SF 2934

1st Unofficial Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/21/2023 12:44pm

A bill for an act
relating to state government; modifying provisions governing disability services,
aging services, behavioral health, opioid overdose prevention and opiate epidemic
response, the opioid prescribing improvement program, the Department of Direct
Care and Treatment, human services licensing, and self-directed worker contract
ratification; requiring reports; appropriating money; amending Minnesota Statutes
2022, sections 4.046, subdivisions 6, 7; 15.01; 15.06, subdivision 1; 16A.151,
subdivision 2; 43A.08, subdivision 1a; 151.065, subdivision 7; 177.24, by adding
a subdivision; 179A.54, by adding a subdivision; 241.021, subdivision 1; 241.31,
subdivision 5; 241.415; 245.91, subdivision 4; 245A.03, subdivision 7; 245A.04,
subdivision 7; 245A.07, by adding subdivisions; 245A.10, subdivisions 3, 6, by
adding a subdivision; 245A.11, subdivisions 7, 7a; 245A.13, subdivisions 1, 2, 3,
6, 7, 9; 245D.03, subdivision 1; 245G.01, by adding subdivisions; 245G.02,
subdivision 2; 245G.05, subdivision 1, by adding a subdivision; 245G.06,
subdivisions 1, 3, 4, by adding subdivisions; 245G.08, subdivision 3; 245G.09,
subdivision 3; 245G.22, subdivision 15; 245I.10, subdivision 6; 252.44; 253B.10,
subdivision 1; 254B.01, by adding subdivisions; 254B.04, by adding a subdivision;
254B.05, subdivision 5; 256.042, subdivisions 2, 4; 256.043, subdivisions 3, 3a;
256.482, by adding a subdivision; 256.975, subdivision 6; 256.9754; 256B.056,
subdivision 3; 256B.057, subdivision 9; 256B.0638, subdivisions 1, 2, 4, 5, by
adding a subdivision; 256B.0659, subdivisions 1, 12, 19, 24, by adding a
subdivision; 256B.0759, subdivision 2; 256B.0911, subdivision 13; 256B.0917,
subdivision 1b; 256B.092, subdivision 1a; 256B.0949, subdivision 15; 256B.49,
subdivision 13; 256B.4905, subdivision 4a; 256B.4914, subdivisions 3, 5, 5a, 5b,
6, 10a, 14, by adding subdivisions; 256B.5012, by adding a subdivision; 256B.851,
subdivisions 3, 5, 6; 256D.425, subdivision 1; 256M.42; 256R.17, subdivision 2;
256R.25; 256R.47; 256S.211; 256S.214; 256S.215, subdivision 15; 268.19,
subdivision 1; Laws 2019, chapter 63, article 3, section 1, as amended; Laws 2021,
chapter 30, article 12, section 5, as amended; Laws 2021, First Special Session
chapter 7, article 16, section 28, as amended; article 17, sections 8; 16; proposing
coding for new law in Minnesota Statutes, chapters 121A; 245D; 252; 254B; 256;
256B; 256I; proposing coding for new law as Minnesota Statutes, chapter 246C;
repealing Minnesota Statutes 2022, sections 245G.06, subdivision 2; 246.18,
subdivisions 2, 2a; 256B.0759, subdivision 6; 256B.0917, subdivisions 1a, 6, 7a,
13; 256B.4914, subdivision 6b; 256S.2101, subdivisions 1, 2.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

ARTICLE 1

DISABILITY SERVICES

Section 1.

Minnesota Statutes 2022, section 177.24, is amended by adding a subdivision
to read:

Subd. 6.

Special certificate prohibition.

(a) On or after August 1, 2026, employers
must not hire any new employee with a disability at a wage that is less than the highest
applicable minimum wage, regardless of whether the employer holds a special certificate
from the United States Department of Labor under section 14(c) of the federal Fair Labor
Standards Act.

(b) On or after August 1, 2028, an employer must not pay an employee with a disability
less than the highest applicable minimum wage, regardless of whether the employer holds
a special certificate from the United States Department of Labor under section 14(c) of the
federal Fair Labor Standards Act.

Sec. 2.

Minnesota Statutes 2022, section 179A.54, is amended by adding a subdivision to
read:

Subd. 11.

Home Care Orientation Trust.

(a) The state and an exclusive representative
certified pursuant to this section may establish a joint labor and management trust, referred
to as the Home Care Orientation Trust, for the exclusive purpose of rendering voluntary
orientation training to individual providers of direct support services who are represented
by the exclusive representative.

(b) Financial contributions made by the state to the Home Care Orientation Trust shall
be made pursuant to a collective bargaining agreement negotiated under this section. All
such financial contributions made by the state shall be held in trust for the purpose of paying
from principle, from interest, or from both, the costs associated with developing, delivering,
and promoting voluntary orientation training for individual providers of direct support
services working under a collective bargaining agreement and providing services through
a covered program under section 256B.0711. The Home Care Orientation Trust shall be
administered, managed, and otherwise controlled jointly by a board of trustees composed
of an equal number of trustees appointed by the state and trustees appointed by the exclusive
representative under this section. The trust shall not be an agent of either the state or the
exclusive representative.

(c) Trust administrative, management, legal, and financial services may be provided by
the board of trustees by a third-party administrator, financial management institution, or
other appropriate entity, as designated by the board of trustees from time to time, and those
services shall be paid from the money held in trust and created by the state's financial
contributions to the Home Care Orientation Trust.

(d) The state is authorized to purchase liability insurance for members of the board of
trustees appointed by the state.

(e) Financial contributions to, and participation in, the administration and management
of the Home Care Orientation Trust shall not be considered an unfair labor practice under
section 179A.13, or a violation of Minnesota law.

Sec. 3.

Minnesota Statutes 2022, 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 family child foster care home or family adult foster care home
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. When approving an exception under this paragraph, the commissioner shall consider
the resource need determination process in paragraph (h), the availability of foster care
licensed beds in the geographic area in which the licensee seeks to operate, the results of a
person's choices during their annual assessment and service plan review, and the
recommendation of the local county board. The determination by the commissioner is final
and not subject to appeal. Exceptions to the moratorium include:

(1) foster care settings where at least 80 percent of the residents are 55 years of age or
older;

(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 for people receiving
customized living or 24-hour customized living services under the brain injury or community
access for disability inclusion waiver plans under section 256B.49 or elderly waiver plan
under chapter 256S and residing in the customized living setting before July 1, 2022, for
which a license is required. A customized living service provider subject to this exception
may rebut the presumption that a license is required by seeking a reconsideration of the
commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until June 30 December 31, 2023. This exception is available when:

(i) the person's customized living services are provided in a customized living service
setting serving four or fewer people under the brain injury or community access for disability
inclusion waiver plans under section 256B.49 in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;

(ii) 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

(iii) 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 customized
living setting as determined by the lead agency.

(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 may decrease
the statewide licensed capacity for adult foster care settings.

(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
data required by section 144A.351, and other data and information shall be used to determine
where the reduced capacity determined under section 256B.493 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 the informed decisions of those
people who want to move out of corporate foster care or community residential settings,
long-term 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
services and supports reports and statewide data and information.

(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 chapter 256S or section 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.

(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493.

(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.

(j) 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. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 4.

Minnesota Statutes 2022, section 245A.10, subdivision 3, is amended to read:

Subd. 3.

Application fee for initial license or certification.

(a) For fees required under
subdivision 1, an applicant for an initial license or certification issued by the commissioner
shall submit a $500 application fee with each new application required under this subdivision.
An applicant for an initial day services facility license under chapter 245D shall submit a
$250 application fee with each new application. The application fee shall not be prorated,
is nonrefundable, and is in lieu of the annual license or certification fee that expires on
December 31. The commissioner shall not process an application until the application fee
is paid.

(b) Except as provided in clauses (1) to (3), an applicant shall apply for a license to
provide services at a specific location.

(1) For a license to provide home and community-based services to persons with
disabilities or age 65 and older under chapter 245D, an applicant shall submit an application
to provide services statewide. Notwithstanding paragraph (a), applications received by the
commissioner between July 1, 2013, and December 31, 2013, for licensure of services
provided under chapter 245D must include an application fee that is equal to the annual
license renewal fee under subdivision 4, paragraph (b), or $500, whichever is less.
Applications received by the commissioner after January 1, 2014, must include the application
fee required under paragraph (a). Applicants who meet the modified application criteria
identified in section 245A.042, subdivision 2, are exempt from paying an application fee.

(2) For a license to provide independent living assistance for youth under section 245A.22,
an applicant shall submit a single application to provide services statewide.

(3) For a license for a private agency to provide foster care or adoption services under
Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single application
to provide services statewide.

(c) The initial application fee charged under this subdivision does not include the
temporary license surcharge under section 16E.22.

Sec. 5.

Minnesota Statutes 2022, section 245A.11, subdivision 7, is amended to read:

Subd. 7.

Adult foster care; variance for alternate overnight supervision.

(a) The
commissioner may grant a variance under section 245A.04, subdivision 9, to rule parts
requiring a caregiver to be present in an adult foster care home during normal sleeping hours
to allow for alternative methods of overnight supervision. The commissioner may grant the
variance if the local county licensing agency recommends the variance and the county
recommendation includes documentation verifying that:

(1) the county has approved the license holder's plan for alternative methods of providing
overnight supervision and determined the plan protects the residents' health, safety, and
rights;

(2) the license holder has obtained written and signed informed consent from each
resident or each resident's legal representative documenting the resident's or legal
representative's agreement with the alternative method of overnight supervision; and

(3) the alternative method of providing overnight supervision, which may include the
use of technology, is specified for each resident in the resident's: (i) individualized plan of
care; (ii) individual service plan under section 256B.092, subdivision 1b, if required; or (iii)
individual resident placement agreement under Minnesota Rules, part 9555.5105, subpart
19, if required.

(b) To be eligible for a variance under paragraph (a), the adult foster care license holder
must not have had a conditional license issued under section 245A.06, or any other licensing
sanction issued under section 245A.07 during the prior 24 months based on failure to provide
adequate supervision, health care services, or resident safety in the adult foster care home.

(c) A license holder requesting a variance under this subdivision to utilize technology
as a component of a plan for alternative overnight supervision may request the commissioner's
review in the absence of a county recommendation. Upon receipt of such a request from a
license holder, the commissioner shall review the variance request with the county.

(d) A variance granted by the commissioner according to this subdivision before January
1, 2014, to a license holder for an adult foster care home must transfer with the license when
the license converts to a community residential setting license under chapter 245D. The
terms and conditions of the variance remain in effect as approved at the time the variance
was granted The variance requirements under this subdivision for alternative overnight
supervision do not apply to community residential settings licensed under chapter 245D.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 6.

Minnesota Statutes 2022, section 245A.11, subdivision 7a, is amended to read:

Subd. 7a.

Alternate overnight supervision technology; adult foster care and
community residential setting licenses.

(a) The commissioner may grant an applicant or
license holder an adult foster care or community residential setting license for a residence
that does not have a caregiver in the residence during normal sleeping hours as required
under Minnesota Rules, part 9555.5105, subpart 37, item B, or section 245D.02, subdivision
33b, but uses monitoring technology to alert the license holder when an incident occurs that
may jeopardize the health, safety, or rights of a foster care recipient. The applicant or license
holder must comply with all other requirements under Minnesota Rules, parts 9555.5105
to 9555.6265, or applicable requirements under chapter 245D, and the requirements under
this subdivision. The license printed by the commissioner must state in bold and large font:

(1) that the facility is under electronic monitoring; and

(2) the telephone number of the county's common entry point for making reports of
suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.

(b) Applications for a license under this section must be submitted directly to the
Department of Human Services licensing division. The licensing division must immediately
notify the county licensing agency. The licensing division must collaborate with the county
licensing agency in the review of the application and the licensing of the program.

(c) Before a license is issued by the commissioner, and for the duration of the license,
the applicant or license holder must establish, maintain, and document the implementation
of written policies and procedures addressing the requirements in paragraphs (d) through
(f).

(d) The applicant or license holder must have policies and procedures that:

(1) establish characteristics of target populations that will be admitted into the home,
and characteristics of populations that will not be accepted into the home;

(2) explain the discharge process when a resident served by the program requires
overnight supervision or other services that cannot be provided by the license holder due
to the limited hours that the license holder is on site;

(3) describe the types of events to which the program will respond with a physical
presence when those events occur in the home during time when staff are not on site, and
how the license holder's response plan meets the requirements in paragraph (e), clause (1)
or (2);

(4) establish a process for documenting a review of the implementation and effectiveness
of the response protocol for the response required under paragraph (e), clause (1) or (2).
The documentation must include:

(i) a description of the triggering incident;

(ii) the date and time of the triggering incident;

(iii) the time of the response or responses under paragraph (e), clause (1) or (2);

(iv) whether the response met the resident's needs;

(v) whether the existing policies and response protocols were followed; and

(vi) whether the existing policies and protocols are adequate or need modification.

When no physical presence response is completed for a three-month period, the license
holder's written policies and procedures must require a physical presence response drill to
be conducted for which the effectiveness of the response protocol under paragraph (e),
clause (1) or (2), will be reviewed and documented as required under this clause; and

(5) establish that emergency and nonemergency phone numbers are posted in a prominent
location in a common area of the home where they can be easily observed by a person
responding to an incident who is not otherwise affiliated with the home.

(e) The license holder must document and include in the license application which
response alternative under clause (1) or (2) is in place for responding to situations that
present a serious risk to the health, safety, or rights of residents served by the program:

(1) response alternative (1) requires only the technology to provide an electronic
notification or alert to the license holder that an event is underway that requires a response.
Under this alternative, no more than ten minutes will pass before the license holder will be
physically present on site to respond to the situation; or

(2) response alternative (2) requires the electronic notification and alert system under
alternative (1), but more than ten minutes may pass before the license holder is present on
site to respond to the situation. Under alternative (2), all of the following conditions are
met:

(i) the license holder has a written description of the interactive technological applications
that will assist the license holder in communicating with and assessing the needs related to
the care, health, and safety of the foster care recipients. This interactive technology must
permit the license holder to remotely assess the well being of the resident served by the
program without requiring the initiation of the foster care recipient. Requiring the foster
care recipient to initiate a telephone call does not meet this requirement;

(ii) the license holder documents how the remote license holder is qualified and capable
of meeting the needs of the foster care recipients and assessing foster care recipients' needs
under item (i) during the absence of the license holder on site;

(iii) the license holder maintains written procedures to dispatch emergency response
personnel to the site in the event of an identified emergency; and

(iv) each resident's individualized plan of care, support plan under sections 256B.0913,
subdivision 8; 256B.092, subdivision 1b; 256B.49, subdivision 15; and 256S.10, if required,
or individual resident placement agreement under Minnesota Rules, part 9555.5105, subpart
19, if required, identifies the maximum response time, which may be greater than ten minutes,
for the license holder to be on site for that resident.

