the community access for disability inclusion waiver at the same level as for contract year 2009. The commissioner may apply other reductions to MnDHO rates to implement decreases in provider payment rates required by state law. Effective January 1, 2011, enrollment and operation of the MnDHO program in effect during 2010 shall cease. The commissioner may reopen the program provided all applicable conditions of this section are met. In developing program specifications for expansion of integrated programs, the commissioner shall involve and consult the state-level stakeholder group established in subdivision 28, paragraph (d), including consultation on whether and how to include home and community-based waiver programs. Plans to reopen MnDHO projects shall be presented to the chairs of the house of representatives and senate committees with jurisdiction over health and human services policy and finance prior to implementation.
(g) Notwithstanding section 256B.0621, health plans providing services under this section are responsible for home care targeted case management and relocation targeted case management. Services must be provided according to the terms of the waivers and contracts approved by the federal government.
Subd. 25.
Continuation of payments through discharge.
In the event a medical assistance recipient or beneficiary enrolled in a health plan under this section is denied nursing facility services after residing in the facility for more than 180 days, any denial of medical assistance payment to a provider under this section shall be prospective only and payments to the provider shall continue until the resident is discharged or 30 days after the effective date of the service denial, whichever is sooner.
Subd. 26.
American Indian recipients.
(a) For American Indian recipients of medical assistance who are required to enroll with a demonstration provider under subdivision 4 or in a county-based purchasing entity, if applicable, under section 256B.692, medical assistance shall cover health care services provided at Indian health services facilities and facilities operated by a tribe or tribal organization under funding authorized by United States Code, title 25, sections 450f to 450n, or title III of the Indian Self-Determination and Education Assistance Act, Public Law 93-638, if those services would otherwise be covered under section 256B.0625. Payments for services provided under this subdivision shall be made on a fee-for-service basis, and may, at the option of the tribe or tribal organization, be made according to rates authorized under sections 256.969, subdivision 16, and 256B.0625, subdivision 34. Implementation of this purchasing model is contingent on federal approval.
(b) The commissioner of human services, in consultation with the tribal governments, shall develop a plan for tribes to assist in the enrollment process for American Indian recipients enrolled in the prepaid medical assistance program under this section. This plan also shall address how tribes will be included in ensuring the coordination of care for American Indian recipients between Indian health service or tribal providers and other providers.
(c) For purposes of this subdivision, "American Indian" has the meaning given to persons to whom services will be provided for in Code of Federal Regulations, title 42, section 36.12.
Subd. 27.
Information for persons with limited English-language proficiency.
Managed care contracts entered into under this section and section 256L.12 must require demonstration providers to provide language assistance to enrollees that ensures meaningful access to its programs and services according to Title VI of the Civil Rights Act and federal regulations adopted under that law or any guidance from the United States Department of Health and Human Services.
Subd. 28.
Medicare special needs plans; medical assistance basic health care.
(a) The commissioner may contract with demonstration providers and current or former sponsors of qualified Medicare-approved special needs plans, to provide medical assistance basic health care services to persons with disabilities, including those with developmental disabilities. Basic health care services include:
(1) those services covered by the medical assistance state plan except for ICF/DD services, home and community-based waiver services, case management for persons with developmental disabilities under section 256B.0625, subdivision 20a, and personal care and certain home care services defined by the commissioner in consultation with the stakeholder group established under paragraph (d); and
(2) basic health care services may also include risk for up to 100 days of nursing facility services for persons who reside in a noninstitutional setting and home health services related to rehabilitation as defined by the commissioner after consultation with the stakeholder group.
The commissioner may exclude other medical assistance services from the basic health care benefit set. Enrollees in these plans can access any excluded services on the same basis as other medical assistance recipients who have not enrolled.
(b) The commissioner may contract with demonstration providers and current and former sponsors of qualified Medicare special needs plans, to provide basic health care services under medical assistance to persons who are dually eligible for both Medicare and Medicaid and those Social Security beneficiaries eligible for Medicaid but in the waiting period for Medicare. The commissioner shall consult with the stakeholder group under paragraph (d) in developing program specifications for these services. Payment for Medicaid services provided under this subdivision for the months of May and June will be made no earlier than July 1 of the same calendar year.
(c) Notwithstanding subdivision 4, beginning January 1, 2012, the commissioner shall enroll persons with disabilities in managed care under this section, unless the individual chooses to opt out of enrollment. The commissioner shall establish enrollment and opt out procedures consistent with applicable enrollment procedures under this section.
(d) The commissioner shall establish a state-level stakeholder group to provide advice on managed care programs for persons with disabilities, including both MnDHO and contracts with special needs plans that provide basic health care services as described in paragraphs (a) and (b). The stakeholder group shall provide advice on program expansions under this subdivision and subdivision 23, including:
(1) implementation efforts;
(2) consumer protections; and
(3) program specifications such as quality assurance measures, data collection and reporting, and evaluation of costs, quality, and results.
(e) Each plan under contract to provide medical assistance basic health care services shall establish a local or regional stakeholder group, including representatives of the counties covered by the plan, members, consumer advocates, and providers, for advice on issues that arise in the local or regional area.
(f) The commissioner is prohibited from providing the names of potential enrollees to health plans for marketing purposes. The commissioner shall mail no more than two sets of marketing materials per contract year to potential enrollees on behalf of health plans, at the health plan's request. The marketing materials shall be mailed by the commissioner within 30 days of receipt of these materials from the health plan. The health plans shall cover any costs incurred by the commissioner for mailing marketing materials.
Subd. 29.
Prepaid health plan rates.
In negotiating prepaid health plan contract rates, the commissioner of human services shall take into consideration, and the rates shall reflect, the anticipated savings in the medical assistance program due to extending medical assistance coverage to services provided in licensed birth centers, the anticipated use of these services within the medical assistance population, and the reduced medical assistance costs associated with the use of birth centers for normal, low-risk deliveries.
Subd. 30.
Provision of required materials in alternative formats.
(a) For the purposes of this subdivision, "alternative format" means a medium other than paper and "prepaid health plan" means managed care plans and county-based purchasing plans.
(b) A prepaid health plan may provide in an alternative format a provider directory and certificate of coverage, or materials otherwise required to be available in writing under Code of Federal Regulations, title 42, section 438.10, or under the commissioner's contract with the prepaid health plan, if the following conditions are met:
(1) the prepaid health plan, local agency, or commissioner, as applicable, informs the enrollee that:
(i) an alternative format is available and the enrollee affirmatively requests of the prepaid health plan that the provider directory, certificate of coverage, or materials otherwise required under Code of Federal Regulations, title 42, section 438.10, or under the commissioner's contract with the prepaid health plan be provided in an alternative format; and
(ii) a record of the enrollee request is retained by the prepaid health plan in the form of written direction from the enrollee or a documented telephone call followed by a confirmation letter to the enrollee from the prepaid health plan that explains that the enrollee may change the request at any time;
(2) the materials are sent to a secure electronic mailbox and are made available at a password-protected secure electronic Web site or on a data storage device if the materials contain enrollee data that is individually identifiable;
(3) the enrollee is provided a customer service number on the enrollee's membership card that may be called to request a paper version of the materials provided in an alternative format; and
(4) the materials provided in an alternative format meets all other requirements of the commissioner regarding content, size of the typeface, and any required time frames for distribution. "Required time frames for distribution" must permit sufficient time for prepaid health plans to distribute materials in alternative formats upon receipt of enrollees' requests for the materials.
(c) A prepaid health plan may provide in an alternative format its primary care network list to the commissioner and to local agencies within its service area. The commissioner or local agency, as applicable, shall inform a potential enrollee of the availability of a prepaid health plan's primary care network list in an alternative format. If the potential enrollee requests an alternative format of the prepaid health plan's primary care network list, a record of that request shall be retained by the commissioner or local agency. The potential enrollee is permitted to withdraw the request at any time.
The prepaid health plan shall submit sufficient paper versions of the primary care network list to the commissioner and to local agencies within its service area to accommodate potential enrollee requests for paper versions of the primary care network list.