(f) Each resident's placement agreement, individual service agreement, and plan must
clearly state that the adult foster care or community residential setting license category is
a program without the presence of a caregiver in the residence during normal sleeping hours;
the protocols in place for responding to situations that present a serious risk to the health,
safety, or rights of residents served by the program under paragraph (e), clause (1) or (2);
and a signed informed consent from each resident served by the program or the person's
legal representative documenting the person's or legal representative's agreement with
placement in the program. If electronic monitoring technology is used in the home, the
informed consent form must also explain the following:

(1) how any electronic monitoring is incorporated into the alternative supervision system;

(2) the backup system for any electronic monitoring in times of electrical outages or
other equipment malfunctions;

(3) how the caregivers or direct support staff are trained on the use of the technology;

(4) the event types and license holder response times established under paragraph (e);

(5) how the license holder protects each resident's privacy related to electronic monitoring
and related to any electronically recorded data generated by the monitoring system. A
resident served by the program may not be removed from a program under this subdivision
for failure to consent to electronic monitoring. The consent form must explain where and
how the electronically recorded data is stored, with whom it will be shared, and how long
it is retained; and

(6) the risks and benefits of the alternative overnight supervision system.

The written explanations under clauses (1) to (6) may be accomplished through
cross-references to other policies and procedures as long as they are explained to the person
giving consent, and the person giving consent is offered a copy.

(g) Nothing in this section requires the applicant or license holder to develop or maintain
separate or duplicative policies, procedures, documentation, consent forms, or individual
plans that may be required for other licensing standards, if the requirements of this section
are incorporated into those documents.

(h) The commissioner may grant variances to the requirements of this section according
to section 245A.04, subdivision 9.

(i) For the purposes of paragraphs (d) through (h), "license holder" has the meaning
under section 245A.02, subdivision 9, and additionally includes all staff, volunteers, and
contractors affiliated with the license holder.

(j) For the purposes of paragraph (e), the terms "assess" and "assessing" mean to remotely
determine what action the license holder needs to take to protect the well-being of the foster
care recipient.

(k) The commissioner shall evaluate license applications using the requirements in
paragraphs (d) to (f). The commissioner shall provide detailed application forms, including
a checklist of criteria needed for approval.

(l) To be eligible for a license under paragraph (a), the adult foster care or community
residential setting license holder must not have had a conditional license issued under section
245A.06 or any licensing sanction under section 245A.07 during the prior 24 months based
on failure to provide adequate supervision, health care services, or resident safety in the
adult foster care home or community residential setting.

(m) The commissioner shall review an application for an alternative overnight supervision
license within 60 days of receipt of the application. When the commissioner receives an
application 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. The commissioner shall complete
subsequent review within 30 days.

(n) Once the application is considered complete under paragraph (m), the commissioner
will approve or deny an application for an alternative overnight supervision license within
60 days.

(o) For the purposes of this subdivision, "supervision" means:

(1) oversight by a caregiver or direct support staff as specified in the individual resident's
place agreement or support plan and awareness of the resident's needs and activities; and

(2) the presence of a caregiver or direct support staff in a residence during normal sleeping
hours, unless a determination has been made and documented in the individual's support
plan that the individual does not require the presence of a caregiver or direct support staff
during normal sleeping hours.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 7.

Minnesota Statutes 2022, 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 disabilities, 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, community alternative care, 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 disabilities waiver plan;

(4) 24-hour emergency assistance, personal emergency response as defined under the
community access for disability inclusion and developmental disabilities waiver plans;

(5) night supervision services as defined under the brain injury, community access for
disability inclusion, community alternative care, and developmental disabilities waiver
plans;

(6) homemaker services as defined under the community access for disability inclusion,
brain injury, community alternative care, developmental disabilities, and elderly waiver
plans, excluding providers licensed by the Department of Health under chapter 144A and
those providers providing cleaning services only;

(7) individual community living support under section 256S.13; and

(8) individualized home supports services as defined under the brain injury, community
alternative care, and community access for disability inclusion, and developmental disabilities
waiver plans.

(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) positive support services as defined under the brain injury and community access for
disability inclusion, community alternative care, and developmental disabilities waiver
plans;

(ii) in-home or out-of-home crisis respite services as defined under the brain injury,
community access for disability inclusion, community alternative care, and developmental
disabilities waiver plans; and

(iii) specialist services as defined under the current brain injury, community access for
disability inclusion, community alternative care, and developmental disabilities waiver
plans;

(2) in-home support services, including:

(i) in-home family support and supported living services as defined under the
developmental disabilities waiver plan;

(ii) independent living services training as defined under the brain injury and community
access for disability inclusion waiver plans;

(iii) semi-independent living services;

(iv) individualized home support with training services as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disabilities waiver plans; and

(v) individualized home support with family training services as defined under the brain
injury, community alternative care, community access for disability inclusion, and
developmental disabilities waiver plans;

(3) residential supports and services, including:

(i) supported living services as defined under the developmental disabilities 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;

(iii) community residential services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disabilities
waiver plans provided in a corporate child foster care residence, a community residential
setting, or a supervised living facility;

(iv) family residential services as defined in the brain injury, community alternative
care, community access for disability inclusion, and developmental disabilities waiver plans
provided in a family child foster care residence or a family adult foster care residence; and

(v) residential services provided to more than four persons with developmental disabilities
in a supervised living facility, including ICFs/DD; and

(vi) life sharing as defined in the brain injury, community alternative care, community
access for disability inclusion, and developmental disabilities waiver plans;

(4) day services, including:

(i) structured day services as defined under the brain injury waiver plan;

(ii) day services under sections 252.41 to 252.46, and as defined under the brain injury,
community alternative care, community access for disability inclusion, and developmental
disabilities waiver plans;

(iii) day training and habilitation services under sections 252.41 to 252.46, and as defined
under the developmental disabilities waiver plan; and

(iv) prevocational services as defined under the brain injury, community alternative care,
community access for disability inclusion, and developmental disabilities waiver plans; and

(5) employment exploration services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disabilities
waiver plans;

(6) employment development services as defined under the brain injury, community
alternative care, community access for disability inclusion, and developmental disabilities
waiver plans;

(7) employment support services as defined under the brain injury, community alternative
care, community access for disability inclusion, and developmental disabilities waiver plans;
and

(8) integrated community support as defined under the brain injury and community
access for disability inclusion waiver plans beginning January 1, 2021, and community
alternative care and developmental disabilities waiver plans beginning January 1, 2023.

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 8.

[245D.261] COMMUNITY RESIDENTIAL SETTINGS; REMOTE
OVERNIGHT SUPERVISION.

Subdivision 1.

Definitions.

(a) For purposes of this section, the following terms have
the meanings given them, unless otherwise specified.

(b) "Resident" means an adult residing in a community residential setting.

(c) "Technology" means:

(1) enabling technology, which is a device capable of live, two-way communication or
engagement between a resident and direct support staff at a remote location; or

(2) monitoring technology, which is the use of equipment to oversee, monitor, and
supervise an individual who receives medical assistance waiver or alternative care services
under section 256B.0913, 256B.092, or 256B.49 or chapter 256S.

Subd. 2.

Documentation of permissible remote overnight supervision.

A license
holder providing remote overnight supervision in a community residential setting in lieu of
on-site direct support staff must comply with the requirements of this chapter, including
the requirement under section 245D.02, subdivision 33b, paragraph (a), clause (3), that the
absence of direct support staff from the community residential setting while services are
being delivered must be documented in the resident's support plan or support plan addendum.

Subd. 3.

Provider requirements for remote overnight supervision; commissioner
notification.

(a) A license holder providing remote overnight supervision in a community
residential setting must:

(1) use technology;

(2) notify the commissioner of the community residential setting's intent to use technology
in lieu of on-site staff. The notification must:

(i) indicate a start date for the use of technology; and

(ii) attest that all requirements under this section are met and policies required under
subdivision 4 are available upon request;

(3) clearly state in each person's support plan addendum that the community residential
setting is a program without the in-person presence of overnight direct support;

(4) include with each person's support plan addendum the license holder's protocols for
responding to situations that present a serious risk to the health, safety, or rights of residents
served by the program; and

(5) include in each person's support plan addendum the person's maximum permissible
response time as determined by the person's support team.

(b) Upon being notified via technology that an incident has occurred that may jeopardize
the health, safety, or rights of a resident, the license holder must conduct an evaluation of
the need for the physical presence of a staff member. If a physical presence is needed, a
staff person, volunteer, or contractor must be on site to respond to the situation within the
resident's maximum permissible response time.

(c) A license holder must notify the commissioner if remote overnight supervision
technology will no longer be used by the license holder.

(d) When no physical presence response is completed for a three-month period, the
license holder must conduct a physical presence response drill. The effectiveness of the
response protocol must be reviewed and documented.

(e) Upon receipt of notification of use of remote overnight supervision or discontinuation
of use of remote overnight supervision by a license holder, the commissioner shall notify
the county licensing agency and update the license.

Subd. 4.

Required policies and procedures for remote overnight supervision.

(a) A
license holder providing remote overnight supervision must have policies and procedures
that:

(1) protect the residents' health, safety, and rights;

(2) explain the discharge process if a person served by the program requires in-person
supervision or other services that cannot be provided by the license holder due to the limited
hours that direct support staff are on site;

(3) explain the backup system for technology in times of electrical outages or other
equipment malfunctions;

(4) explain how the license holder trains the direct support staff on the use of the
technology; and

(5) establish a plan for dispatching emergency response personnel to the site in the event
of an identified emergency.

(b) Nothing in this section requires the license holder to develop or maintain separate
or duplicative policies, procedures, documentation, consent forms, or individual plans that
may be required for other licensing standards if the requirements of this section are
incorporated into those documents.

Subd. 5.

Consent to use of monitoring technology.

If a license holder uses monitoring
technology in a community residential setting, the license holder must obtain a signed
informed consent form from each resident served by the program or the resident's legal
representative documenting the resident's or legal representative's agreement to use of the
specific monitoring technology used in the setting. The informed consent form documenting
this agreement must also explain:

(1) how the license holder uses monitoring technology to provide remote supervision;

(2) the risks and benefits of using monitoring technology;

(3) how the license holder protects each resident's privacy while monitoring technology
is being used in the setting; and

(4) how the license holder protects each resident's privacy when the monitoring
technology system electronically records personally identifying data.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 9.

Minnesota Statutes 2022, section 252.44, is amended to read:

252.44 LEAD AGENCY BOARD RESPONSIBILITIES.

When the need for day services in a county or Tribe has been determined under section
252.28, the board of commissioners for that lead agency shall:

(1) authorize the delivery of services according to the support plans and support plan
addendums required as part of the lead agency's provision of case management services
under sections 256B.0913, subdivision 8; 256B.092, subdivision 1b; 256B.49, subdivision
15; and 256S.10 and Minnesota Rules, parts 9525.0004 to 9525.0036;

(2) ensure that transportation is provided or arranged by the vendor in the most efficient
and reasonable way possible; and

(3) monitor and evaluate the cost and effectiveness of the services.;

(4) ensure that on or after August 1, 2026, employers do not hire any new employee at
a wage that is less than the highest applicable minimum wage, regardless of whether the
employer holds a special certificate from the United States Department of Labor under
section 14(c) of the federal Fair Labor Standards Act; and

(5) ensure that on or after August 1, 2028, any day service program, including county,
Tribal, or privately funded day services, pay employees with disabilities the highest applicable
minimum wage, regardless of whether the employer holds a special certificate from the
United States Department of Labor under section 14(c) of the federal Fair Labor Standards
Act.

Sec. 10.

[252.54] STATEWIDE DISABILITY EMPLOYMENT TECHNICAL
ASSISTANCE CENTER.

The commissioner must establish a statewide technical assistance center to provide
resources and assistance to programs, people, and families to support individuals with
disabilities to achieve meaningful and competitive employment in integrated settings. Duties
of the technical assistance center include but are not limited to:

(1) offering provider business model transition support to ensure ongoing access to
employment and day services;

(2) identifying and providing training on innovative, promising, and emerging practices;

(3) maintaining a resource clearinghouse to serve as a hub of information to ensure
programs, people, and families have access to high-quality materials and information;

(4) fostering innovation and actionable progress by providing direct technical assistance
to programs; and

(5) cultivating partnerships and mentorship across support programs, people, and families
in the exploration of and successful transition to competitive, integrated employment.

Sec. 11.

[252.55] LEAD AGENCY EMPLOYMENT FIRST CAPACITY BUILDING
GRANTS.

The commissioner shall establish a grant program to expand lead agency capacity to
support people with disabilities to contemplate, explore, and maintain competitive, integrated
employment options. Allowable uses of money include:

(1) enhancing resources and staffing to support people and families in understanding
employment options and navigating service options;

(2) implementing and testing innovative approaches to better support people with
disabilities and their families in achieving competitive, integrated employment; and

(3) other activities approved by the commissioner.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 12.

Minnesota Statutes 2022, section 256.482, is amended by adding a subdivision
to read:

Subd. 9.

Report to legislature.

On or before January 15, 2025, and annually on January
15 thereafter, the Minnesota Council on Disability shall submit a report to the chair and
ranking minority members of the legislative committees with jurisdiction over state
government finance and local government specifying the number of cities and counties that
received training or technical assistance on website accessibility, the outcomes of website
accessibility training and outreach, the costs incurred by cities and counties to make website
accessibility improvements, and any other information that the council deems relevant.

Sec. 13.

Minnesota Statutes 2022, section 256B.056, subdivision 3, is amended to read:

Subd. 3.

Asset limitations for certain individuals.

(a) To be eligible for medical
assistance, a person must not individually own more than $3,000 in assets, or if a member
of a household with two family members, husband and wife, or parent and child, the
household must not own more than $6,000 in assets, plus $200 for each additional legal
dependent. 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 accumulation of the clothing and personal needs allowance
according to section 256B.35 must also be reduced to the maximum at the time of the
eligibility redetermination. The value of assets that are not considered in determining
eligibility for medical assistance is the value of those assets excluded under the Supplemental
Security Income program for aged, blind, and disabled persons, with the following
exceptions:

(1) household goods and personal effects are not considered;

(2) capital and operating assets of a trade or business that the local agency determines
are necessary to the person's ability to earn an income are not considered;

(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;

(4) assets designated as burial expenses are excluded to the same extent excluded by the
Supplemental Security Income program. Burial expenses funded by annuity contracts or
life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;

(5) for a person who no longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical assistance under section 256B.057,
subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility
as an employed person with a disability, to the extent that the person's total assets remain
within the allowed limits of section 256B.057, subdivision 9, paragraph (d);

(6) a designated employment incentives asset account is disregarded when determining
eligibility for medical assistance for a person age 65 years or older under section 256B.055,
subdivision 7. An employment incentives asset account must only be designated by a person
who has been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person and the person's spouse in the last month of enrollment
in medical assistance under section 256B.057, subdivision 9. Qualified assets include
retirement and pension accounts, medical expense accounts, and up to $17,000 of the person's
other nonexcluded liquid assets. An employment incentives asset account is no longer
designated when a person loses medical assistance eligibility for a calendar month or more
before turning age 65. A person who loses medical assistance eligibility before age 65 can
establish a new designated employment incentives asset account by establishing a new
24-consecutive-month period of enrollment under section 256B.057, subdivision 9. The
income of a spouse of a person enrolled in medical assistance under section 256B.057,
subdivision 9, during each of the 24 consecutive months before the person's 65th birthday
must be disregarded when determining eligibility for medical assistance under section
256B.055, subdivision 7. Persons eligible under this clause are not subject to the provisions
in section 256B.059; and

(7) 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.

(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
15.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 14.

Minnesota Statutes 2022, 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, advanced practice registered nurse, or physician
assistant; 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. "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 cause. 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) The commissioner is authorized to determine that a premium amount was calculated
or billed in error, make corrections to financial records and billing systems, and refund
premiums collected in error.

(j) (k) 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).

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 15.

Minnesota Statutes 2022, section 256B.0659, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For the purposes of this section, the terms defined in
paragraphs (b) to (r) have the meanings given unless otherwise provided in text.

(b) "Activities of daily living" means grooming, dressing, bathing, transferring, mobility,
positioning, eating, and toileting.

(c) "Behavior," effective January 1, 2010, means a category to determine the home care
rating and is based on the criteria found in this section. "Level I behavior" means physical
aggression towards toward self, others, or destruction of property that requires the immediate
response of another person.

(d) "Complex health-related needs," effective January 1, 2010, means a category to
determine the home care rating and is based on the criteria found in this section.

(e) "Critical activities of daily living," effective January 1, 2010, means transferring,
mobility, eating, and toileting.

(f) "Dependency in activities of daily living" means a person requires assistance to begin
and complete one or more of the activities of daily living.

(g) "Extended personal care assistance service" means personal care assistance services
included in a service plan under one of the home and community-based services waivers
authorized under chapter 256S and sections 256B.092, subdivision 5, and 256B.49, which
exceed the amount, duration, and frequency of the state plan personal care assistance services
for participants who:

(1) need assistance provided periodically during a week, but less than daily will not be
able to remain in their homes without the assistance, and other replacement services are
more expensive or are not available when personal care assistance services are to be reduced;
or

(2) need additional personal care assistance services beyond the amount authorized by
the state plan personal care assistance assessment in order to ensure that their safety, health,
and welfare are provided for in their homes.

(h) "Health-related procedures and tasks" means procedures and tasks that can be
delegated or assigned by a licensed health care professional under state law to be performed
by a personal care assistant.

(i) "Instrumental activities of daily living" means activities to include meal planning and
preparation; basic assistance with paying bills; shopping for food, clothing, and other
essential items; performing household tasks integral to the personal care assistance services;
communication by telephone and other media; and traveling, including to medical
appointments and to participate in the community. For purposes of this paragraph, traveling
includes driving and accompanying the recipient in the recipient's chosen mode of
transportation and according to the recipient's personal care assistance care plan.

(j) "Managing employee" has the same definition as Code of Federal Regulations, title
42, section 455.

(k) "Qualified professional" means a professional providing supervision of personal care
assistance services and staff as defined in section 256B.0625, subdivision 19c.

(l) "Personal care assistance provider agency" means a medical assistance enrolled
provider that provides or assists with providing personal care assistance services and includes
a personal care assistance provider organization, personal care assistance choice agency,
class A licensed nursing agency, and Medicare-certified home health agency.

(m) "Personal care assistant" or "PCA" means an individual employed by a personal
care assistance agency who provides personal care assistance services.

(n) "Personal care assistance care plan" means a written description of personal care
assistance services developed by the personal care assistance provider according to the
service plan.

(o) "Responsible party" means an individual who is capable of providing the support
necessary to assist the recipient to live in the community.

(p) "Self-administered medication" means medication taken orally, by injection, nebulizer,
or insertion, or applied topically without the need for assistance.

(q) "Service plan" means a written summary of the assessment and description of the
services needed by the recipient.

(r) "Wages and benefits" means wages and salaries, the employer's share of FICA taxes,
Medicare taxes, state and federal unemployment taxes, workers' compensation, mileage
reimbursement, health and dental insurance, life insurance, disability insurance, long-term
care insurance, uniform allowance, and contributions to employee retirement accounts.

EFFECTIVE DATE.

This section is effective 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.

Sec. 16.

Minnesota Statutes 2022, section 256B.0659, subdivision 12, is amended to read:

Subd. 12.

Documentation of personal care assistance services provided.

(a) Personal
care assistance services for a recipient must be documented daily by each personal care
assistant, on a time sheet form approved by the commissioner. All documentation may be
web-based, electronic, or paper documentation. The completed form must be submitted on
a monthly basis to the provider and kept in the recipient's health record.

(b) The activity documentation must correspond to the personal care assistance care plan
and be reviewed by the qualified professional.

(c) The personal care assistant time sheet must be on a form approved by the
commissioner documenting time the personal care assistant provides services in the home.
The following criteria must be included in the time sheet:

(1) full name of personal care assistant and individual provider number;

(2) provider name and telephone numbers;

(3) full name of recipient and either the recipient's medical assistance identification
number or date of birth;

(4) consecutive dates, including month, day, and year, and arrival and departure times
with a.m. or p.m. notations;

(5) signatures of recipient or the responsible party;

(6) personal signature of the personal care assistant;

(7) any shared care provided, if applicable;

(8) a statement that it is a federal crime to provide false information on personal care
service billings for medical assistance payments; and

(9) dates and location of recipient stays in a hospital, care facility, or incarceration.; and

(10) any time spent traveling, as described in subdivision 1, paragraph (i), including
start and stop times with a.m. and p.m. designations, the origination site, and the destination
site.

EFFECTIVE DATE.

This section is effective 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.

Sec. 17.

Minnesota Statutes 2022, section 256B.0659, is amended by adding a subdivision
to read:

Subd. 14a.

Qualified professional; remote supervision.

(a) For recipients with chronic
health conditions or severely compromised immune systems, a qualified professional may
conduct the supervision required under subdivision 14 via two-way interactive audio and
visual telecommunication if, at the recipient's request, the recipient's primary health care
provider:

(1) determines that remote supervision is appropriate; and

(2) documents the determination under clause (1) in a statement of need or other document
that is subsequently included in the recipient's personal care assistance care plan.

(b) Notwithstanding any other provision of law, a care plan developed or amended via
remote supervision may be executed by electronic signature.

(c) A personal care assistance provider agency must not conduct its first supervisory
visit for a recipient and complete its initial personal care assistance care plan via a remote
visit.

(d) A recipient may request to return to in-person supervisory visits at any time.

EFFECTIVE DATE.

This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 18.

Minnesota Statutes 2022, section 256B.0659, subdivision 19, is amended to read:

Subd. 19.

Personal care assistance choice option; qualifications; duties.

(a) Under
personal care assistance choice, the recipient or responsible party shall:

(1) recruit, hire, schedule, and terminate personal care assistants according to the terms
of the written agreement required under subdivision 20, paragraph (a);

(2) develop a personal care assistance care plan based on the assessed needs and
addressing the health and safety of the recipient with the assistance of a qualified professional
as needed;

(3) orient and train the personal care assistant with assistance as needed from the qualified
professional;

(4) supervise and evaluate the personal care assistant with the qualified professional,
who is required to visit the recipient at least every 180 days;

(5) monitor and verify in writing and report to the personal care assistance choice agency
the number of hours worked by the personal care assistant and the qualified professional;

(6) engage in an annual reassessment as required in subdivision 3a to determine
continuing eligibility and service authorization; and

(7) use the same personal care assistance choice provider agency if shared personal
assistance care is being used.; and

(8) ensure that a personal care assistant driving the recipient under subdivision 1,
paragraph (i), has a valid driver's license and the vehicle used is registered and insured
according to Minnesota law.

(b) The personal care assistance choice provider agency shall:

(1) meet all personal care assistance provider agency standards;

(2) enter into a written agreement with the recipient, responsible party, and personal
care assistants;

(3) not be related as a parent, child, sibling, or spouse to the recipient or the personal
care assistant; and

(4) ensure arm's-length transactions without undue influence or coercion with the recipient
and personal care assistant.

(c) The duties of the personal care assistance choice provider agency are to:

(1) be the employer of the personal care assistant and the qualified professional for
employment law and related regulations including but not limited to purchasing and
maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
and liability insurance, and submit any or all necessary documentation including but not
limited to workers' compensation, unemployment insurance, and labor market data required
under section 256B.4912, subdivision 1a;

(2) bill the medical assistance program for personal care assistance services and qualified
professional services;

(3) request and complete background studies that comply with the requirements for
personal care assistants and qualified professionals;

(4) pay the personal care assistant and qualified professional based on actual hours of
services provided;

(5) withhold and pay all applicable federal and state taxes;

(6) verify and keep records of hours worked by the personal care assistant and qualified
professional;

(7) make the arrangements and pay taxes and other benefits, if any, and comply with
any legal requirements for a Minnesota employer;

(8) enroll in the medical assistance program as a personal care assistance choice agency;
and

(9) enter into a written agreement as specified in subdivision 20 before services are
provided.

EFFECTIVE DATE.

This section is effective 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.

Sec. 19.

Minnesota Statutes 2022, section 256B.0659, subdivision 24, is amended to read:

Subd. 24.

Personal care assistance provider agency; general duties.

A personal care
assistance provider agency shall:

(1) enroll as a Medicaid provider meeting all provider standards, including completion
of the required provider training;

(2) comply with general medical assistance coverage requirements;

(3) demonstrate compliance with law and policies of the personal care assistance program
to be determined by the commissioner;

(4) comply with background study requirements;

(5) verify and keep records of hours worked by the personal care assistant and qualified
professional;

(6) not engage in any agency-initiated direct contact or marketing in person, by phone,
or other electronic means to potential recipients, guardians, or family members;

(7) pay the personal care assistant and qualified professional based on actual hours of
services provided;

(8) withhold and pay all applicable federal and state taxes;

(9) document that the agency uses a minimum of 72.5 percent of the revenue generated
by the medical assistance rate for personal care assistance services for employee personal
care assistant wages and benefits. The revenue generated by the qualified professional and
the reasonable costs associated with the qualified professional shall not be used in making
this calculation;

(10) make the arrangements and pay unemployment insurance, taxes, workers'
compensation, liability insurance, and other benefits, if any;

(11) enter into a written agreement under subdivision 20 before services are provided;

(12) report suspected neglect and abuse to the common entry point according to section
256B.0651;

(13) provide the recipient with a copy of the home care bill of rights at start of service;

(14) request reassessments at least 60 days prior to the end of the current authorization
for personal care assistance services, on forms provided by the commissioner;

(15) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a; and

(16) document that the agency uses the additional revenue due to the enhanced rate under
subdivision 17a for the wages and benefits of the PCAs whose services meet the requirements
under subdivision 11, paragraph (d).; and

(17) ensure that a personal care assistant driving a recipient under subdivision 1,
paragraph (i), has a valid driver's license and the vehicle used is registered and insured
according to Minnesota law.

EFFECTIVE DATE.

This section is effective 90 days following federal approval. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.

Sec. 20.

Minnesota Statutes 2022, section 256B.0911, subdivision 13, is amended to read:

Subd. 13.

MnCHOICES assessor qualifications, training, and certification.

(a) The
commissioner shall develop and implement a curriculum and an assessor certification
process.

(b) MnCHOICES certified assessors must:

(1) either have a bachelor's degree in social work, nursing with a public health nursing
certificate, or other closely related field with at least one year of home and community-based
experience or be a registered nurse with at least two years of home and community-based
experience; and

(2) have received training and certification specific to assessment and consultation for
long-term care services in the state.

(c) Certified assessors shall demonstrate best practices in assessment and support
planning, including person-centered planning principles, and have a common set of skills
that ensures consistency and equitable access to services statewide.

(d) Certified assessors must be recertified every three years.

Sec. 21.

Minnesota Statutes 2022, section 256B.092, subdivision 1a, is amended to read:

Subd. 1a.

Case management services.

(a) Each recipient of a home and community-based
waiver shall be provided case management services by qualified vendors as described in
the federally approved waiver application.

(b) Case management service activities provided to or arranged for a person include:

(1) development of the person-centered support plan under subdivision 1b;

(2) informing the individual or the individual's legal guardian or conservator, or parent
if the person is a minor, of service options, including all service options available under the
waiver plan;

(3) consulting with relevant medical experts or service providers;

(4) assisting the person in the identification of potential providers of chosen services,
including:

(i) providers of services provided in a non-disability-specific setting;

(ii) employment service providers;

(iii) providers of services provided in settings that are not controlled by a provider; and

(iv) providers of financial management services;

(5) assisting the person to access services and assisting in appeals under section 256.045;

(6) coordination of services, if coordination is not provided by another service provider;

(7) evaluation and monitoring of the services identified in the support plan, which must
incorporate at least one annual face-to-face visit by the case manager with each person; and

(8) reviewing support plans and providing the lead agency with recommendations for
service authorization based upon the individual's needs identified in the support plan.

(c) Case management service activities that are provided to the person with a
developmental disability shall be provided directly by county agencies or under contract.
If a county agency contracts for case management services, the county agency must provide
each recipient of home and community-based services who is receiving contracted case
management services with the contact information the recipient may use to file a grievance
with the county agency about the quality of the contracted services the recipient is receiving
from a county-contracted case manager. Case management services must be provided by a
public or private agency that is enrolled as a medical assistance provider determined by the
commissioner to meet all of the requirements in the approved federal waiver plans. Case
management services must not be provided to a recipient by a private agency that has a
financial interest in the provision of any other services included in the recipient's support
plan. For purposes of this section, "private agency" means any agency that is not identified
as a lead agency under section 256B.0911, subdivision 10.

(d) Case managers are responsible for service provisions listed in paragraphs (a) and
(b). Case managers shall collaborate with consumers, families, legal representatives, and
relevant medical experts and service providers in the development and annual review of the
person-centered support plan and habilitation plan.

(e) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.

(f) The Department of Human Services shall offer ongoing education in case management
to case managers. Case managers shall receive no less than ten 20 hours of case management
education and disability-related training each year. The education and training must include
person-centered planning, informed choice, cultural competency, employment planning,
community living planning, self-direction options, and use of technology supports. By
August 1, 2024, all case managers must complete an employment support training course
identified by the commissioner of human services. For case managers hired after August
1, 2024, this training must be completed within the first six months of providing case
management services. For the purposes of this section, "person-centered planning" or
"person-centered" has the meaning given in section 256B.0911, subdivision 10. Case
managers must document completion of training in a system identified by the commissioner.