(d) A prepaid health plan may provide in an alternative format materials otherwise required to be available in writing under Code of Federal Regulations, title 42, section 438.10, or under the commissioner's contract with the prepaid health plan, if the conditions of paragraphs (b) and (c) are met for persons who are eligible for enrollment in managed care.
(e) The commissioner shall consult with managed care plans, county-based purchasing plans, counties, and other interested parties to determine how materials required to be made available to enrollees under Code of Federal Regulations, title 42, section 438.10, or under the commissioner's contract with a prepaid health plan may be provided in an alternative format on the basis that the enrollee has not opted in to receive the alternative format. The commissioner shall consult with managed care plans, county-based purchasing plans, counties, and other interested parties to develop recommendations relating to the conditions that must be met for an opt-out process to be granted.
Subd. 31.
Payment reduction.
(a) Beginning September 1, 2011, the commissioner shall reduce payments and limit future rate increases paid to managed care plans and county-based purchasing plans. The limits in paragraphs (a) to (f) shall be achieved on a statewide aggregate basis by program. The commissioner may use competitive bidding, payment reductions, or other reductions to achieve the reductions and limits in this subdivision.
(b) Beginning September 1, 2011, the commissioner shall reduce payments to managed care plans and county-based purchasing plans as follows:
(1) 2.0 percent for medical assistance elderly basic care. This shall not apply to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
(2) 2.82 percent for medical assistance families and children;
(3) 10.1 percent for medical assistance adults without children; and
(4) 6.0 percent for MinnesotaCare families and children.
(c) Beginning January 1, 2012, the commissioner shall limit rates paid to managed care plans and county-based purchasing plans for calendar year 2012 to a percentage of the rates in effect on August 31, 2011, as follows:
(1) 98 percent for medical assistance elderly basic care. This shall not apply to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
(2) 97.18 percent for medical assistance families and children;
(3) 89.9 percent for medical assistance adults without children; and
(4) 94 percent for MinnesotaCare families and children.
(d) Beginning January 1, 2013, to December 31, 2013, the commissioner shall limit the maximum annual trend increases to rates paid to managed care plans and county-based purchasing plans as follows:
(1) 7.5 percent for medical assistance elderly basic care. This shall not apply to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
(2) 5.0 percent for medical assistance special needs basic care;
(3) 2.0 percent for medical assistance families and children;
(4) 3.0 percent for medical assistance adults without children;
(5) 3.0 percent for MinnesotaCare families and children; and
(6) 3.0 percent for MinnesotaCare adults without children.
(e) The commissioner may limit trend increases to less than the maximum. Beginning July 1, 2014, the commissioner shall limit the maximum annual trend increases to rates paid to managed care plans and county-based purchasing plans as follows for calendar years 2014 and 2015:
(1) 7.5 percent for medical assistance elderly basic care. This shall not apply to Medicare cost-sharing, nursing facility, personal care assistance, and elderly waiver services;
(2) 5.0 percent for medical assistance special needs basic care;
(3) 2.0 percent for medical assistance families and children;
(4) 3.0 percent for medical assistance adults without children;
(5) 3.0 percent for MinnesotaCare families and children; and
(6) 4.0 percent for MinnesotaCare adults without children.
The commissioner may limit trend increases to less than the maximum. For calendar year 2014, the commissioner shall reduce the maximum aggregate trend increases by $47,000,000 in state and federal funds to account for the reductions in administrative expenses in subdivision 5i.
Subd. 32a.
Initiatives to improve early screening, diagnosis, and treatment of children with autism spectrum disorder and other developmental conditions.
(a) The commissioner shall require managed care plans and county-based purchasing plans, as a condition of contract, to implement strategies that facilitate access for young children between the ages of one and three years to periodic developmental and social-emotional screenings, as recommended by the Minnesota Interagency Developmental Screening Task Force, and that those children who do not meet milestones are provided access to appropriate evaluation and assessment, including treatment recommendations, expected to improve the child's functioning, with the goal of meeting milestones by age five.
(b) The following information from encounter data provided to the commissioner shall be reported on the department's public Web site for each managed care plan and county-based purchasing plan annually by July 31 of each year beginning in 2014:
(1) the number of children who received a diagnostic assessment;
(2) the total number of children ages one to six with a diagnosis of autism spectrum disorder who received treatments;
(3) the number of children identified under clause (2) reported by each 12-month age group beginning with age one and ending with age six; and
(4) the types of treatments provided to children identified under clause (2) listed by billing code, including the number of units billed for each child.
(c) The managed care plans and county-based purchasing plans shall also report on any barriers to providing screening, diagnosis, and treatment of young children between the ages of one and three years, any strategies implemented to address those barriers, and make recommendations on how to measure and report on the effectiveness of the strategies implemented to facilitate access for young children to provide developmental and social-emotional screening, diagnosis, and treatment as described in paragraph (a).
Subd. 33.
Competitive bidding.
(a) For managed care contracts effective on or after January 1, 2014, the commissioner may utilize a competitive price bidding program for nonelderly, nondisabled adults and children in medical assistance and MinnesotaCare in the seven-county metropolitan area. The program must allow a minimum of two managed care plans to serve the metropolitan area.
(b) In designing the competitive bid program, the commissioner shall consider, and incorporate where appropriate, the procedures and criteria used in the competitive bidding pilot authorized under Laws 2011, First Special Session chapter 9, article 6, section 96. The pilot program operating in Hennepin County under the authority of section 256B.0756 shall continue to be exempt from competitive bid.
(c) The commissioner shall use past performance data as a factor in selecting vendors and shall consider this information, along with competitive bid and other information, in determining whether to contract with a managed care plan under this subdivision. Where possible, the assessment of past performance in serving persons on public programs shall be based on encounter data submitted to the commissioner. The commissioner shall evaluate past performance based on both the health outcomes of care and success rates in securing participation in recommended preventive and early diagnostic care. Data provided by managed care plans must be provided in a uniform manner as specified by the commissioner and must include only data on medical assistance and MinnesotaCare enrollees. The data submitted must include health outcome measures on reducing the incidence of low birth weight established by the managed care plan under subdivision 32.
Subd. 34.
Supplemental recovery program.
The commissioner shall conduct a supplemental recovery program for third-party liabilities identified through coordination of benefits not recovered by managed care plans and county-based purchasing plans for state public health programs. Any third-party liability identified through coordination of benefits and recovered by the commissioner more than eight months after the date a managed care plan or county-based purchasing plan adjudicates a health care claim shall be retained by the commissioner and deposited in the general fund. The commissioner shall establish a mechanism, including a reconciliation process, for managed care plans and county-based purchasing plans to coordinate third-party liability collections efforts resulting from coordination of benefits under this subdivision with the commissioner to ensure there is no duplication of efforts. The coordination mechanism must be consistent with the reporting requirements in subdivision 9c. The commissioner shall share accurate and timely third-party liability data with managed care plans and county-based purchasing plans.
Subd. 35.
Statewide procurement.
(a) For calendar year 2015, the commissioner may extend a demonstration provider's contract under this section for a sixth year after the most recent procurement. For calendar year 2015, section 16B.98, subdivision 5, paragraph (b), and section 16C.05, subdivision 2, paragraph (b), shall not apply to contracts under this section.
(b) For calendar year 2016 contracts under this section, the commissioner shall procure through a statewide procurement, which includes all 87 counties, demonstration providers, and participating entities as defined in section 256L.01, subdivision 7. The commissioner shall publish a request for proposals by January 5, 2015. As part of the procurement process, the commissioner shall:
(1) seek each individual county's input;
(2) organize counties into regional groups, and consider single counties for the largest and most diverse counties; and
(3) seek regional and county input regarding the respondent's ability to fully and adequately deliver required health care services, offer an adequate provider network, provide care coordination with county services, and serve special populations, including enrollees with language and cultural needs.
256C.23 DEFINITIONS.
Subd. 3.
Regional service center.
"Regional service center" means a facility designed to provide an entry point for deaf, deafblind, and hard-of-hearing persons of that region in need of education, employment, social, human, or other services.
256C.25 INTERPRETER SERVICES.
Subd. 2.
Duties.
Interpreting or interpreter referral services must include:
(1) statewide access to interpreter referral and direct interpreting services, coordinated with the regional service centers;
(2) maintenance of a statewide directory of qualified interpreters;
(3) assessment of the present and projected supply and demand for interpreter services statewide; and
(4) coordination with the regional service centers on projects to train interpreters and advocate for and evaluate interpreter services.
Repealed Minnesota Rule: 17-2331
3400.0185 TERMINATION AND ADVERSE ACTIONS; NOTICE REQUIRED.
Subp. 5.
Notice to providers of actions adverse to the provider.
The county must give a provider written notice of the following actions adverse to the provider: a denial of authorization, a termination of authorization, a reduction in the number of hours of care with that provider, and a determination that the provider has an overpayment. The notice must include the following information:
C.
a statement that unless a family appeals the adverse action before the effective date or the provider appeals the overpayment determination, the adverse action will occur on the effective date. The notice must be mailed to the provider at least 15 calendar days before the effective date of the adverse action.
5600.2500 FEES.
The fees charged by the board are fixed at the following rates:
Z.
report creation and generation, $60 per hour billed in quarter-hour increments with a quarter-hour minimum; and
9503.0145 FOOD AND WATER.
Subp. 6.
Food allergy information.
Information about food allergies of the children in the center must be available in the area where food is prepared or served to children with allergies. All staff providing care to the child must be informed of the allergy.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 1a.
Administration of medications.
"Administration of medications" means performing a task to provide medications to a client, and includes the following tasks, performed in the following order:
D.
documenting the administration, or the reason for not administering medications as prescribed; and
E.
reporting information to a licensed practitioner or a nurse regarding problems with the administration of the medication or the client's refusal to take the medication.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 4.
Applicant.
"Applicant" means an individual, corporation, partnership, voluntary association, controlling individual, or other organization that has applied for licensure under this chapter.
9530.6405 DEFINITIONS.
Subp. 5.
Capacity management system.
"Capacity management system" means a database operated by the Department of Human Services to compile and make information available to the public about the waiting list status and current admission capability of each program serving intravenous drug abusers.
9530.6405 DEFINITIONS.
Subp. 6.
Central registry.
"Central registry" means a database maintained by the department that collects identifying information from two or more programs about individuals applying for maintenance treatment or detoxification treatment for addiction to opiates for the purpose of avoiding an individual's concurrent enrollment in more than one program.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 7a.
Chemical dependency treatment.
"Chemical dependency treatment" means treatment of a substance use disorder, including the process of assessment of a client's needs, development of planned interventions or services to address those needs, provision of services, facilitation of services provided by other service providers, and reassessment by a qualified professional. The goal of treatment is to assist or support the client's efforts to recover from substance use disorder.
9530.6405 DEFINITIONS.
Subp. 8.
Client.
"Client" means an individual accepted by a license holder for assessment or treatment of a substance use disorder. An individual remains a client until the license holder no longer provides or plans to provide the individual with treatment services.
9530.6405 DEFINITIONS.
Subp. 9.
Commissioner.
"Commissioner" means the commissioner of the Department of Human Services or the commissioner's designee.
9530.6405 DEFINITIONS.
Subp. 10.
Co-occurring or co-occurring client.
"Co-occurring" or "co-occurring client" means a diagnosis that indicates a client suffers from a substance use disorder and a mental health problem.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 13.
License.
"License" means a certificate issued by the commissioner authorizing the license holder to provide a specific program for a specified period of time in accordance with the terms of the license and the rules of the commissioner.
9530.6405 DEFINITIONS.
Subp. 14.
License holder.
"License holder" means an individual, corporation, partnership, voluntary organization, or other organization that is legally responsible for the operation of the program, has been granted a license by the commissioner under this chapter, and is a controlling individual.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 15.
Licensed professional in private practice.
"Licensed professional in private practice" means an individual who meets the following criteria:
A.
is licensed under Minnesota Statutes, chapter 148C, or is exempt from licensure under that chapter but is otherwise licensed to provide alcohol and drug counseling services;
B.
practices solely within the permissible scope of the individual's license as defined in the law authorizing licensure; and
C.
does not affiliate with other licensed or unlicensed professionals for the purpose of providing alcohol and drug counseling services. Affiliation does not include conferring with other professionals or making client referrals.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 16.
Paraprofessional.
"Paraprofessional" means an employee, agent, or independent contractor of the license holder who performs tasks in support of the provision of treatment services. Paraprofessionals may be referred to by a variety of titles including technician, case aide, or counselor assistant. An individual may not be a paraprofessional employed by the license holder if the individual is a client of the license holder.
9530.6405 DEFINITIONS.
Subp. 17.
Program serving intravenous drug abusers.
"Program serving intravenous drug abusers" means a program whose primary purpose is providing agonist medication-assisted therapy to clients who are narcotic dependent, regardless of whether the client's narcotic use was intravenous or by other means.
9530.6405 DEFINITIONS.
Subp. 17a.
Student intern.
"Student intern" means a person who is enrolled in an alcohol and drug counselor education program at an accredited school or educational program and is earning a minimum of nine semester credits per calendar year toward the completion of an associate's, bachelor's, master's, or doctorate degree requirements. Degree requirements must include an additional 18 semester credits or 270 hours of alcohol and drug counseling related course work and 440 hours of practicum.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 17c.
Substance use disorder.
"Substance use disorder" means a pattern of substance use as defined in the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM), et seq. The DSM-IV-TR is incorporated by reference. The DSM was published by the American Psychiatric Association in 1994, in Washington D.C., and is not subject to frequent change. The DSM-IV-TR is available through the Minitex interlibrary loan system.
9530.6405 DEFINITIONS.
Subp. 18.
Target population.
"Target population" means individuals experiencing problems with a substance use disorder having the specified characteristics that a license holder proposes to serve.
9530.6405 DEFINITIONS.
9530.6405 DEFINITIONS.
Subp. 21.
Treatment service.
"Treatment service" means a therapeutic intervention or series of interventions.
9530.6410 APPLICABILITY.
Subpart 1.
Applicability.
Except as provided in subparts 2 and 3, no person, corporation, partnership, voluntary association, controlling individual, or other organization may provide chemical dependency treatment services to an individual who has a substance use disorder unless licensed by the commissioner.
Subp. 2.
Activities exempt from license requirement.
Parts 9530.6405 to 9530.6505 do not apply to organizations whose primary functions are information, referral, diagnosis, case management, and assessment for the purposes of placement, education, support group services, or self-help programs. Parts 9530.6405 to 9530.6505do not apply to the activities of licensed professionals in private practice which are not paid for by the consolidated chemical dependency treatment fund.
Subp. 3.
Certain hospitals excluded from license requirement.
Parts 9530.6405 to 9530.6505 do not apply to chemical dependency treatment provided by hospitals licensed under Minnesota Statutes, chapter 62J, or under Minnesota Statutes, sections 144.50 to 144.56, unless the hospital accepts funds for chemical dependency treatment under the consolidated chemical dependency treatment fund under Minnesota Statutes, chapter 254B, medical assistance under Minnesota Statutes, chapter 256B, MinnesotaCare or health care cost containment under Minnesota Statutes, chapter 256L, or general assistance medical care under Minnesota Statutes, chapter 256D.
Subp. 4.
Applicability of chapter 2960.
Beginning July 1, 2005, residential adolescent chemical dependency treatment programs must be licensed according to chapter 2960.
9530.6415 LICENSING REQUIREMENTS.
Subpart 1.
General application and license requirements.
An applicant for a license to provide treatment must comply with the general requirements in Minnesota Statutes, chapters 245A and 245C, and Minnesota Statutes, sections 626.556 and 626.557.
Subp. 2.
Contents of application.
Prior to issuance of a license, an applicant must submit, on forms provided by the commissioner, any documents the commissioner requires to demonstrate the following:
B.
compliance with applicable building, fire and safety codes, health rules, zoning ordinances, and other applicable rules and regulations or documentation that a waiver has been granted. The granting of a waiver does not constitute modification of any requirement of parts 9530.6405 to 9530.6505;
C.
completion of an assessment of need for a new or expanded program according to part 9530.6800; and
D.
insurance coverage, including bonding, sufficient to cover all client funds, property, and interests.