Sec. 22.

Minnesota Statutes 2022, section 256B.0949, subdivision 15, is amended to read:

Subd. 15.

EIDBI provider qualifications.

(a) A QSP must be employed by an agency
and be:

(1) a licensed mental health professional who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
ASD diagnostics, ASD developmental and behavioral treatment strategies, and typical child
development; or

(2) a developmental or behavioral pediatrician who has at least 2,000 hours of supervised
clinical experience or training in examining or treating people with ASD or a related condition
or equivalent documented coursework at the graduate level by an accredited university in
the areas of ASD diagnostics, ASD developmental and behavioral treatment strategies, and
typical child development.

(b) A level I treatment provider must be employed by an agency and:

(1) have at least 2,000 hours of supervised clinical experience or training in examining
or treating people with ASD or a related condition or equivalent documented coursework
at the graduate level by an accredited university in ASD diagnostics, ASD developmental
and behavioral treatment strategies, and typical child development or an equivalent
combination of documented coursework or hours of experience; and

(2) have or be at least one of the following:

(i) a master's degree in behavioral health or child development or related fields including,
but not limited to, mental health, special education, social work, psychology, speech
pathology, or occupational therapy from an accredited college or university;

(ii) a bachelor's degree in a behavioral health, child development, or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy, from an accredited college or university, and
advanced certification in a treatment modality recognized by the department;

(iii) a board-certified behavior analyst; or

(iv) a board-certified assistant behavior analyst with 4,000 hours of supervised clinical
experience that meets all registration, supervision, and continuing education requirements
of the certification.

(c) A level II treatment provider must be employed by an agency and must be:

(1) a person who has a bachelor's degree from an accredited college or university in a
behavioral or child development science or related field including, but not limited to, mental
health, special education, social work, psychology, speech pathology, or occupational
therapy; and meets at least one of the following:

(i) has at least 1,000 hours of supervised clinical experience or training in examining or
treating people with ASD or a related condition or equivalent documented coursework at
the graduate level by an accredited university in ASD diagnostics, ASD developmental and
behavioral treatment strategies, and typical child development or a combination of
coursework or hours of experience;

(ii) has certification as a board-certified assistant behavior analyst from the Behavior
Analyst Certification Board;

(iii) is a registered behavior technician as defined by the Behavior Analyst Certification
Board; or

(iv) is certified in one of the other treatment modalities recognized by the department;
or

(2) a person who has:

(i) an associate's degree in a behavioral or child development science or related field
including, but not limited to, mental health, special education, social work, psychology,
speech pathology, or occupational therapy from an accredited college or university; and

(ii) at least 2,000 hours of supervised clinical experience in delivering treatment to people
with ASD or a related condition. Hours worked as a mental health behavioral aide or level
III treatment provider may be included in the required hours of experience; or

(3) a person who has at least 4,000 hours of supervised clinical experience in delivering
treatment to people with ASD or a related condition. Hours worked as a mental health
behavioral aide or level III treatment provider may be included in the required hours of
experience; or

(4) a person who is a graduate student in a behavioral science, child development science,
or related field and is receiving clinical supervision by a QSP affiliated with an agency to
meet the clinical training requirements for experience and training with people with ASD
or a related condition; or

(5) a person who is at least 18 years of age and who:

(i) is fluent in a non-English language or is an individual certified by a Tribal nation;

(ii) completed the level III EIDBI training requirements; and

(iii) receives observation and direction from a QSP or level I treatment provider at least
once a week until the person meets 1,000 hours of supervised clinical experience.

(d) A level III treatment provider must be employed by an agency, have completed the
level III training requirement, be at least 18 years of age, and have at least one of the
following:

(1) a high school diploma or commissioner of education-selected high school equivalency
certification;

(2) fluency in a non-English language or Tribal nation certification;

(3) one year of experience as a primary personal care assistant, community health worker,
waiver service provider, or special education assistant to a person with ASD or a related
condition within the previous five years; or

(4) completion of all required EIDBI training within six months of employment.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 23.

Minnesota Statutes 2022, section 256B.49, subdivision 13, is amended to read:

Subd. 13.

Case management.

(a) Each recipient of a home and community-based waiver
shall be provided case management services by qualified vendors as described in the federally
approved waiver application. The case management service activities provided must include:

(1) finalizing the person-centered written support plan within the timelines established
by the commissioner and section 256B.0911, subdivision 29;

(2) informing the recipient or the recipient's legal guardian or conservator of service
options, including all service options available under the waiver plans;

(3) assisting the recipient in the identification of potential service providers of chosen
services, including:

(i) available options for case management service and providers;

(ii) providers of services provided in a non-disability-specific setting;

(iii) employment service providers;

(iv) providers of services provided in settings that are not community residential settings;
and

(v) providers of financial management services;

(4) assisting the recipient to access services and assisting with appeals under section
256.045; and

(5) coordinating, evaluating, and monitoring of the services identified in the service
plan.

(b) The case manager may delegate certain aspects of the case management service
activities to another individual provided there is oversight by the case manager. The case
manager may not delegate those aspects which require professional judgment including:

(1) finalizing the person-centered support plan;

(2) ongoing assessment and monitoring of the person's needs and adequacy of the
approved person-centered support plan; and

(3) adjustments to the person-centered support plan.

(c) Case management services must be provided by a public or private agency that is
enrolled as a medical assistance provider determined by the commissioner to meet all of
the requirements in the approved federal waiver plans. Case management services must not
be provided to a recipient by a private agency that has any financial interest in the provision
of any other services included in the recipient's support plan. For purposes of this section,
"private agency" means any agency that is not identified as a lead agency under section
256B.0911, subdivision 10.

(d) For persons who need a positive support transition plan as required in chapter 245D,
the case manager shall participate in the development and ongoing evaluation of the plan
with the expanded support team. At least quarterly, the case manager, in consultation with
the expanded support team, shall evaluate the effectiveness of the plan based on progress
evaluation data submitted by the licensed provider to the case manager. The evaluation must
identify whether the plan has been developed and implemented in a manner to achieve the
following within the required timelines:

(1) phasing out the use of prohibited procedures;

(2) acquisition of skills needed to eliminate the prohibited procedures within the plan's
timeline; and

(3) accomplishment of identified outcomes.

If adequate progress is not being made, the case manager shall consult with the person's
expanded support team to identify needed modifications and whether additional professional
support is required to provide consultation.

(e) The Department of Human Services shall offer ongoing education in case management
to case managers. Case managers shall receive no less than ten 20 hours of case management
education and disability-related training each year. The education and training must include
person-centered planning, informed choice, cultural competency, employment planning,
community living planning, self-direction options, and use of technology supports. By
August 1, 2024, all case managers must complete an employment support training course
identified by the commissioner of human services. For case managers hired after August
1, 2024, this training must be completed within the first six months of providing case
management services. For the purposes of this section, "person-centered planning" or
"person-centered" has the meaning given in section 256B.0911, subdivision 10. Case
managers shall document completion of training in a system identified by the commissioner.

Sec. 24.

Minnesota Statutes 2022, section 256B.4905, subdivision 4a, is amended to read:

Subd. 4a.

Informed choice in employment policy.

It is the policy of this state that
working-age individuals who have disabilities:

(1) can work and achieve competitive integrated employment with appropriate services
and supports, as needed;

(2) make informed choices about their postsecondary education, work, and career goals;
and

(3) will be offered the opportunity to make an informed choice, at least annually, to
pursue postsecondary education or to work and earn a competitive wage.; and

(4) will be offered benefits planning assistance and supports to understand available
work incentive programs and to understand the impact of work on benefits.

Sec. 25.

[256B.4906] SUBMINIMUM WAGES IN HOME AND
COMMUNITY-BASED SERVICES PROHIBITION; REQUIREMENTS.

Subdivision 1.

Subminimum wage outcome reporting.

(a) A provider of home and
community-based services for people with developmental disabilities under section 256B.092
or home and community-based services for people with disabilities under section 256B.49
that holds a credential listed in clause (1) or (2) as of August 1, 2023, must submit to the
commissioner of human services data on individuals who are currently being paid
subminimum wages or were being paid subminimum wages by the provider organization
as of August 1, 2023:

(1) a certificate through the United States Department of Labor under United States
Code, title 29, section 214(c), of the Fair Labor Standards Act authorizing the payment of
subminimum wages to workers with disabilities; or

(2) a permit by the Minnesota Department of Labor and Industry under section 177.28.

(b) The report required under paragraph (a) must include the following data about each
individual being paid subminimum wages:

(1) name;

(2) date of birth;

(3) identified race and ethnicity;

(4) disability type;

(5) key employment status measures as determined by the commissioner; and

(6) key community-life engagement measures as determined by the commissioner.

(c) The information in paragraph (b) must be submitted in a format determined by the
commissioner.

(d) A provider must submit the data required under this section annually on a date
specified by the commissioner. The commissioner must give a provider at least 30 calendar
days to submit the data following notice of the due date. If a provider fails to submit the
requested data by the date specified by the commissioner, the commissioner may delay
medical assistance reimbursement until the requested data is submitted.

(e) Individually identifiable data submitted to the commissioner under this section are
considered private data on individuals as defined by section 13.02, subdivision 12.

(f) The commissioner must analyze data annually for tracking employment and
community-life engagement outcomes.

Subd. 2.

Prohibition of subminimum wages.

Providers of home and community-based
services are prohibited from paying a person with a disability wages below the state minimum
wage pursuant to section 177.24, or below the prevailing local minimum wage on the basis
of the person's disability. A special certificate authorizing the payment of less than the
minimum wage to a person with a disability issued pursuant to a law of this state or to a
federal law is without effect as of August 1, 2028.

Sec. 26.

Minnesota Statutes 2022, 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 services;

(3) adult day services bath;

(4) community residential services;

(5) customized living;

(6) day support services;

(7) employment development services;

(8) employment exploration services;

(9) employment support services;

(10) family residential services;

(11) individualized home supports;

(12) individualized home supports with family training;

(13) individualized home supports with training;

(14) integrated community supports;

(15) life sharing;

(15) (16) night supervision;

(16) (17) positive support services;

(17) (18) prevocational services;

(18) (19) residential support services;

(19) (20) respite services;

(20) (21) transportation services; and

(21) (22) other services as approved by the federal government in the state home and
community-based services waiver plan.

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 27.

Minnesota Statutes 2022, section 256B.4914, subdivision 5, is amended to read:

Subd. 5.

Base wage index; establishment and updates.

(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 calculating the 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 Occupational
Handbook must be used.

(b) The commissioner shall update the base wage index in subdivision 5a, publish these
updated values, and load them into the rate management system as follows:

(1) on January 1, 2022, based on wage data by SOC from the Bureau of Labor Statistics
available as of December 31, 2019;

(2) on November January 1, 2024, based on wage data by SOC from the Bureau of Labor
Statistics available as of December 31, 2021 published in March 2022; and

(3) on July January 1, 2026, and every two years thereafter, based on wage data by SOC
from the Bureau of Labor Statistics available 30 months and one day published in March,
22 months prior to the scheduled update.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 28.

Minnesota Statutes 2022, section 256B.4914, subdivision 5a, is amended to read:

Subd. 5a.

Base wage index; calculations.

The base wage index must be calculated as
follows:

(1) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialist, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);

(2) for registered nurse staff, 100 percent of the median wage for registered nurses (SOC
code 29-1141);

(3) for licensed practical nurse staff, 100 percent of the median wage for licensed practical
nurses (SOC code 29-2061);

(4) for residential asleep-overnight staff, the minimum wage in Minnesota for large
employers, with the exception of asleep-overnight staff for family residential services, which
is 36 percent of the minimum wage in Minnesota for large employers;

(5) for residential direct care staff, the sum of:

(i) 15 percent of the subtotal of 50 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 30 percent of the median wage for nursing assistant
(SOC code 31-1131); 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 40 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 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);

(6) for adult day services staff, 70 percent of the median wage for nursing assistant (SOC
code 31-1131); and 30 percent of the median wage for home health and personal care aide
(SOC code 31-1120);

(7) for day support services staff and prevocational services staff, 20 percent of the
median wage for nursing assistant (SOC code 31-1131); 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 positive supports analyst staff, 100 percent of the median wage for substance
abuse, behavioral disorder, and mental health counselor (SOC code 21-1018);

(9) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);

(10) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);

(11) for individualized home supports with family training staff, 20 percent of the median
wage for nursing aide (SOC code 31-1131); 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);

(12) for individualized home supports with training services 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);

(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(14) for employment exploration services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);

(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);

(16) for individualized home support without training staff, 50 percent of the median
wage for home health and personal care aide (SOC code 31-1120); and 50 percent of the
median wage for nursing assistant (SOC code 31-1131);

(17) for night supervision staff, 40 percent of the median wage for home health and
personal care aide (SOC code 31-1120); 20 percent of the median wage for nursing assistant
(SOC code 31-1131); 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); and

(18) for respite staff, 50 percent of the median wage for home health and personal care
aide (SOC code 31-1131); and 50 percent of the median wage for nursing assistant (SOC
code 31-1014).

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 29.

Minnesota Statutes 2022, section 256B.4914, subdivision 5b, is amended to read:

Subd. 5b.

Standard component value adjustments.

The commissioner shall update
the client and programming support, transportation, and program facility cost component
values as required in subdivisions 6 to 9a and the rates identified in subdivision 19 for
changes in the Consumer Price Index. The commissioner shall adjust these values higher
or lower, publish these updated values, and load them into the rate management system as
follows:

(1) on January 1, 2022, by the percentage change in the CPI-U from the date of the
previous update to the data available on December 31, 2019;

(2) on November January 1, 2024, by the percentage change in the CPI-U from the date
of the previous update to the data available as of December 31, 2021 2022; and

(3) on July January 1, 2026, and every two years thereafter, by the percentage change
in the CPI-U from the date of the previous update to the data available 30 months and one
day prior to the scheduled update.

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later, except that the amendments to clauses (2) and (3), are effective January
1, 2024, or upon federal approval, whichever is later. The commissioner of human services
shall notify the revisor of statutes when federal approval is obtained.

Sec. 30.

Minnesota Statutes 2022, section 256B.4914, subdivision 6, is amended to read:

Subd. 6.

Residential support services; generally.

(a) For purposes of this section,
residential support services includes 24-hour customized living services, community
residential services, customized living services, family residential services, and integrated
community supports.

(b) A unit of service for residential support services 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. The number of days authorized for all individuals enrolling in residential
support services must include every day that services start and end.