Subp. 3.
Changes in license terms.
A.
A license holder must notify the commissioner before one of the following occurs and the commissioner must determine the need for a new license:
B.
A license holder must notify the commissioner and must apply for a new license if there is a change in program ownership.
9530.6420 INITIAL SERVICES PLAN.
The license holder must complete an initial services plan during or immediately following the intake interview. The plan must address the client's immediate health and safety concerns, identify the issues to be addressed in the first treatment sessions, and make treatment suggestions for the client during the time between intake and completion of the treatment plan. The initial services plan must include a determination whether a client is a vulnerable adult as defined in Minnesota Statutes, section 626.5572, subdivision 21. All adult clients of a residential program are vulnerable adults. An individual abuse prevention plan, according to Minnesota Statutes, sections 245A.65, subdivision 2, paragraph (b), and 626.557, subdivision 14, paragraph (b), is required for all clients who meet the definition of "vulnerable adult."
9530.6422 COMPREHENSIVE ASSESSMENT.
Subpart 1.
Comprehensive assessment of substance use disorder.
A comprehensive assessment of the client's substance use disorder must be coordinated by an alcohol and drug counselor and completed within three calendar days after service initiation for a residential program or three sessions of the client's initiation to services for all other programs. The alcohol and drug counselor may rely on current information provided by a referring agency or other sources as a supplement when information is available. Information gathered more than 45 days before the date of admission is not current. If the comprehensive assessment cannot be completed in the time specified, the treatment plan must indicate how and when it will be completed. The assessment must include sufficient information to complete the assessment summary according to subpart 2 and part 9530.6425. The comprehensive assessment must include information about the client's problems that relate to chemical use and personal strengths that support recovery, including:
A.
age, sex, cultural background, sexual orientation, living situation, economic status, and level of education;
C.
previous attempts at treatment for chemical use or dependency, compulsive gambling, or mental illness;
D.
chemical use history including amounts and types of chemicals used, frequency and duration of use, periods of abstinence, and circumstances of relapse, if any. For each chemical used within the previous 30 days, the information must include the date and time of the most recent use and any previous experience with withdrawal;
F.
current family status, family history, including history or presence of physical or sexual abuse, level of family support, and chemical use, abuse, or dependency among family members and significant others;
G.
physical concerns or diagnoses, the severity of the concerns, and whether or not the concerns are being addressed by a health care professional;
H.
mental health history and current psychiatric status, including symptoms, disability, current treatment supports, and psychotropic medication needed to maintain stability;
L.
risk-taking behavior, including behavior that puts the client at risk of exposure to blood borne or sexually transmitted diseases;
M.
social network in relation to expected support for recovery and leisure time activities that have been associated with chemical use;
N.
whether the client is pregnant and if so, the health of the unborn child and current involvement in prenatal care; and
O.
whether the client recognizes problems related to substance use and is willing to follow treatment recommendations.
Subp. 2.
Assessment summary.
An alcohol and drug counselor must prepare an assessment summary within three calendar days for a residential program or within three treatment sessions of service initiation. The narrative summary of the comprehensive assessment results must meet the requirements of items A and B:
A.
An assessment summary must be prepared by an alcohol and drug counselor and include:
(3)
a determination of whether the client meets the DSM criteria for a person with a substance use disorder.
B.
Contain information relevant to treatment planning and recorded in the dimensions in subitems (1) to (6):
(1)
Dimension 1, acute intoxication/withdrawal potential. The license holder must consider the client's ability to cope with withdrawal symptoms and current state of intoxication.
(2)
Dimension 2, biomedical conditions and complications. The license holder must consider the degree to which any physical disorder would interfere with treatment for substance abuse, and the client's ability to tolerate any related discomfort. The license holder must determine the impact of continued chemical use on the unborn child if the client is pregnant.
(3)
Dimension 3, emotional, behavioral, and cognitive conditions and complications. The license holder must determine the degree to which any condition or complications are likely to interfere with treatment for substance abuse or with functioning in significant life areas and the likelihood of risk of harm to self or others.
(4)
Dimension 4, readiness for change. The license holder must also consider the amount of support and encouragement necessary to keep the client involved in treatment.
(5)
Dimension 5, relapse, continued use, and continued problem potential. The license holder must consider the degree to which the client recognizes relapse issues and has the skills to prevent relapse of either substance use or mental health problems.
(6)
Dimension 6, recovery environment. The license holder must consider the degree to which key areas of the client's life are supportive of or antagonistic to treatment participation and recovery.
9530.6425 INDIVIDUAL TREATMENT PLANS.
Subpart 1.
General.
Individual treatment plans for clients in treatment must be completed within seven calendar days of completion of the assessment summary. Treatment plans must continually be updated, based on new information gathered about the client's condition and on whether planned treatment interventions have had the intended effect. Treatment planning must include ongoing assessment in each of the six dimensions according to part 9530.6422, subpart 2. The plan must provide for the involvement of the client's family and those people selected by the client as being important to the success of the treatment experience at the earliest opportunity, consistent with the client's treatment needs and written consent. The plan must be developed after completion of the comprehensive assessment and is subject to amendment until services to the client are terminated. The client must have an opportunity to have active, direct involvement in selecting the anticipated outcomes of the treatment process and in developing the individual treatment plan. The individual treatment plan must be signed by the client and the alcohol and drug counselor. The individual treatment plan may be a continuation of the initial services plan required in part 9530.6420.
Subp. 2.
Plan contents.
An individual treatment plan must be recorded in the six dimensions listed in part 9530.6422, subpart 2, item B, and address each problem identified in the assessment summary, and include:
A.
specific methods to be used to address identified problems, including amount, frequency, and anticipated duration of treatment service. The methods must be appropriate to the client's language, reading skills, cultural background, and strengths;
B.
resources to which the client is being referred for problems when problems are to be addressed concurrently by another provider; and
Subp. 3.
Progress notes and plan review.
A.
Progress notes must be entered in a client's file weekly or after each treatment service, whichever is less frequent, by the staff person providing the service. The note must reference the treatment plan. Progress notes must be recorded and address each of the six dimensions listed in part 9530.6422, subpart 2, item B. Progress notes must:
(1)
be entered immediately following any significant event. Significant events include those events which have an impact on the client's relationship with other clients, staff, the client's family, or the client's treatment plan;
(3)
include monitoring of any physical and mental health problems and the participation of others in the treatment plan;
(5)
document that the client has been notified of each treatment plan change and that the client either does or does not agree with the change.
B.
Treatment plan review must:
(3)
address whether the strategies to address the goals are effective, and if not, must include changes to the treatment plan; and
C.
All entries in a client's record must be legible, signed, and dated. Late entries must be clearly labeled "late entry." Corrections to an entry must be made in a way in which the original entry can still be read.
Subp. 3a.
Documentation.
Progress notes and plan review do not require separate documentation if the information in the client file meets the requirements of subpart 3, items A and B.
Subp. 4.
Summary at termination of services.
An alcohol and drug counselor must write a discharge summary for each client. The summary must be completed within five days of the client's service termination or within five days from the client's or program's decision to terminate services, whichever is earlier.
A.
The summary at termination of services must be recorded in the six dimensions listed in part 9530.6422, subpart 2, item B, and include the following information:
(1)
client's problems, strengths, and needs while participating in treatment, including services provided;
(2)
client's progress toward achieving each of the goals identified in the individual treatment plan;
9530.6430 TREATMENT SERVICES.
Subpart 1.
Treatment services offered by license holder.
A.