(c) When the available shared staffing hours in a residential setting are insufficient to
meet the needs of an individual who enrolled in residential support services after January
1, 2014, then individual staffing hours shall be used.

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 31.

Minnesota Statutes 2022, section 256B.4914, subdivision 10a, is amended to
read:

Subd. 10a.

Reporting and analysis of cost data.

(a) The commissioner must ensure
that wage values and component values in subdivisions 5 to 9a reflect the cost to provide
the service. As determined by the commissioner, in consultation with stakeholders identified
in subdivision 17, a provider enrolled to provide services with rates determined under this
section must submit requested cost data to the commissioner to support research on the cost
of providing services that have rates determined by the disability waiver rates system.
Requested cost data may include, but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

(5) vacation, sick, and training time paid;

(6) taxes, workers' compensation, and unemployment insurance costs paid;

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

(11) other data relating to costs required to provide services requested by the
commissioner.

(b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to its submission due date. If a provider
fails to submit required reporting data, the commissioner shall provide notice to providers
that have not provided required data 30 days after the required submission date, and a second
notice for providers who have not provided required data 60 days after the required
submission date. The commissioner shall temporarily suspend payments to the provider if
cost data is not received 90 days after the required submission date. Withheld payments
shall be made once data is received by the commissioner.

(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy. The commissioner shall analyze cost documentation
in paragraph (a) and provide recommendations for adjustments to cost components.

(d) The commissioner shall analyze cost data submitted under paragraph (a) and, in
consultation with stakeholders identified in subdivision 17, may submit recommendations
on component values and inflationary factor adjustments to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services once every
four years beginning January 1, 2021. The commissioner shall make recommendations in
conjunction with reports submitted to the legislature according to subdivision 10, paragraph
(c). The commissioner shall release cost data in an aggregate form. Cost data from individual
providers must not be released except as provided for in current law.

(e) The commissioner shall release cost data in an aggregate form, and cost data from
individual providers shall not be released except as provided for in current law. The
commissioner shall use data collected in paragraph (a) to determine the compliance with
requirements identified under subdivision 10d. The commissioner shall identify providers
who have not met the thresholds identified under subdivision 10d on the Department of
Human Services website for the year for which the providers reported their costs.

(f) The commissioner, in consultation with stakeholders identified in subdivision 17,
shall develop and implement a process for providing training and technical assistance
necessary to support provider submission of cost documentation required under paragraph
(a).

EFFECTIVE DATE.

This section is effective January 1, 2025.

Sec. 32.

Minnesota Statutes 2022, section 256B.4914, is amended by adding a subdivision
to read:

Subd. 10d.

Direct care staff; compensation.

(a) A provider paid with rates determined
under subdivision 6 must use a minimum of 66 percent of the revenue generated by rates
determined under that subdivision for direct care staff compensation.

(b) A provider paid with rates determined under subdivision 7 must use a minimum of
45 percent of the revenue generated by rates determined under that subdivision for direct
care compensation.

(c) A provider paid with rates determined under subdivision 8 or 9 must use a minimum
of 60 percent of the revenue generated by rates determined under those subdivisions for
direct care compensation.

(d) Compensation under this subdivision includes:

(1) wages;

(2) taxes and workers' compensation;

(3) health insurance;

(4) dental insurance;

(5) vision insurance;

(6) life insurance;

(7) short-term disability insurance;

(8) long-term disability insurance;

(9) retirement spending;

(10) tuition reimbursement;

(11) wellness programs;

(12) paid vacation time;

(13) paid sick time; or

(14) other items of monetary value provided to direct care staff.

EFFECTIVE DATE.

This section is effective January 1, 2025.

Sec. 33.

Minnesota Statutes 2022, section 256B.4914, subdivision 14, is amended to read:

Subd. 14.

Exceptions.

(a) In a format prescribed by the commissioner, lead agencies
must identify individuals with exceptional needs that cannot be met under the disability
waiver rate system. The commissioner shall use that information to evaluate and, if necessary,
approve an alternative payment rate for those individuals. Whether granted, denied, or
modified, the commissioner shall respond to all exception requests in writing. The
commissioner shall include in the written response the basis for the action and provide
notification of the right to appeal under paragraph (h).

(b) Lead agencies must act on an exception request within 30 days and notify the initiator
of the request of their recommendation in writing. A lead agency shall submit all exception
requests along with its recommendation to the commissioner.

(c) An application for a rate exception may be submitted for the following criteria:

(1) an individual has service needs that cannot be met through additional units of service;

(2) an individual's rate determined under subdivisions 6 to 9a is so insufficient that it
has resulted in an individual receiving a notice of discharge from the individual's provider;
or

(3) an individual's service needs, including behavioral changes, require a level of service
which necessitates a change in provider or which requires the current provider to propose
service changes beyond those currently authorized.

(d) Exception requests must include the following information:

(1) the service needs required by each individual that are not accounted for in subdivisions
6 to 9a;

(2) the service rate requested and the difference from the rate determined in subdivisions
6 to 9a;

(3) a basis for the underlying costs used for the rate exception and any accompanying
documentation; and

(4) any contingencies for approval.

(e) Approved rate exceptions shall be managed within lead agency allocations under
sections 256B.092 and 256B.49.

(f) Individual disability waiver recipients, an interested party, or the license holder that
would receive the rate exception increase may request that a lead agency submit an exception
request. A lead agency that denies such a request shall notify the individual waiver recipient,
interested party, or license holder of its decision and the reasons for denying the request in
writing no later than 30 days after the request has been made and shall submit its denial to
the commissioner in accordance with paragraph (b). The reasons for the denial must be
based on the failure to meet the criteria in paragraph (c).

(g) The commissioner shall determine whether to approve or deny an exception request
no more than 30 days after receiving the request. If the commissioner denies the request,
the commissioner shall notify the lead agency and the individual disability waiver recipient,
the interested party, and the license holder in writing of the reasons for the denial.

(h) The individual disability waiver recipient may appeal any denial of an exception
request by either the lead agency or the commissioner, pursuant to sections 256.045 and
256.0451. When the denial of an exception request results in the proposed demission of a
waiver recipient from a residential or day habilitation program, the commissioner shall issue
a temporary stay of demission, when requested by the disability waiver recipient, consistent
with the provisions of section 256.045, subdivisions 4a and 6, paragraph (c). The temporary
stay shall remain in effect until the lead agency can provide an informed choice of
appropriate, alternative services to the disability waiver.

(i) Providers may petition lead agencies to update values that were entered incorrectly
or erroneously into the rate management system, based on past service level discussions
and determination in subdivision 4, without applying for a rate exception.

(j) The starting date for the rate exception will be the later of the date of the recipient's
change in support or the date of the request to the lead agency for an exception.

(k) The commissioner shall track all exception requests received and their dispositions.
The commissioner shall issue quarterly public exceptions statistical reports, including the
number of exception requests received and the numbers granted, denied, withdrawn, and
pending. The report shall include the average amount of time required to process exceptions.

(l) Approved rate exceptions remain in effect in all cases until an individual's needs
change as defined in paragraph (c).

(m) Rates determined under subdivision 19 are ineligible for rate exceptions.

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 34.

Minnesota Statutes 2022, section 256B.4914, is amended by adding a subdivision
to read:

Subd. 19.

Payments for family residential and life sharing services.

The commissioner
shall establish rates for family residential services and life sharing services based on a
person's assessed need, as described in the federally-approved waiver plans. Rates for life
sharing services must be ten percent higher than the corresponding family residential services
rate.

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 35.

Minnesota Statutes 2022, section 256B.5012, is amended by adding a subdivision
to read:

Subd. 19.

ICF/DD rate transition.

(a) Effective January 1, 2024, the minimum daily
operating rate for intermediate care facilities for persons with developmental disabilities is
$260.00.

(b) Beginning January 1, 2026, and every two years thereafter, the rate in paragraph (a)
must be updated for the percentage change in the Consumer Price Index (CPI-U) from the
date of the previous CPI-U update to the data available 12 months and one day prior to the
scheduled update.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 36.

Minnesota Statutes 2022, section 256B.851, subdivision 3, is amended to read:

Subd. 3.

Payment rates; base wage index.

When initially establishing the base wage
component values, the commissioner must use the Minnesota-specific median wage for the
standard occupational classification (SOC) codes published by the Bureau of Labor Statistics
in the edition of the Occupational Handbook available January 1, published in March 2021.
The commissioner must calculate the base wage component values as follows for:

(1) personal care assistance services, CFSS, extended personal care assistance services,
and extended CFSS. The base wage component value equals the median wage for personal
care aide (SOC code 31-1120);

(2) enhanced rate personal care assistance services and enhanced rate CFSS. The base
wage component value equals the product of median wage for personal care aide (SOC
code 31-1120) and the value of the enhanced rate under section 256B.0659, subdivision
17a; and

(3) qualified professional services and CFSS worker training and development. The base
wage component value equals the sum of 70 percent of the median wage for registered nurse
(SOC code 29-1141), 15 percent of the median wage for health care social worker (SOC
code 21-1099), and 15 percent of the median wage for social and human service assistant
(SOC code 21-1093).

EFFECTIVE DATE.

This section is effective January 1, 2024, or within 90 days of
federal approval, whichever is later. The commissioner of human services shall notify the
revisor of statutes when federal approval is obtained.

Sec. 37.

Minnesota Statutes 2022, section 256B.851, subdivision 5, is amended to read:

Subd. 5.

Payment rates; component values.

(a) The commissioner must use the
following component values:

(1) employee vacation, sick, and training factor, 8.71 percent;

(2) employer taxes and workers' compensation factor, 11.56 percent;

(3) employee benefits factor, 12.04 percent;

(4) client programming and supports factor, 2.30 percent;

(5) program plan support factor, 7.00 percent;

(6) general business and administrative expenses factor, 13.25 percent;

(7) program administration expenses factor, 2.90 percent; and

(8) absence and utilization factor, 3.90 percent.

(b) For purposes of implementation, the commissioner shall use the following
implementation components:

(1) personal care assistance services and CFSS: 75.45 88.66 percent;

(2) enhanced rate personal care assistance services and enhanced rate CFSS: 75.45 88.66
percent; and

(3) qualified professional services and CFSS worker training and development: 75.45
88.66 percent.

(c) Effective January 1, 2025, for purposes of implementation, the commissioner shall
use the following implementation components:

(1) personal care assistance services and CFSS: 92.08 percent;

(2) enhanced rate personal care assistance services and enhanced rate CFSS: 92.08
percent; and

(3) qualified professional services and CFSS worker training and development: 92.08
percent.

(d) The commissioner shall use the following worker retention components:

(1) for workers who have provided fewer than 1,001 cumulative hours in personal care
assistance services or CFSS, the worker retention component is zero percent;

(2) for workers who have provided between 1,001 and 2,000 cumulative hours in personal
care assistance services or CFSS, the worker retention component is 2.17 percent;

(3) for workers who have provided between 2,001 and 6,000 cumulative hours in personal
care assistance services or CFSS, the worker retention component is 4.36 percent;

(4) for workers who have provided between 6,001 and 10,000 cumulative hours in
personal care assistance services or CFSS, the worker retention component is 7.35 percent;
and

(5) for workers who have provided more than 10,000 cumulative hours in personal care
assistance services or CFSS, the worker retention component is 10.81 percent.

(e) The commissioner shall define the appropriate worker retention component based
on the total number of units billed for services rendered by the individual provider since
July 1, 2017. The worker retention component must be determined by the commissioner
for each individual provider and is not subject to appeal.

EFFECTIVE DATE.

The amendments to paragraph (b) are effective January 1, 2024,
or within 90 days of federal approval, whichever is later. Paragraph (b) expires January 1,
2025, or within 90 days of federal approval of paragraph (c), whichever is later. Paragraphs
(c) to (e) are effective January 1, 2025, or within 90 days of federal approval, whichever is
later. The commissioner of human services shall notify the revisor of statutes when federal
approval is obtained.

Sec. 38.

Minnesota Statutes 2022, section 256B.851, subdivision 6, is amended to read:

Subd. 6.

Payment rates; rate determination.

(a) The commissioner must determine
the rate for personal care assistance services, CFSS, extended personal care assistance
services, extended CFSS, enhanced rate personal care assistance services, enhanced rate
CFSS, qualified professional services, and CFSS worker training and development as
follows:

(1) multiply the appropriate total wage component value calculated in subdivision 4 by
one plus the employee vacation, sick, and training factor in subdivision 5;

(2) for program plan support, multiply the result of clause (1) by one plus the program
plan support factor in subdivision 5;

(3) for employee-related expenses, add the employer taxes and workers' compensation
factor in subdivision 5 and the employee benefits factor in subdivision 5. The sum is
employee-related expenses. Multiply the product of clause (2) by one plus the value for
employee-related expenses;

(4) for client programming and supports, multiply the product of clause (3) by one plus
the client programming and supports factor in subdivision 5;

(5) for administrative expenses, add the general business and administrative expenses
factor in subdivision 5, the program administration expenses factor in subdivision 5, and
the absence and utilization factor in subdivision 5;

(6) divide the result of clause (4) by one minus the result of clause (5). The quotient is
the hourly rate;

(7) multiply the hourly rate by the appropriate implementation component under
subdivision 5. This is the adjusted hourly rate; and

(8) divide the adjusted hourly rate by four. The quotient is the total adjusted payment
rate.

(b) In processing claims, the commissioner shall incorporate the worker retention
component specified in subdivision 5, by multiplying one plus the total adjusted payment
rate by the appropriate worker retention component under subdivision 5, paragraph (d).

(b) (c) The commissioner must publish the total adjusted final payment rates.

EFFECTIVE DATE.

This section is effective January 1, 2025, or 90 days after federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained.

Sec. 39.

Minnesota Statutes 2022, section 256D.425, subdivision 1, is amended to read:

Subdivision 1.

Persons entitled to receive aid.

A person who is aged, blind, or 18 years
of age or older and disabled and who is receiving supplemental security benefits under Title
XVI on the basis of age, blindness, or disability (or would be eligible for such benefits
except for excess income) is eligible for a payment under the Minnesota supplemental aid
program, if the person's net income is less than the standards in section 256D.44. A person
who is receiving benefits under the Minnesota supplemental aid program in the month prior
to becoming eligible under section 1619(b) of the Social Security Act is eligible for a
payment under the Minnesota supplemental aid program while they remain in section 1619(b)
status. Persons who are not receiving Supplemental Security Income benefits under Title
XVI of the Social Security Act or disability insurance benefits under Title II of the Social
Security Act due to exhausting time limited benefits are not eligible to receive benefits
under the MSA program. Persons who are not receiving Social Security or other maintenance
benefits for failure to meet or comply with the Social Security or other maintenance program
requirements are not eligible to receive benefits under the MSA program. Persons who are
found ineligible for Supplemental Security Income because of excess income, but whose
income is within the limits of the Minnesota supplemental aid program, must have blindness
or disability determined by the state medical review team.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 40.

Minnesota Statutes 2022, section 268.19, subdivision 1, is amended to read:

Subdivision 1.

Use of data.

(a) Except as provided by this section, data gathered from
any person under the administration of the Minnesota Unemployment Insurance Law are
private data on individuals or nonpublic data not on individuals as defined in section 13.02,
subdivisions 9 and 12, and may not be disclosed except according to a district court order
or section 13.05. A subpoena is not considered a district court order. These data may be
disseminated to and used by the following agencies without the consent of the subject of
the data:

(1) state and federal agencies specifically authorized access to the data by state or federal
law;

(2) any agency of any other state or any federal agency charged with the administration
of an unemployment insurance program;

(3) any agency responsible for the maintenance of a system of public employment offices
for the purpose of assisting individuals in obtaining employment;

(4) the public authority responsible for child support in Minnesota or any other state in
accordance with section 256.978;

(5) human rights agencies within Minnesota that have enforcement powers;

(6) the Department of Revenue to the extent necessary for its duties under Minnesota
laws;

(7) public and private agencies responsible for administering publicly financed assistance
programs for the purpose of monitoring the eligibility of the program's recipients;

(8) the Department of Labor and Industry and the Commerce Fraud Bureau in the
Department of Commerce for uses consistent with the administration of their duties under
Minnesota law;

(9) the Department of Human Services and the Office of Inspector General and its agents
within the Department of Human Services, including county fraud investigators, for
investigations related to recipient or provider fraud and employees of providers when the
provider is suspected of committing public assistance fraud;

(10) the Department of Human Services for the purpose of evaluating medical assistance
services and supporting program improvement;

(10) (11) local and state welfare agencies for monitoring the eligibility of the data subject
for assistance programs, or for any employment or training program administered by those
agencies, whether alone, in combination with another welfare agency, or in conjunction
with the department or to monitor and evaluate the statewide Minnesota family investment
program and other cash assistance programs, the Supplemental Nutrition Assistance Program,
and the Supplemental Nutrition Assistance Program Employment and Training program by
providing data on recipients and former recipients of Supplemental Nutrition Assistance
Program (SNAP) benefits, cash assistance under chapter 256, 256D, 256J, or 256K, child
care assistance under chapter 119B, or medical programs under chapter 256B or 256L or
formerly codified under chapter 256D;

(11) (12) local and state welfare agencies for the purpose of identifying employment,
wages, and other information to assist in the collection of an overpayment debt in an
assistance program;

(12) (13) local, state, and federal law enforcement agencies for the purpose of ascertaining
the last known address and employment location of an individual who is the subject of a
criminal investigation;

(13) (14) the United States Immigration and Customs Enforcement has access to data
on specific individuals and specific employers provided the specific individual or specific
employer is the subject of an investigation by that agency;

(14) (15) the Department of Health for the purposes of epidemiologic investigations;

(15) (16) the Department of Corrections for the purposes of case planning and internal
research for preprobation, probation, and postprobation employment tracking of offenders
sentenced to probation and preconfinement and postconfinement employment tracking of
committed offenders;

(16) (17) the state auditor to the extent necessary to conduct audits of job opportunity
building zones as required under section 469.3201; and

(17) (18) the Office of Higher Education for purposes of supporting program
improvement, system evaluation, and research initiatives including the Statewide
Longitudinal Education Data System.

(b) Data on individuals and employers that are collected, maintained, or used by the
department in an investigation under section 268.182 are confidential as to data on individuals
and protected nonpublic data not on individuals as defined in section 13.02, subdivisions 3
and 13, and must not be disclosed except under statute or district court order or to a party
named in a criminal proceeding, administrative or judicial, for preparation of a defense.

(c) Data gathered by the department in the administration of the Minnesota unemployment
insurance program must not be made the subject or the basis for any suit in any civil
proceedings, administrative or judicial, unless the action is initiated by the department.

Sec. 41.

Laws 2021, First Special Session chapter 7, article 17, section 16, is amended to
read:

Sec. 16. RESEARCH ON ACCESS TO LONG-TERM CARE SERVICES AND
FINANCING.

(a) This act includes $400,000 in fiscal year 2022 and $300,000 in fiscal year 2023 for
an actuarial research study of public and private financing options for long-term services
and supports reform to increase access across the state. Any unexpended amount in fiscal
year 2023 is available through June 30, 2024. The commissioner of human services must
conduct the study. Of this amount, the commissioner may transfer up to $100,000 to the
commissioner of commerce for costs related to the requirements of the study. The general
fund base included in this act for this purpose is $0 in fiscal year 2024 and $0 in fiscal year
2025.

(b) All activities must be completed by June 30, 2024.

Sec. 42. HOME AND COMMUNITY-BASED WORKFORCE INCENTIVE FUND
GRANTS.

Subdivision 1.

Grant program established.

The commissioner of human services shall
establish grants for disability and home and community-based providers to assist with
recruiting and retaining direct support and frontline workers.

Subd. 2.

Definitions.

(a) For purposes of this section, the following terms have the
meanings given.

(b) "Commissioner" means the commissioner of human services.

(c) "Eligible employer" means an organization enrolled in a Minnesota health care
program or providing housing services and is:

(1) a provider of home and community-based services under Minnesota Statutes, chapter
245D; or

(2) a facility certified as an intermediate care facility for persons with developmental
disabilities.

(d) "Eligible worker" means a worker who earns $30 per hour or less and is currently
employed or recruited to be employed by an eligible employer.

Subd. 3.

Allowable uses of grant money.

(a) Grantees must use grant money to provide
payments to eligible workers for the following purposes:

(1) retention, recruitment, and incentive payments;

(2) postsecondary loan and tuition payments;

(3) child care costs;

(4) transportation-related costs; and

(5) other costs associated with retaining and recruiting workers, as approved by the
commissioner.

(b) Eligible workers may receive payments up to $1,000 per year from the home and
community-based workforce incentive fund.

(c) The commissioner must develop a grant cycle distribution plan that allows for
equitable distribution of money among eligible employers. The commissioner's determination
of the grant awards and amounts is final and is not subject to appeal.

Subd. 4.

Attestation.

As a condition of obtaining grant payments under this section, an
eligible employer must attest and agree to the following:

(1) the employer is an eligible employer;

(2) the total number of eligible employees;

(3) the employer will distribute the entire value of the grant to eligible workers allowed
under this section;

(4) the employer will create and maintain records under subdivision 6;

(5) the employer will not use the money appropriated under this section for any purpose
other than the purposes permitted under this section; and

(6) the entire value of any grant amounts will be distributed to eligible workers identified
by the employer.

Subd. 5.

Distribution plan; report.

(a) A provider agency or individual provider that
receives a grant under subdivision 4 shall prepare, and upon request submit to the
commissioner, a distribution plan that specifies the amount of money the provider expects
to receive and how that money will be distributed for recruitment and retention purposes
for eligible employees. Within 60 days of receiving the grant, the provider must post the
distribution plan and leave it posted for a period of at least six months in an area of the
provider's operation to which all direct support professionals have access.

(b) Within 12 months of receiving a grant under this section, each provider agency or
individual provider that receives a grant under subdivision 4 shall submit a report to the
commissioner that includes the following information:

(1) a description of how grant money was distributed to eligible employees; and

(2) the total dollar amount distributed.

(c) Failure to submit the report under paragraph (b) may result in recoupment of grant
money.

Subd. 6.

Audits and recoupment.

(a) The commissioner may perform an audit under
this section up to six years after a grant is awarded to ensure:

(1) the grantee used the money solely for allowable purposes under subdivision 3;

(2) the grantee was truthful when making attestations under subdivision 4; and

(3) the grantee complied with the conditions of receiving a grant under this section.

(b) If the commissioner determines that a grantee used grant money for purposes not
authorized under this section, the commissioner must treat any amount used for a purpose
not authorized under this section as an overpayment. The commissioner must recover any
overpayment.

Subd. 7.

Grants not to be considered income.

(a) Notwithstanding any law to the
contrary, grant awards under this section must not be considered income, assets, or personal
property for purposes of determining eligibility or recertifying eligibility for:

(1) child care assistance programs under Minnesota Statutes, chapter 119B;

(2) general assistance, Minnesota supplemental aid, and food support under Minnesota
Statutes, chapter 256D;

(3) housing support under Minnesota Statutes, chapter 256I;

(4) the Minnesota family investment program and diversionary work program under
Minnesota Statutes, chapter 256J; and

(5) economic assistance programs under Minnesota Statutes, chapter 256P.

(b) The commissioner must not consider grant awards under this section as income or
assets under Minnesota Statutes, section 256B.056, subdivision 1a, paragraph (a), 3, or 3c,
or for persons with eligibility determined under Minnesota Statutes, section 256B.057,
subdivision 3, 3a, 3b, 4, or 9.

Sec. 43.

NEW AMERICAN LEGAL AND SOCIAL SERVICES WORKFORCE
GRANT PROGRAM.

Subdivision 1.

Definition.

"Eligible workers" means persons who require legal services
to seek or maintain status and secure or maintain legal authorization for employment.

Subd. 2.

Grant program established.

The commissioner of human services shall
establish a new American legal and social services workforce grant program for organizations
that assist eligible workers:

(1) in seeking or maintaining legal or citizenship status to become or remain legally
authorized for employment in any field or industry, including but not limited to the long-term
care workforce; or

(2) to provide supports during the legal process or while seeking qualified legal assistance.

Subd. 3.

Distribution of grants.

The commissioner shall ensure that grant money is
awarded to organizations and entities that demonstrate that they have the qualifications,
experience, expertise, cultural competency, and geographic reach to offer legal or social
services under this section to eligible workers. In distributing grant awards, the commissioner
shall prioritize organizations or entities serving populations for whom existing legal services
and social services for the purposes listed in subdivision 2 are unavailable or insufficient.

Subd. 4.

Eligible grantees.

Organizations or entities eligible to receive grant money
under this section include local governmental units, federally recognized Tribal Nations,
and nonprofit organizations as defined under section 501(c)(3) of the Internal Revenue Code
that provide legal or social services to eligible populations. Priority should be given to
organizations and entities that serve populations in areas of the state where worker shortages
are most acute.

Subd. 5.

Grantee duties.

Organizations or entities receiving grant money under this
section must provide services that include the following activities:

(1) intake, assessment, referral, orientation, legal advice, or representation to eligible
workers to seek or maintain legal or citizenship status and secure or maintain legal
authorization for employment in the United States; or

(2) social services designed to help eligible populations meet their immediate basic needs
during the process of seeking or maintaining legal status and legal authorization for
employment, including but not limited to accessing housing, food, employment or
employment training, education, course fees, community orientation, transportation, child
care, and medical care. Social services may also include navigation services to address
ongoing needs once immediate basic needs have been met and repaying student loan debt
directly incurred as a result of pursuing a qualifying course of study or training.

Subd. 6.

Reporting.

(a) Grant recipients under this section must collect and report to
the commissioner information on program participation and program outcomes. The
commissioner shall determine the form and timing of reports.

(b) Grant recipients providing immigration legal services under this section must collect
and report to the commissioner data that are consistent with the requirements established
for the advisory committee established by the supreme court under Minnesota Statutes,
section 480.242, subdivision 1.

Sec. 44. SUPPORTING NEW AMERICANS IN THE LONG-TERM CARE
WORKFORCE GRANTS.

Subdivision 1.

Definition.

For the purposes of this section, "new American" means an
individual born abroad and the individual's children, irrespective of immigration status.

Subd. 2.

Grant program established.

The commissioner of human services shall
establish a grant program for organizations that support immigrants, refugees, and new
Americans interested in entering the long-term care workforce.

Subd. 3.

Eligibility.

(a) The commissioner shall select projects for funding under this
section. An eligible applicant for the grant program in subdivision 1 is an:

(1) organization or provider that is experienced in working with immigrants, refugees,
and people born outside of the United States and that demonstrates cultural competency;
or

(2) organization or provider with the expertise and capacity to provide training, peer
mentoring, supportive services, and workforce development or other services to develop
and implement strategies for recruiting and retaining qualified employees.

(b) The commissioner shall prioritize applications from joint labor management programs.

Subd. 4.

Allowable grant activities.

Money allocated under this section must be used
to:

(1) support immigrants, refugees, or new Americans to obtain or maintain employment
in the long-term care workforce;

(2) develop connections to employment with long-term care employers and potential
employees;

(3) provide recruitment, training, guidance, mentorship, and other support services
necessary to encourage employment, employee retention, and successful community
integration;

(4) provide career education, wraparound support services, and job skills training in
high-demand health care and long-term care fields;

(5) pay for program expenses, including but not limited to hiring instructors and
navigators, space rentals, and supportive services to help participants attend classes.
Allowable uses for supportive services include but are not limited to:

(i) course fees;

(ii) child care costs;

(iii) transportation costs;

(iv) tuition fees;

(v) financial coaching fees; or

(vi) mental health supports and uniforms costs incurred as a direct result of participating
in classroom instruction or training; or

(6) repay student loan debt directly incurred as a result of pursuing a qualifying course
of study or training.

Sec. 45.

PROVIDER CAPACITY GRANTS FOR RURAL AND UNDERSERVED
COMMUNITIES.

Subdivision 1.

Establishment and authority.

(a) The commissioner of human services
shall award grants to organizations that provide community-based services to rural or
underserved communities. The grants must be used to build organizational capacity to
provide home and community-based services in the state and to build new or expanded
infrastructure to access medical assistance reimbursement.

(b) The commissioner shall conduct community engagement, provide technical assistance,
and establish a collaborative learning community related to the grants available under this
section and shall work with the commissioners of management and budget and administration
to mitigate barriers in accessing grant money.

(c) The commissioner shall limit expenditures under this subdivision to the amount
appropriated for this purpose.

(d) The commissioner shall give priority to organizations that provide culturally specific
and culturally responsive services or that serve historically underserved communities
throughout the state.

Subd. 2.

Eligibility.

An eligible applicant for the capacity grants under subdivision 1 is
an organization or provider that serves, or will serve, rural or underserved communities
and:

(1) provides, or will provide, home and community-based services in the state; or

(2) serves, or will serve, as a connector for communities to available home and
community-based services.

Subd. 3.

Allowable grant activities.

Grants under this section must be used by recipients
for the following activities:

(1) expanding existing services;

(2) increasing access in rural or underserved areas;

(3) creating new home and community-based organizations;

(4) connecting underserved communities to benefits and available services; or

(5) building new or expanded infrastructure to access medical assistance reimbursement.

Sec. 46. APPROVAL OF CORPORATE FOSTER CARE MORATORIUM
EXCEPTIONS.