A license holder must offer the following treatment services unless clinically inappropriate and the justifying clinical rationale is documented:
(1)
individual and group counseling to help the client identify and address problems related to chemical use and develop strategies to avoid inappropriate chemical use after discharge;
(2)
client education strategies to avoid inappropriate chemical use and health problems related to chemical use and the necessary changes in lifestyle to regain and maintain health. Client education must include information concerning the human immunodeficiency virus, according to Minnesota Statutes, section 245A.19, other sexually transmitted diseases, drug and alcohol use during pregnancy, hepatitis, and tuberculosis;
(3)
transition services to help the client integrate gains made during treatment into daily living and to reduce reliance on the license holder's staff for support;
(4)
services to address issues related to co-occurring mental illness, including education for clients on basic symptoms of mental illness, the possibility of comorbidity, and the need for continued medication compliance while working on recovery from substance use disorder. Groups must address co-occurring mental illness issues, as needed. When treatment for mental health problems is indicated, it is integrated into the client's treatment plan; and
(5)
service coordination to help the client obtain the services and to support the client's need to establish a lifestyle free of the harmful effects of substance use disorder.
B.
Treatment services provided to individual clients must be provided according to the individual treatment plan and must address cultural differences and special needs of all clients.
Subp. 2.
Additional treatment services.
A license holder may provide or arrange the following additional treatment services as a part of the individual treatment plan:
A.
relationship counseling provided by a qualified professional to help the client identify the impact of the client's substance use disorder on others and to help the client and persons in the client's support structure identify and change behaviors that contribute to the client's substance use disorder;
B.
therapeutic recreation to provide the client with an opportunity to participate in recreational activities without the use of mood-altering chemicals and to learn to plan and select leisure activities that do not involve the inappropriate use of chemicals;
C.
stress management and physical well-being to help the client reach and maintain an acceptable level of health, physical fitness, and well-being;
D.
living skills development to help the client learn basic skills necessary for independent living;
F.
socialization skills development to help the client live and interact with others in a positive and productive manner; and
G.
room, board, and supervision provided at the treatment site to give the client a safe and appropriate environment in which to gain and practice new skills.
Subp. 3.
Counselors to provide treatment services.
Treatment services, including therapeutic recreation, must be provided by alcohol and drug counselors qualified according to part 9530.6450, unless the individual providing the service is specifically qualified according to the accepted standards of that profession. Therapeutic recreation does not include planned leisure activities.
Subp. 4.
Location of service provision.
A client of a license holder may only receive services at any of the license holder's licensed locations or at the client's home, except that services under subpart 1, item A, subitems (3) and (5), and subpart 2, items B and E, may be provided in another suitable location.
9530.6435 MEDICAL SERVICES.
Subpart 1.
Health care services description.
An applicant or license holder must maintain a complete description of the health care services, nursing services, dietary services, and emergency physician services offered by the license holder.
Subp. 1a.
Procedures.
The applicant or license holder must have written procedures for obtaining medical interventions when needed for a client, that are approved in writing by a physician who is licensed under Minnesota Statutes, chapter 147, unless:
B.
all medical interventions are referred to 911, the emergency telephone number, or the client's physician.
Subp. 2.
Consultation services.
The license holder must have access to and document the availability of a licensed mental health professional to provide diagnostic assessment and treatment planning assistance.
Subp. 3.
Administration of medications and assistance with self-medication.
A license holder must meet the requirements in items A and B if services include medication administration.
A.
A staff member, other than a licensed practitioner or nurse, who is delegated by a licensed practitioner or a registered nurse the task of administration of medication or assistance with self-medication must:
(1)
document that the staff member has successfully completed a medication administration training program for unlicensed personnel through an accredited Minnesota postsecondary educational institution. Completion of the course must be documented in writing and placed in the staff member's personnel file; or
(2)
be trained according to a formalized training program which is taught by a registered nurse and offered by the license holder. Completion of the course must be documented in writing and placed in the staff member's personnel records; or
B.
A registered nurse must be employed or contracted to develop the policies and procedures for medication administration or assistance with self-administration of medication or both. A registered nurse must provide supervision as defined in part 6321.0100. The registered nurse supervision must include monthly on-site supervision or more often as warranted by client health needs. The policies and procedures must include:
(1)
a provision that delegations of administration of medication are limited to administration of those medications which are oral, suppository, eye drops, ear drops, inhalant, or topical;
(2)
a provision that each client's file must include documentation indicating whether staff will be administering medication or the client will be doing self-administration or a combination of both;
(3)
a provision that clients may carry emergency medication such as nitroglycerin as instructed by their physician;
(4)
a provision for medication to be self-administered when a client is scheduled not to be at the facility;
(5)
a provision that if medication is to be self-administered at a time when the client is present in the facility, medication will be self-administered under observation of a trained staff person;
(6)
a provision that when a license holder serves clients who are parents with children, the parent may only administer medication to the child under staff supervision;
(7)
requirements for recording the client's use of medication, including staff signatures with date and time;
(8)
guidelines for when to inform a registered nurse of problems with self-administration, including failure to administer, client refusal of a medication, adverse reactions, or errors; and
(9)
procedures for acceptance, documentation, and implementation of prescriptions, whether written, verbal, telephonic, or electronic.
Subp. 4.
Control of drugs.
A license holder must have in place and implement written policies and procedures developed by a registered nurse that contains the following provisions:
A.
a requirement that all drugs must be stored in a locked compartment. Schedule II drugs, as defined by Minnesota Statutes, section 152.02, must be stored in a separately locked compartment, permanently affixed to the physical plant or medication cart;
C.
a procedure for recording the client's use of medication, including the signature of the administrator of the medication with the time and date;
E.
a statement that only authorized personnel are permitted to have access to the keys to the locked drug compartments; and
9530.6440 CLIENT RECORDS.
Subpart 1.
Client records required.
A license holder must maintain a file of current client records on the premises where the treatment services are provided or coordinated. The content and format of client records must be uniform and entries in each case must be signed and dated by the staff member making the entry. Client records must be protected against loss, tampering, or unauthorized disclosure in compliance with Minnesota Statutes, section 254A.09, Code of Federal Regulations, title 42, chapter 1, part 2, subpart B, sections 2.1 to 2.67, and Code of Federal Regulations, title 45, parts 160 to 164, and, if applicable, Minnesota Statutes, chapter 13.
Subp. 2.
Records retention.
Records of discharged clients must be retained by a license holder for seven years. License holders that cease to provide treatment services must retain client records for seven years from the date of facility closure and must notify the commissioner of the location of the records and the name of a person responsible for maintaining the records.
Subp. 3.
Client records, contents.
Client records must contain the following:
A.
documentation that the client was given information on client rights, responsibilities, grievance procedures, tuberculosis, and HIV, and that the client was provided an orientation to the program abuse prevention plan as required under Minnesota Statutes, section 245A.65, subdivision 2, paragraph (a), clause (4);
Subp. 4.
Electronic records.
A license holder who intends to use electronic record keeping or electronic signatures to comply with parts 9530.6405 to 9530.6505 must first obtain written permission from the commissioner. The commissioner must grant permission after the license holder provides documentation demonstrating the license holder's use of a system for ensuring security of electronic records. Use of electronic record keeping or electronic signatures does not alter the license holder's obligations under state or federal law, regulation, or rule.
9530.6445 STAFFING REQUIREMENTS.
Subp. 2.
Alcohol and drug counselor supervisor requirements.
A license holder must employ an alcohol and drug counselor supervisor who meets the requirements under part 9530.6450, subpart 4. An individual may be simultaneously employed as a treatment director, alcohol and drug counselor supervisor, and an alcohol and drug counselor if the individual meets the qualifications for each position. If an alcohol and drug counselor is simultaneously an alcohol and drug counselor supervisor or treatment director, that individual must be considered a 0.5 full-time equivalent alcohol and drug counselor for purposes of meeting the staffing requirements under subpart 4.
Subp. 3.
Responsible staff person.
A treatment director must designate a staff member who, when present in the facility, is responsible for the delivery of treatment services. A license holder must have a designated staff person during all hours of operation. A license holder providing room and board and treatment at the same site must have a responsible staff person on duty 24 hours a day. The designated staff person must know and understand the implications of parts 9530.6405 to 9530.6505 and Minnesota Statutes, sections 245A.65, 626.556, 626.557, and 626.5572.
Subp. 4.
Staffing requirements.