(a) The commissioner of human services may approve or deny corporate foster care
moratorium exceptions requested under Minnesota Statutes, section 245A.03, subdivision
7, paragraph (a), clause (5), prior to approval of a service provider's home and
community-based services license under Minnesota Statutes, chapter 245D. Approval of
the moratorium exception must not be construed as final approval of a service provider's
home and community-based services or community residential setting license.

(b) Approval under paragraph (a) must be available only for service providers that have
requested a home and community-based services license under Minnesota Statutes, chapter
245D.

(c) Approval under paragraph (a) must be rescinded if the service provider's application
for a home and community-based services or community residential setting license is denied.

(d) This section expires December 31, 2023.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 47. BUDGET INCREASE FOR CONSUMER-DIRECTED COMMUNITY
SUPPORTS.

(a) Effective January 1, 2024, or upon federal approval, whichever is later,
consumer-directed community support budgets identified in the waiver plans under Minnesota
Statutes, sections 256B.092 and 256B.49, and chapter 256S, and the alternative care program
under Minnesota Statutes, section 256B.0913, must be increased by 8.49 percent.

(b) Effective January 1, 2025, or upon federal approval, whichever is later,
consumer-directed community support budgets identified in the waiver plans under Minnesota
Statutes, sections 256B.092 and 256B.49, and chapter 256S, and the alternative care program
under Minnesota Statutes, section 256B.0913, must be increased by 4.53 percent.

Sec. 48. EARLY INTENSIVE DEVELOPMENTAL AND BEHAVIORAL
INTERVENTION LICENSURE STUDY.

(a) The commissioner of human services must review the medical assistance early
intensive developmental and behavioral intervention (EIDBI) service and evaluate the need
for licensure or other regulatory modifications. At a minimum, the evaluation must include:

(1) an examination of current Department of Human Services-licensed programs that
are similar to EIDBI;

(2) an environmental scan of licensure requirements for Medicaid autism programs in
other states; and

(3) consideration of health and safety needs for populations with autism and related
conditions.

(b) The commissioner must consult with interested stakeholders, including self-advocates
who use EIDBI services, EIDBI providers, parents of youth who use EIDBI services, and
advocacy organizations. The commissioner must convene stakeholder meetings to obtain
feedback on licensure or regulatory recommendations.

Sec. 49. STUDY TO EXPAND ACCESS TO SERVICES FOR PEOPLE WITH
CO-OCCURRING BEHAVIORAL HEALTH CONDITIONS AND DISABILITIES.

The commissioner of human services, in consultation with stakeholders, must evaluate
options to expand services authorized under Minnesota's federally approved home and
community-based waivers, including positive support, crisis respite, respite, and specialist
services. The evaluation may include options to authorize services under Minnesota's medical
assistance state plan and strategies to decrease the number of people who remain in hospitals,
jails, and other acute or crisis settings when they no longer meet medical or other necessity
criteria.

Sec. 50. SELF-DIRECTED WORKER CONTRACT RATIFICATION.

The labor agreement between the state of Minnesota and the Service Employees
International Union Healthcare Minnesota and Iowa, submitted to the Legislative
Coordinating Commission on February 27, 2023, is ratified.

Sec. 51. MEMORANDUMS OF UNDERSTANDING.

The memorandums of understanding with the Service Employees International Union
Healthcare Minnesota and Iowa, submitted by the commissioner of management and budget
on February 27, 2023, are ratified.

Sec. 52. SPECIALIZED EQUIPMENT AND SUPPLIES LIMIT INCREASE.

Upon federal approval, the commissioner of human services must increase the annual
limit for specialized equipment and supplies under Minnesota's federally approved home
and community-based service waiver plans, alternative care, and essential community
supports to $10,000.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 53. INTERAGENCY EMPLOYMENT SUPPORTS ALIGNMENT STUDY.

The commissioners of human services, employment and economic development, and
education must conduct an interagency alignment study on employment supports for people
with disabilities. The study must evaluate:

(1) service rates;

(2) provider enrollment and monitoring standards; and

(3) eligibility processes and people's lived experience transitioning between employment
programs.

Sec. 54. MONITORING EMPLOYMENT OUTCOMES.

By January 15, 2025, the Departments of Human Services, Employment and Economic
Development, and Education must provide the chairs and ranking minority members of the
legislative committees with jurisdiction over health, human services, and labor with a plan
for tracking employment outcomes for people with disabilities served by programs
administered by the agencies. This plan must include any needed changes to state law to
track supports received and outcomes across programs.

Sec. 55. PHASE-OUT OF THE USE OF SUBMINIMUM WAGE FOR MEDICAL
ASSISTANCE DISABILITY SERVICES.

The commissioner of human services must seek all necessary amendments to Minnesota's
federally approved disability waiver plans to require that people receiving prevocational or
employment support services are compensated at or above the state minimum wage or at
or above the prevailing local minimum wage no later than August 1, 2028.

Sec. 56. RATE INCREASE FOR CERTAIN DISABILITY WAIVER SERVICES.

The commissioner of human services shall increase payment rates for chore services,
homemaker services, and home-delivered meals provided under Minnesota Statutes, sections
256B.092 and 256B.49, by 15.8 percent from the rates in effect on December 31, 2023.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 57. RATE INCREASE FOR EARLY INTENSIVE DEVELOPMENTAL AND
BEHAVIORAL INTERVENTION BENEFIT SERVICES.

The commissioner of human services shall increase payment rates for early intensive
developmental and behavioral intervention services under Minnesota Statutes, section
256B.0949, by 15.8 percent from the rates in effect on December 31, 2023.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 58. RATE INCREASE FOR HOME CARE SERVICES.

The commissioner of human services shall increase payment rates for home health
services and home care nursing services under Minnesota Statutes, section 256B.0651,
subdivision 2, clauses (1) and (3); respiratory therapy under Minnesota Rules, part 9505.0295,
subpart 2, item E; and home health agency services under Minnesota Statutes, section
256B.0653, by 15.8 percent from the rates in effect on December 31, 2023.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 59. RATE INCREASE FOR INTERMEDIATE CARE FACILITIES FOR
PERSONS WITH DEVELOPMENTAL DISABILITIES DAY TRAINING AND
HABILITATION SERVICES.

The commissioner of human services shall increase payment rates for day training and
habilitation services under Minnesota Statutes, section 252.46, by 15.8 percent from the
rates in effect on December 31, 2023.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 60. STUDY ON PRESUMPTIVE ELIGIBILITY FOR LONG-TERM SERVICES
AND SUPPORTS.

(a) The commissioner of human services must study presumptive functional eligibility
for people with disabilities and older adults in the following programs:

(1) medical assistance, alternative care, and essential community supports; and

(2) home and community-based services.

(b) The commissioner must evaluate the following in the study of presumptive eligibility
within the programs listed in paragraph (a):

(1) current eligibility processes;

(2) barriers to timely eligibility determinations; and

(3) strategies to enhance access to home and community-based services in the least
restrictive setting.

(c) By January 1, 2025, the commissioner must report recommendations and draft
legislation to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services finance and policy.

Sec. 61. SYSTEMIC REVIEW OF ACUTE CARE HOSPITALIZATIONS STUDY.

(a) The commissioner of human services must conduct a systemic review of acute care
hospitalizations for older adults on medical assistance and people on medical assistance
with disabilities and behavioral health conditions. The review must include:

(1) an analysis of reimbursement rates to support people with complex support needs;

(2) a survey of other states' policies, models, and service options to reduce and respond
to acute care hospitalizations;

(3) systemic critical incident reviews of people who are hospitalized in acute care
hospitals for longer than 90 days in order to determine systemic, regulatory, staff training,
or other reoccurring barriers keeping individuals from returning to the community or lower
levels of care; and

(4) a comparison of different methods to increase and enhance statewide provider capacity
to support people with complex needs.

(b) The commissioner must submit a report to the chairs and ranking minority members
of the legislative committees and divisions with jurisdiction over health and human services
policy and finance by January 15, 2025. The report must include proposed legislation
necessary to enact the report's recommendations.

Sec. 62. REPEALER.

Minnesota Statutes 2022, section 256B.4914, subdivision 6b, is repealed.

EFFECTIVE DATE.

This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

ARTICLE 2

AGING SERVICES

Section 1.

Minnesota Statutes 2022, section 256.975, subdivision 6, is amended to read:

Subd. 6.

Indian Native American elders coordinator position.

(a) The Minnesota
Board on Aging shall create an Indian a Native American elders coordinator position, and
shall hire staff as appropriations permit for the purposes of coordinating efforts with the
National Indian Council on Aging and developing facilitating the coordination and
development of a comprehensive statewide Tribal-based service system for Indian Native
American elders. An Indian elder is defined for purposes of this subdivision as an Indian
enrolled in a band or tribe who is 55 years or older.

(b) For purposes of this subdivision, the following terms have the meanings given:

(1) "Native American elder" means an individual enrolled in a federally recognized
Tribe and identified as an elder according to the requirements of the individual's home Tribe;
and

(2) "Tribal government" means representatives of each of the 11 federally recognized
Native American Tribes located wholly or partially within the boundaries of the state of
Minnesota.

(c) The statewide Tribal-based service system must may include the following
components:

(1) an assessment of the program eligibility, examining the need to change the age-based
eligibility criteria to need-based eligibility criteria;

(2) (1) a planning system that would plan to grant, or make recommendations for granting,
federal and state funding for statewide Tribal-based Native American programs and services;

(2) a plan to develop business initiatives involving Tribal members that will qualify for
federal- and state-funded elder service contracts;

(3) a plan for statewide Tribal-based service focal points, senior centers, or community
centers for socialization and service accessibility for Indian Native American elders;

(4) a plan to develop and implement statewide education and public awareness campaigns
promotions, including awareness programs, sensitivity cultural sensitivity training, and
public education on Indian elder needs Native American elders;

(5) a plan for statewide culturally appropriate information and referral services for Native
American elders, including legal advice and counsel and trained advocates and an Indian
elder newsletter;

(6) a plan for a coordinated statewide Tribal-based health care system including health
promotion/prevention promotion and prevention, in-home service, long-term care service,
and health care services;

(7) a plan for ongoing research involving Indian elders including needs assessment and
needs analysis; collection of significant data on Native American elders, including population,
health, socialization, mortality, homelessness, and economic status; and

(8) information and referral services for legal advice or legal counsel; and

(9) (8) a plan to coordinate services with existing organizations, including but not limited
to the state of Minnesota, the Council of Minnesota Indian Affairs Council, the Minnesota
Indian Council of Elders, the Minnesota Board on Aging, Wisdom Steps, and Minnesota
Tribal governments.

Sec. 2.

Minnesota Statutes 2022, section 256.9754, is amended to read:

256.9754 COMMUNITY SERVICES DEVELOPMENT LIVE WELL AT HOME
GRANTS PROGRAM.

Subdivision 1.

Definitions.

For purposes of this section, the following terms have the
meanings given.

(a) "Community" means a town, township, city, or targeted neighborhood within a city,
or a consortium of towns, townships, cities, or targeted neighborhoods within cities.

(b) "Core home and community-based services provider" means a Faith in Action, Living
at Home/Block Nurse, congregational nurse, or similar community-based program governed
by a board, the majority of whose members reside within the program's service area, that
organizes and uses volunteers and paid staff to deliver nonmedical services intended to
assist older adults to identify and manage risks and to maintain their community living and
integration in the community.

(c) "Long-term services and supports" means any service available under the elderly
waiver program or alternative care grant programs, nursing facility services, transportation
services, caregiver support and respite care services, and other home and community-based
services identified as necessary either to maintain lifestyle choices for older adults or to
support them to remain in their own home.

(b) (d) "Older adult services" means any services available under the elderly waiver
program or alternative care grant programs; nursing facility services; transportation services;
respite services; and other community-based services identified as necessary either to
maintain lifestyle choices for older Minnesotans, or to promote independence.

(c) (e) "Older adult" refers to individuals 65 years of age and older.

Subd. 2.

Creation; purpose.

(a) The community services development live well at home
grants program is are created under the administration of the commissioner of human
services.

(b) The purpose of projects selected by the commissioner of human services under this
section is to make strategic changes in the long-term services and supports system for older
adults and people with dementia, including statewide capacity for local service development
and technical assistance, and statewide availability of home and community-based services
for older adult services, caregiver support and respite care services, and other supports in
Minnesota. These projects are intended to create incentives for new and expanded home
and community-based services in Minnesota in order to:

(1) reach older adults early in the progression of their need for long-term services and
supports, providing them with low-cost, high-impact services that will prevent or delay the
use of more costly services;

(2) support older adults to live in the most integrated, least restrictive community setting;

(3) support the informal caregivers of older adults;

(4) develop and implement strategies to integrate long-term services and supports with
health care services, in order to improve the quality of care and enhance the quality of life
of older adults and their informal caregivers;

(5) ensure cost-effective use of financial and human resources;

(6) build community-based approaches and community commitment to delivering
long-term services and supports for older adults in their own homes;

(7) achieve a broad awareness and use of lower-cost in-home services as an alternative
to nursing homes and other residential services;

(8) strengthen and develop additional home and community-based services and
alternatives to nursing homes and other residential services; and

(9) strengthen programs that use volunteers.

(c) The services provided by these projects are available to older adults who are eligible
for medical assistance and the elderly waiver under chapter 256S, the alternative care
program under section 256B.0913, or the essential community supports grant under section
256B.0922, and to persons who have their own money to pay for services.

Subd. 3.

Provision of Community services development grants.

The commissioner
shall make community services development grants available to communities, providers of
older adult services identified in subdivision 1, or to a consortium of providers of older
adult services, to establish older adult services. Grants may be provided for capital and other
costs including, but not limited to, start-up and training costs, equipment, and supplies
related to older adult services or other residential or service alternatives to nursing facility
care. Grants may also be made to renovate current buildings, provide transportation services,
fund programs that would allow older adults or individuals with a disability to stay in their
own homes by sharing a home, fund programs that coordinate and manage formal and
informal services to older adults in their homes to enable them to live as independently as
possible in their own homes as an alternative to nursing home care, or expand state-funded
programs in the area.

Subd. 3a.

Priority for other grants.

The commissioner of health shall give priority to
a grantee selected under subdivision 3 when awarding technology-related grants, if the
grantee is using technology as part of the proposal unless that priority conflicts with existing
state or federal guidance related to grant awards by the Department of Health. The
commissioner of transportation shall give priority to a grantee under subdivision 3 when
distributing transportation-related funds to create transportation options for older adults
unless that preference conflicts with existing state or federal guidance related to grant awards
by the Department of Transportation.

Subd. 3b.

State waivers.

The commissioner of health may waive applicable state laws
and rules for grantees under subdivision 3 on a time-limited basis if the commissioner of
health determines that a participating grantee requires a waiver in order to achieve
demonstration project goals.

Subd. 3c.

Caregiver support and respite care projects.