At least 25 percent of a counselor's scheduled work hours must be allocated to indirect services, including documentation of client services, coordination of services with others, treatment team meetings, and other duties. A counseling group shall not exceed an average of 16 clients during any 30 consecutive calendar days. It is the responsibility of the license holder to determine an acceptable group size based on the client's needs. A counselor in a program treating intravenous drug abusers must not supervise more than 50 clients. The license holder must maintain a record that documents compliance with this subpart.
Subp. 5.
Medical emergencies.
When clients are present, a license holder must have at least one staff person on the premises who has a current American Red Cross standard first aid certificate or an equivalent certificate and at least one staff person on the premises who has a current American Red Cross community, American Heart Association, or equivalent CPR certificate. A single staff person with both certifications satisfies this requirement.
9530.6450 STAFF QUALIFICATIONS.
Subpart 1.
Qualifications of all staff members with direct client contact.
All staff members who have direct client contact must be at least 18 years of age. At the time of hiring, all staff members must meet the qualifications in item A or B. A chemical use problem for purposes of this subpart is a problem listed by the license holder in the personnel policies and procedures according to part 9530.6460, subpart 1, item E.
A.
Treatment directors, supervisors, nurses, counselors, and other professionals must be free of chemical use problems for at least the two years immediately preceding their hiring and must sign a statement attesting to that fact.
B.
Paraprofessionals and all other staff members with direct client contact must be free of chemical use problems for at least one year immediately preceding their hiring and must sign a statement attesting to that fact.
Subp. 2.
Employment; prohibition on chemical use problems.
Staff members with direct client contact must be free from chemical use problems as a condition of employment, but are not required to sign additional statements. Staff members with direct client contact who are not free from chemical use problems must be removed from any responsibilities that include direct client contact for the time period specified in subpart 1. The time period begins to run on the date the employee begins receiving treatment services or the date of the last incident as described in the list developed according to part 9530.6460, subpart 1, item E.
Subp. 3.
Treatment director qualifications.
In addition to meeting the requirements of subpart 1, a treatment director must know and understand the implications of parts 9530.6405 to 9530.6505 and Minnesota Statutes, chapter 245A, and sections 626.556, 626.557, and 626.5572. A treatment director must:
A.
have at least one year of work experience in direct service to individuals with chemical use problems or one year of work experience in the management or administration of direct service to individuals with chemical use problems; and
B.
have a baccalaureate degree or three years of work experience in administration or personnel supervision in human services.
Subp. 4.
Alcohol and drug counselor supervisor qualifications.
In addition to meeting the requirements of subpart 1, an alcohol and drug counselor supervisor must meet the following qualifications:
B.
the individual has three or more years of experience providing individual and group counseling to chemically dependent clients except that, prior to January 1, 2005, an individual employed in a program formerly licensed under parts 9530.5000 to 9530.6400is required to have one or more years experience; and
Subp. 5.
Alcohol and drug counselor qualifications.
In addition to meeting the requirements of subpart 1, an alcohol and drug counselor must be either licensed or exempt from licensure under Minnesota Statutes, chapter 148C. An alcohol and drug counselor must document competence in screening for and working with clients with mental health problems, through education, training, and experience.
A.
Alcohol and drug counselors licensed under Minnesota Statutes, chapter 148C, must comply with rules adopted under Minnesota Statutes, chapter 148C.
B.
Counselors exempt under Minnesota Statutes, chapter 148C, must be competent, as evidenced by one of the following:
(1)
completion of at least a baccalaureate degree with a major or concentration in social work, nursing, sociology, human services, or psychology, or licensure as a registered nurse; successful completion of a minimum of 120 hours of classroom instruction in which each of the core functions listed in Minnesota Statutes, chapter 148C, is covered; and successful completion of 440 hours of supervised experience as an alcohol and drug counselor, either as a student or as a staff member;
(2)
completion of 270 hours of alcohol and drug counselor training in which each of the core functions listed in Minnesota Statutes, chapter 148C, is covered, and successful completion of 880 hours of supervised experience as an alcohol and drug counselor, either as a student, or as a staff member;
(3)
current certification as an alcohol and drug counselor or alcohol and drug counselor reciprocal, through the evaluation process established by the International Certification and Reciprocity Consortium Alcohol and Other Drug Abuse, Inc., and published in the Case Presentation Method Trainer's Manual, copyright 1993. The manual is incorporated by reference. It is available at the State Law Library, Judicial Center, 25 Reverend Dr. Martin Luther King Jr. Blvd., St. Paul, Minnesota 55155;
(4)
completion of a bachelor's degree including 480 hours of alcohol and drug counseling education from an accredited school or educational program and 880 hours of alcohol and drug counseling practicum; or
Subp. 6.
Paraprofessional qualifications and duties.
A paraprofessional must comply with subpart 1 and have knowledge of client rights, outlined in Minnesota Statutes, section 148F.165, and of staff responsibilities. A paraprofessional may not admit, transfer, or discharge clients but may be the person responsible for the delivery of treatment services as required in part 9530.6445, subpart 3.
Subp. 7.
Volunteers.
Volunteers may provide treatment services when they are supervised and can be seen or heard by a staff member meeting the criteria in subpart 4 or 5, but may not practice alcohol and drug counseling unless qualified under subpart 5.
Subp. 8.
Student interns.
A qualified staff person must supervise and be responsible for all treatment services performed by student interns and must review and sign all assessments, progress notes, and treatment plans prepared by the intern. Student interns must meet the requirements in subpart 1, item A, and receive the orientation and training required in part 9530.6460, subpart 1, item G, and subpart 2.
Subp. 9.
Individuals with temporary permit.
Individuals with a temporary permit from the Board of Behavioral Health and Therapy may provide chemical dependency treatment services under the conditions in either item A or B.
A.
The individual is supervised by a licensed alcohol and drug counselor assigned by the license holder. The licensed alcohol and drug counselor must document the amount and type of supervision at least weekly. The supervision must relate to clinical practices. One licensed alcohol and drug counselor may not supervise more than three individuals with temporary permits, according to Minnesota Statutes, section 148C.01, subdivision 12a.
9530.6455 PROVIDER POLICIES AND PROCEDURES.
License holders must develop a written policy and procedures manual indexed according to Minnesota Statutes, section 245A.04, subdivision 14, paragraph (c), so that staff may have immediate access to all policies and procedures and so that consumers of the services and other authorized parties may have access to all policies and procedures. The manual must contain the following materials:
A.
assessment and treatment planning policies, which include screening for mental health concerns, and the inclusion of treatment objectives related to identified mental health concerns in the client's treatment plan;
C.
the methods and resources used by the license holder to provide information on tuberculosis and tuberculosis screening to all clients and to report known cases of tuberculosis infection according to Minnesota Statutes, section 144.4804;
9530.6460 PERSONNEL POLICIES AND PROCEDURES.
Subpart 1.
Policy requirements.
License holders must have written personnel policies and must make them available to each staff member. The policies must:
A.
assure that staff member retention, promotion, job assignment, or pay are not affected by a good faith communication between a staff member and the Department of Health, the Department of Human Services, the ombudsman for mental health and developmental disabilities, law enforcement, or local agencies for the investigation of complaints regarding a client's rights, health, or safety;
B.
contain job descriptions for each position specifying responsibilities, degree of authority to execute job responsibilities, and qualifications;
C.
provide for job performance evaluations based on standards of job performance to be conducted on a regular and continuing basis, including a written annual review;
D.
describe behavior that constitutes grounds for disciplinary action, suspension or dismissal, including policies that address chemical use problems and meet the requirements of part 9530.6450, subpart 1, policies prohibiting personal involvement with clients in violation of Minnesota Statutes, chapter 604, and policies prohibiting client abuse as specified under Minnesota Statutes, sections 245A.65, 626.556, 626.557, and 626.5572;
E.
list behaviors or incidents that are considered chemical use problems. The list must include:
(1)
receiving treatment for chemical use within the period specified for the position in the staff qualification requirements;
(3)
chemical use that affects the credibility of treatment services with clients, referral sources, or other members of the community; and
F.
include a chart or description of the organizational structure indicating lines of authority and responsibilities;
G.
include orientation within 24 working hours of starting for all new staff based on a written plan that, at a minimum, must provide for training related to the specific job functions for which the staff member was hired, policies and procedures, client confidentiality, the human immunodeficiency virus minimum standards, and client needs; and
H.
policies outlining the license holder's response to staff members with behavior problems that interfere with the provision of treatment services.
Subp. 2.
Staff development.
A license holder must ensure that each staff person has the training required in items A to E.
A.
All staff must be trained every two years in client confidentiality rules and regulations and client ethical boundaries.
B.
All staff must be trained every two years in emergency procedures and client rights as specified in Minnesota Statutes, sections 144.651, 148F.165, and 253B.03.
C.
All staff with direct client contact must be trained every year on mandatory reporting as specified under Minnesota Statutes, sections 245A.65, 626.556, 626.5561, 626.5563, 626.557, and 626.5572, including specific training covering the facility's policies concerning obtaining client releases of information.
D.
All staff with direct client contact must receive training upon hiring and annually thereafter on the human immunodeficiency virus minimum standards according to Minnesota Statutes, section 245A.19.
E.
Treatment directors, supervisors, nurses, and counselors must obtain 12 hours of training in co-occurring mental health problems and substance use disorder that includes competencies related to philosophy, screening, assessment, diagnosis and treatment planning, documentation, programming, medication, collaboration, mental health consultation, and discharge planning. Staff employed by a license holder on the date this rule is adopted must obtain the training within 12 months of the date of adoption. New staff who have not obtained such training must obtain it within 12 months of the date this rule is adopted or within six months of hire, whichever is later. Staff may request, and the license holder may grant credit for, relevant training obtained prior to January 1, 2005.
Subp. 3.
Personnel files.
The license holder must maintain a separate personnel file for each staff member. At a minimum, the personnel file must be maintained to meet the requirements under parts 9530.6405 to 9530.6505 and contain the following:
A.
a completed application for employment signed by the staff member and containing the staff member's qualifications for employment;
B.
documentation related to the applicant's background study data, as defined in Minnesota Statutes, chapter 245C;
C.
for staff members who will be providing psychotherapy services, employer names and addresses for the past five years for which the staff member provided psychotherapy services, and documentation of an inquiry made to these former employers regarding substantiated sexual contact with a client as required by Minnesota Statutes, chapter 604;
9530.6465 SERVICE INITIATION AND TERMINATION POLICIES.
Subpart 1.
Service initiation policy.
A license holder must have a written service initiation policy containing service initiation preferences which comply with this rule and Code of Federal Regulations, title 45, part 96.131, and specific service initiation criteria. The license holder must not initiate services for individuals who do not meet the service initiation criteria. The service initiation criteria must be either posted in the area of the facility where services for clients are initiated, or given to all interested persons upon request. Titles of all staff members authorized to initiate services for clients must be listed in the services initiation and termination policies. A license holder that serves intravenous drug abusers must have a written policy that provides service initiation preference as required by Code of Federal Regulations, title 45, part 96.131.
Subp. 2.
License holder responsibilities; terminating or denying services.
A license holder has specific responsibilities when terminating services or denying treatment service initiation to clients for reasons of health, behavior, or criminal activity.
A.
The license holder must have and comply with a written protocol for assisting clients in need of care not provided by the license holder, and for clients who pose a substantial likelihood of harm to themselves or others, if the behavior is beyond the behavior management capabilities of the staff. All service terminations and denials of service initiation which pose an immediate threat to the health of any individual or require immediate medical intervention must be referred to a medical facility capable of admitting the individual.
B.
All service termination policies and denials of service initiation that involve the commission of a crime against a license holder's staff member or on a license holder's property, as provided under Code of Federal Regulations, title 42, section 2.12(c)(5), and Code of Federal Regulations, title 45, parts 160 to 164, must be reported to a law enforcement agency with proper jurisdiction.
Subp. 3.
Service termination and transfer policies.
A license holder must have a written policy specifying the conditions under which clients must be discharged. The policy must include:
B.
a description of client behavior that constitutes reason for a staff-requested service termination and a process for providing this information to clients;
C.
procedures consistent with Minnesota Statutes, section 253B.16, subdivision 2, that staff must follow when a client admitted under Minnesota Statutes, chapter 253B, is to have services terminated;
D.
procedures staff must follow when a client leaves against staff or medical advice and when the client may be dangerous to self or others;
E.
procedures for communicating staff-approved service termination criteria to clients, including the expectations in the client's individual treatment plan according to part 9530.6425; and
F.
titles of staff members authorized to terminate client services must be listed in the service initiation and termination policies.
9530.6470 POLICIES AND PROCEDURES THAT PROTECT CLIENT RIGHTS.
Subpart 1.
Client rights; explanation.
Clients have the rights identified in Minnesota Statutes, sections 144.651, 148F.165, and 253B.03, as applicable. The license holder must give each client upon service initiation a written statement of client's rights and responsibilities. Staff must review the statement with clients at that time.
Subp. 2.
Grievance procedure.
Upon service initiation, the license holder must explain the grievance procedure to the client or their representative. The grievance procedure must be posted in a place visible to clients, and made available upon a client's request. The grievance procedure must also be made available to former clients upon request. The grievance procedure must require that:
B.
telephone numbers and addresses of the Department of Human Services, licensing division; the Office of Ombudsman for Mental Health and Developmental Disabilities; the Minnesota Department of Health, Office of Alcohol and Drug Counselor Licensing Program, and Office of Health Facilities Complaints; when applicable, be made available to clients; and
C.
a license holder be obligated to respond to the client's grievance within three days of a staff member's receipt of the grievance, and the client be permitted to bring the grievance to the highest level of authority in the program if not resolved by other staff members.
Subp. 3.
Photographs of client.
All photographs, video tapes, and motion pictures of clients taken in the provision of treatment services are considered client records. Photographs for identification and recordings by video and audio tape for the purpose of enhancing either therapy or staff supervision may be required of clients, but may only be available for use as communications within a program. Clients must be informed when their actions are being recorded by camera or tape, and have the right to deny any taping or photography, except as authorized by this subpart.
9530.6475 BEHAVIORAL EMERGENCY PROCEDURES.
A.
A license holder or applicant must have written procedures that staff must follow when responding to a client who exhibits behavior that is threatening to the safety of the client or others. The procedures must include:
(2)
contact information for emergency resources that staff must consult when a client's behavior cannot be controlled by the procedures established in the plan;
B.
Behavioral emergency procedures must not be used to enforce facility rules or for the convenience of staff. Behavioral emergency procedures must not be part of any client's treatment plan, or used at any time for any reason except in response to specific current behaviors that threaten the safety of the client or others. Behavioral emergency procedures may not include the use of seclusion or restraint.
9530.6480 EVALUATION.
Subpart 1.
Participation in drug and alcohol abuse normative evaluation system.
License holders must participate in the drug and alcohol abuse normative evaluation system by submitting information about each client to the commissioner in a format specified by the commissioner.
Subp. 2.
Commissioner requests.
A license holder must submit additional information requested by the commissioner that is necessary to meet statutory or federal funding requirements.
9530.6485 LICENSE HOLDERS SERVING ADOLESCENTS.
Subpart 1.
License holders serving adolescents.
A residential treatment program that serves persons under 18 years of age must be licensed as a residential program for children in out-of-home placement by the department unless the license holder is exempt under Minnesota Statutes, section 245A.03, subdivision 2.
Subp. 2.
Alcohol and drug counselor qualifications.
In addition to the requirements specified in part 9530.6450, subparts 1 and 5, an alcohol and drug counselor providing treatment services to adolescents must have:
A.
an additional 30 hours of classroom instruction or one three-credit semester college course in adolescent development. This training need only be completed one time; and
B.
at least 150 hours of supervised experience as an adolescent counselor, either as a student or as a staff member.
Subp. 3.
Staffing ratios.
At least 25 percent of a counselor's scheduled work hours must be allocated to indirect services, including documentation of client services, coordination of services with others, treatment team meetings, and other duties. A counseling group consisting entirely of adolescents must not exceed 16 clients. It is the responsibility of the license holder to determine an acceptable group size based on the needs of the clients.
Subp. 4.
Academic program requirements.
Clients who are required to attend school must be enrolled and attending an educational program that has been approved by the Minnesota Department of Education.
9530.6490 LICENSE HOLDERS SERVING CLIENTS WITH CHILDREN.
Subpart 1.
Health license requirements.
In addition to the requirements of parts 9530.6405 to 9530.6480, all license holders that offer supervision of children of clients are subject to the requirements of this part. License holders providing room and board for clients and their children must have an appropriate facility license from the Minnesota Department of Health.
Subp. 2.
Supervision of children defined.
"Supervision of children" means a caregiver is within sight or hearing of an infant, toddler, or preschooler at all times so that the caregiver can intervene to protect the health and safety of the child. For the school age child it means a caregiver is available to help and care for the child so that the child's health and safety is protected.
Subp. 3.
Policy and schedule required.
License holders must meet the following requirements:
A.
license holders must have a policy and schedule delineating the times and circumstances under which the license holder is responsible for supervision of children in the program and when the child's parents are responsible for child supervision. The policy must explain how the program will communicate its policy about child supervision responsibility to the parents; and
B.
license holders must have written procedures addressing the actions to be taken by staff if children are neglected or abused including while the children are under the supervision of their parents.
Subp. 4.
Additional licensing requirements.
During the times the license holder is responsible for the supervision of children, the license holder must meet the following standards:
9530.6495 LICENSE HOLDERS SERVING PERSONS WITH SUBSTANCE USE AND MENTAL HEALTH DISORDERS.
In addition to meeting the requirements of parts 9530.6405 to 9530.6490, license holders specializing in the treatment of persons with substance use disorder and mental health problems must:
A.
demonstrate that staffing levels are appropriate for treating clients with substance use disorder and mental health problems, and that there is adequate staff with mental health training;
B.
have continuing access to a medical provider with appropriate expertise in prescribing psychotropic medications;
D.
determine group size, structure, and content with consideration for the special needs of those with substance use disorder and mental health disorders;
E.
have documentation of active interventions to stabilize mental health symptoms present in treatment plans and progress notes;
F.
have continuing documentation of collaboration with continuing care mental health providers, and involvement of those providers in treatment planning meetings;
H.
have policies that provide flexibility for clients who may lapse in treatment or may have difficulty adhering to established treatment rules as a result of a mental illness, with the goal of helping clients successfully complete treatment; and
9530.6500 PROGRAMS SERVING INTRAVENOUS DRUG ABUSERS.
Subpart 1.
Additional requirements.
In addition to the requirements of parts 9530.6405 to 9530.6505, programs serving intravenous drug abusers must comply with the requirements of this part.
Subp. 2.
Capacity management and waiting list system compliance.
A program serving intravenous drug abusers must notify the department within seven days of when the program reaches both 90 and 100 percent of the program's capacity to care for clients. Each week, the program must report its capacity, current enrolled dosing clients, and any waiting list. A program reporting 90 percent of capacity must also notify the department when its census has increased or decreased from the 90 percent level.
Subp. 3.
Waiting list.
A program serving intravenous drug abusers must have a waiting list system. Each person seeking admission must be placed on the waiting list if the person cannot be admitted within 14 days of the date of application, unless the applicant is assessed by the program and found not to be eligible for admission according to parts 9530.6405 to 9530.6505, and Code of Federal Regulations, title 42, part 1, subchapter A, section 8.12(e), and Code of Federal Regulations, title 45, parts 160 to 164. The waiting list must assign a unique patient identifier for each intravenous drug abuser seeking treatment while awaiting admission. An applicant on a waiting list who receives no services under part 9530.6430, subpart 1, must not be considered a "client" as defined in part 9530.6405, subpart 8.
Subp. 4.
Client referral.
Programs serving intravenous drug abusers must consult the capacity management system so that persons on waiting lists are admitted at the earliest time to a program providing appropriate treatment within a reasonable geographic area. If the patient has been referred through a public payment system and if the program is not able to serve the client within 14 days of the date of application for admission, the program must contact and inform the referring agency of any available treatment capacity listed in the state capacity management system.
Subp. 5.
Outreach.
Programs serving intravenous drug abusers must carry out activities to encourage individuals in need of treatment to undergo treatment. The program's outreach model must:
B.
contact, communicate, and follow up with high risk substance abusers, their associates, and neighborhood residents within the constraints of federal and state confidentiality requirements, including Code of Federal Regulations, title 42, sections 2.1 to 2.67, and Code of Federal Regulations, title 45, parts 160 to 164;
C.
promote awareness among injecting drug abusers about the relationship between injecting drug abuse and communicable diseases such as HIV; and
Subp. 6.
Central registry.
Programs serving intravenous drug abusers must comply with requirements to submit information and necessary consents to the state central registry for each client admitted, as specified by the commissioner. The client's failure to provide the information will prohibit involvement in an opiate treatment program. The information submitted must include the client's:
G.
driver's license number, if any.
The information in items A to G must be submitted in a format prescribed by the commissioner, with the original kept in the client's chart, whenever a client is accepted for treatment, the client's type or dosage of a drug is changed, or the client's treatment is interrupted, resumed, or terminated.
9530.6505 REQUIREMENTS FOR LICENSED RESIDENTIAL TREATMENT.
Subpart 1.
Applicability.
A license holder who provides supervised room and board at the licensed program site as a treatment component is defined as a residential program according to Minnesota Statutes, section 245A.02, subdivision 14, and is subject to this part.
Subp. 2.
Visitors.
Clients must be allowed to receive visitors at times prescribed by the license holder. The license holder must set and post a notice of visiting rules and hours, including both day and evening times. A client's right to receive visitors other than a personal physician, religious advisor, county case manager, parole or probation officer, or attorney may be subject to visiting hours established by the license holder for all clients. The treatment director or designee may impose limitations as necessary for the welfare of a client provided that limitations and the reasons for them are documented in the client's file. Clients must be allowed to receive visits at all reasonable times from their personal physicians, religious advisors, county case managers, parole or probation officers, and attorneys.
Subp. 3.
Client property management.
A license holder who provides room and board and treatment services to clients in the same facility, and any license holder that accepts client property must meet the requirements in Minnesota Statutes, section 245A.04, subdivision 13, for handling resident funds and property. In the course of client property management, license holders:
A.
may establish policies regarding the use of personal property to assure that treatment activities and the rights of other patients are not infringed;
C.
must retain the client's property for a minimum of seven days after discharge if the client does not reclaim property upon service termination, or for a minimum of 30 days if the client does not reclaim property upon service termination and has received room and board services from the license holder; and
D.
must return all property held in trust to the client upon service termination regardless of the client's service termination status, except:
(1)
drugs, drug paraphernalia, and drug containers that are forfeited under Minnesota Statutes, section 609.5316, must be destroyed by staff or given over to the custody of a local law enforcement agency, according to Code of Federal Regulations, title 42, chapter 1, part 2, subpart B, sections 2.1 to 2.67, and Code of Federal Regulations, title 45, parts 160 to 164;
(2)
weapons, explosives, and other property which can cause serious harm to self or others must be given over to the custody of a local law enforcement agency, and the client must be notified of the transfer and of the right to reclaim any lawful property transferred; and
(3)
medications that have been determined by a physician to be harmful after examining the client, except when the client's personal physician approves the medication for continued use.
Subp. 4.
Health facility license.
A license holder who provides room and board and treatment services in the same facility must have the appropriate license from the Department of Health.
Subp. 5.
Facility abuse prevention plan.
A license holder must establish and enforce an ongoing facility abuse prevention plan consistent with Minnesota Statutes, sections 245A.65 and 626.557, subdivision 14.
Subp. 6.
Individual abuse prevention plan.
A license holder must prepare an individual abuse prevention plan for each client as specified under Minnesota Statutes, sections 245A.65, subdivision 2, and 626.557, subdivision 14.
Subp. 7.
Health services.
License holders must have written procedures for assessing and monitoring client health, including a standardized data collection tool for collecting health-related information about each client. The policies and procedures must be approved and signed by a registered nurse.