(a) The commissioner shall
establish projects to expand the availability of caregiver support and respite care services
for family and other caregivers. The commissioner shall use a request for proposals to select
nonprofit entities to administer the projects. Projects must:

(1) establish a local coordinated network of volunteer and paid respite workers;

(2) coordinate assignment of respite care services to caregivers of older adults;

(3) assure the health and safety of the older adults;

(4) identify at-risk caregivers;

(5) provide information, education, and training for caregivers in the designated
community; and

(6) demonstrate the need in the proposed service area, particularly where nursing facility
closures have occurred or are occurring or areas with service needs identified by section
144A.351. Preference must be given for projects that reach underserved populations.

(b) Projects must clearly describe:

(1) how they will achieve their purpose;

(2) the process for recruiting, training, and retraining volunteers; and

(3) a plan to promote the project in the designated community, including outreach to
persons needing the services.

(c) Money for all projects under this subdivision may be used to:

(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
care services and assign workers to clients;

(2) recruit and train volunteer providers;

(3) provide information, training, and education to caregivers;

(4) advertise the availability of the caregiver support and respite care project; and

(5) purchase equipment to maintain a system of assigning workers to clients.

(d) Volunteer and caregiver training must include resources on how to support an
individual with dementia.

(e) Project money may not be used to supplant existing funding sources.

Subd. 3d.

Core home and community-based services projects.

The commissioner
shall select and contract with core home and community-based services providers for projects
to provide services and supports to older adults both with and without family and other
informal caregivers using a request for proposals process. Projects must:

(1) have a credible public or private nonprofit sponsor providing ongoing financial
support;

(2) have a specific, clearly defined geographic service area;

(3) use a practice framework designed to identify high-risk older adults and help them
take action to better manage their chronic conditions and maintain their community living;

(4) have a team approach to coordination and care, ensuring that the older adult
participants, their families, and the formal and informal providers are all part of planning
and providing services;

(5) provide information, support services, homemaking services, counseling, and training
for the older adults and family caregivers;

(6) encourage service area or neighborhood residents and local organizations to
collaborate in meeting the needs of older adults in their geographic service areas;

(7) recruit, train, and direct the use of volunteers to provide informal services and other
appropriate support to older adults and their caregivers; and

(8) provide coordination and management of formal and informal services to older adults
and their families using less expensive alternatives.

Subd. 3e.

Community service grants.

The commissioner shall award contracts for
grants to public and private nonprofit agencies to establish services that strengthen a
community's ability to provide a system of home and community-based services for elderly
persons. The commissioner shall use a request for proposals process.

Subd. 4.

Eligibility.

Grants may be awarded only to communities and providers or to a
consortium of providers that have a local match of 50 percent of the costs for the project in
the form of donations, local tax dollars, in-kind donations, fundraising, or other local matches.

Subd. 5.

Grant preference.

The commissioner of human services shall give preference
when awarding grants under this section to areas where nursing facility closures have
occurred or are occurring or areas with service needs identified by section 144A.351. The
commissioner may award grants to the extent grant funds are available and to the extent
applications are approved by the commissioner. Denial of approval of an application in one
year does not preclude submission of an application in a subsequent year. The maximum
grant amount is limited to $750,000.

Sec. 3.

[256.9756] CAREGIVER RESPITE SERVICES GRANTS.

Subdivision 1.

Caregiver respite services grant program established.

The
commissioner of human services must establish a caregiver respite services grant program
to increase the availability of respite services for family caregivers of people with dementia
and older adults and to provide information, education, and training to respite caregivers
and volunteers regarding caring for people with dementia. From the money made available
for this purpose, the commissioner must award grants on a competitive basis to respite
service providers, giving priority to areas of the state where there is a high need of respite
services.

Subd. 2.

Eligible uses.

Grant recipients awarded grant money under this section must
use a portion of the grant award as determined by the commissioner to provide free or
subsidized respite services for family caregivers of people with dementia and older adults.

Subd. 3.

Report.

By January 15, 2026, and every other January 15 thereafter, the
commissioner shall submit a progress report about the caregiver respite services grants in
this section to the chairs and ranking minority members of the legislative committees with
jurisdiction over human services finance and policy. The progress report must include
metrics of the use of the grant program money.

Sec. 4.

Minnesota Statutes 2022, section 256B.0917, subdivision 1b, is amended to read:

Subd. 1b.

Definitions.

(a) For purposes of this section, the following terms have the
meanings given.

(b) "Community" means a town; township; city; or targeted neighborhood within a city;
or a consortium of towns, townships, cities, or specific neighborhoods within a city.

(c) "Core home and community-based services provider" means a Faith in Action, Living
at Home Block Nurse, Congregational Nurse, or similar community-based program governed
by a board, the majority of whose members reside within the program's service area, that
organizes and uses volunteers and paid staff to deliver nonmedical services intended to
assist older adults to identify and manage risks and to maintain their community living and
integration in the community.

(d) (b) "Eldercare development partnership" means a team of representatives of county
social service and public health agencies, the area agency on aging, local nursing home
providers, local home care providers, and other appropriate home and community-based
providers in the area agency's planning and service area.

(e) (c) "Long-term services and supports" means any service available under the elderly
waiver program or alternative care grant programs, nursing facility services, transportation
services, caregiver support and respite care services, and other home and community-based
services identified as necessary either to maintain lifestyle choices for older adults or to
support them to remain in their own home.

(f) (d) "Older adult" refers to an individual who is 65 years of age or older.

Sec. 5.

Minnesota Statutes 2022, section 256M.42, is amended to read:

256M.42 ADULT PROTECTION GRANT ALLOCATIONS.

Subdivision 1.

Formula.

(a) The commissioner shall allocate state money appropriated
under this section on an annual basis to each county board and tribal government approved
by the commissioner to assume county agency duties for adult protective services or as a
lead investigative agency protection under section 626.557 on an annual basis in an amount
determined and to Tribal Nations that have voluntarily chosen by resolution of Tribal
government to participate in vulnerable adult protection programs according to the following
formula after the award of the amounts in paragraph (c):

(1) 25 percent must be allocated to the responsible agency on the basis of the number
of reports of suspected vulnerable adult maltreatment under sections 626.557 and 626.5572,
when the county or tribe is responsible as determined by the most recent data of the
commissioner; and

(2) 75 percent must be allocated to the responsible agency on the basis of the number
of screened-in reports for adult protective services or vulnerable adult maltreatment
investigations under sections 626.557 and 626.5572, when the county or tribe is responsible
as determined by the most recent data of the commissioner.

(b) The commissioner is precluded from changing the formula under this subdivision
or recommending a change to the legislature without public review and input.
Notwithstanding this subdivision, no county must be awarded less than a minimum allocation
established by the commissioner.

(c) To receive money under this subdivision, a participating Tribal Nation must apply
to the commissioner. Of the amount appropriated for purposes of this section, the
commissioner must award $100,000 to each federally recognized Tribal Nation with a Tribal
resolution establishing a vulnerable adult protection program. Money received by a Tribal
Nation under this section must be used for its vulnerable adult protection program.

Subd. 2.

Payment.

The commissioner shall make allocations for the state fiscal year
starting July 1, 2019 2023, and to each county board or Tribal government on or before
October 10, 2019 2023. The commissioner shall make allocations under subdivision 1 to
each county board or Tribal government each year thereafter on or before July 10.

Subd. 3.

Prohibition on supplanting existing money Purpose of expenditures.

Money
received under this section must be used for staffing for protection of vulnerable adults or
to meet the agency's duties under section 626.557 and to expand adult protective services
to stop, prevent, and reduce risks of maltreatment for adults accepted for services under
section 626.557 or for multidisciplinary teams under section 626.5571. Money must not be
used to supplant current county or tribe expenditures for these purposes.

Subd. 4.

Required expenditures.

State money must be used to expand, not supplant,
county or Tribal expenditures for the fiscal year 2023 base for adult protection programs,
service interventions, or multidisciplinary teams. This prohibition on county or Tribal
expenditures supplanting state money ends July 1, 2027.

Subd. 5.

County performance on adult protection measures.

The commissioner must
set vulnerable adult protection measures and standards for money received under this section.
The commissioner must require an underperforming county to demonstrate that the county
designated money allocated under this section for the purpose required and implemented a
reasonable strategy to improve adult protection performance, including the development of
a performance improvement plan and additional remedies identified by the commissioner.
The commissioner may redirect up to 20 percent of an underperforming county's money
under this section toward the performance improvement plan.

Subd. 6.

American Indian adult protection.

Tribal Nations shall establish vulnerable
adult protection measures and standards and report annually to the commissioner on these
outcomes and the number of adults served.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 6.

Minnesota Statutes 2022, section 256R.17, subdivision 2, is amended to read:

Subd. 2.

Case mix indices.

(a) The commissioner shall assign a case mix index to each
case mix classification based on the Centers for Medicare and Medicaid Services staff time
measurement study as determined by the commissioner of health under section 144.0724.

(b) An index maximization approach shall be used to classify residents. "Index
maximization" has the meaning given in section 144.0724, subdivision 2, paragraph (c).

Sec. 7.

Minnesota Statutes 2022, section 256R.25, is amended to read:

256R.25 EXTERNAL FIXED COSTS PAYMENT RATE.

(a) The payment rate for external fixed costs is the sum of the amounts in paragraphs
(b) to (o) (p).

(b) For a facility licensed as a nursing home, the portion related to the provider surcharge
under section 256.9657 is equal to $8.86 per resident day. For a facility licensed as both a
nursing home and a boarding care home, the portion related to the provider surcharge under
section 256.9657 is equal to $8.86 per resident day multiplied by the result of its number
of nursing home beds divided by its total number of licensed beds.

(c) The portion related to the licensure fee under section 144.122, paragraph (d), is the
amount of the fee divided by the sum of the facility's resident days.

(d) The portion related to development and education of resident and family advisory
councils under section 144A.33 is $5 per resident day divided by 365.

(e) The portion related to scholarships is determined under section 256R.37.

(f) The portion related to planned closure rate adjustments is as determined under section
256R.40, subdivision 5, and Minnesota Statutes 2010, section 256B.436.

(g) The portion related to consolidation rate adjustments shall be as determined under
section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d.

(h) The portion related to single-bed room incentives is as determined under section
256R.41.

(i) The portions related to real estate taxes, special assessments, and payments made in
lieu of real estate taxes directly identified or allocated to the nursing facility are the allowable
amounts divided by the sum of the facility's resident days. Allowable costs under this
paragraph for payments made by a nonprofit nursing facility that are in lieu of real estate
taxes shall not exceed the amount which the nursing facility would have paid to a city or
township and county for fire, police, sanitation services, and road maintenance costs had
real estate taxes been levied on that property for those purposes.

(j) The portion related to employer health insurance costs is the allowable costs divided
by the sum of the facility's resident days.

(k) The portion related to the Public Employees Retirement Association is the allowable
costs divided by the sum of the facility's resident days.

(l) The portion related to quality improvement incentive payment rate adjustments is
the amount determined under section 256R.39.

(m) The portion related to performance-based incentive payments is the amount
determined under section 256R.38.

(n) The portion related to special dietary needs is the amount determined under section
256R.51.

(o) The portion related to the rate adjustments for border city facilities is the amount
determined under section 256R.481.

(p) The portion related to the rate adjustment for critical access nursing facilities is the
amount determined under section 256R.47.

Sec. 8.

Minnesota Statutes 2022, 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:, the commissioner shall allow a supplemental
payment above a facility's operating payment rate as determined to be necessary by the
commissioner to maintain access to nursing facility services in isolated areas identified in
paragraph (b). The commissioner must approve the amounts of supplemental payments
through a memorandum of understanding. Supplemental payments to facilities under this
section must be in the form of time-limited rate adjustments included in the external fixed
costs payment rate under section 256R.25.

(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 maximum period of up to
two years, after which the benefits benefit 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, 2019.

(e) The memorandum of understanding required by paragraph (c) must state that the
designation of a critical access nursing facility must be removed if the facility undergoes a
change of ownership as defined in section 144A.06, subdivision 2.

Sec. 9.

Minnesota Statutes 2022, section 256S.211, is amended to read:

256S.211 RATE SETTING; RATE ESTABLISHMENT UPDATING RATES;
EVALUATION; COST REPORTING.

Subdivision 1.

Establishing base wages.

When establishing the base wages according
to section 256S.212, the commissioner shall use standard occupational classification (SOC)
codes from the Bureau of Labor Statistics as defined in the edition of the Occupational
Handbook published immediately prior to January 1, 2019, using Minnesota-specific wages
taken from job descriptions.

Subd. 2.

Establishing Updating rates.

By January 1 of each year, The commissioner
shall establish factors, update component rates, and rates effective January 1, 2024, according
to sections 256S.213 and 256S.212 to 256S.215, using the factor and base wages established
according to section 256S.212 values the commissioner used to establish rates effective
January 1, 2019.

Subd. 3.

Spending requirements.

(a) Except for community access for disability
inclusion customized living and brain injury customized living under section 256B.49, at
least 80 percent of the marginal increase in revenue from the implementation of any rate
adjustments under this section must be used to increase compensation-related costs for
employees directly employed by the provider.

(b) For the purposes of this subdivision, compensation-related costs include:

(1) wages and salaries;

(2) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, workers' compensation, and mileage reimbursement;

(3) the employer's paid share of health and dental insurance, life insurance, disability
insurance, long-term care insurance, uniform allowance, pensions, and contributions to
employee retirement accounts; and

(4) benefits that address direct support professional workforce needs above and beyond
what employees were offered prior to the implementation of any rate adjustments under
this section, including any concurrent or subsequent adjustments to the base wage indices.

(c) Compensation-related costs for persons employed in the central office of a corporation
or entity that has an ownership interest in the provider or exercises control over the provider,
or for persons paid by the provider under a management contract, do not count toward the
80 percent requirement under this subdivision.

(d) A provider agency or individual provider that receives additional revenue subject to
the requirements of this subdivision shall prepare, and upon request submit to the
commissioner, a distribution plan that specifies the amount of money the provider expects
to receive that is subject to the requirements of this subdivision, including how that money
was or will be distributed to increase compensation-related costs for employees. Within 60
days of final implementation of the new phase-in proportion or adjustment to the base wage
indices subject to the requirements of this subdivision, the provider must post the distribution
plan and leave it posted for a period of at least six months in an area of the provider's
operation to which all employees have access. The posted distribution plan must include
instructions regarding how to contact the commissioner, or the commissioner's representative,
if an employee has not received the compensation-related increase described in the plan.

Subd. 4.

Evaluation of rate setting.

(a) Beginning January 1, 2024, and every two years
thereafter, the commissioner, in consultation with stakeholders, shall use all available data
and resources to evaluate the following rate setting elements:

(1) the base wage index;

(2) the factors and supervision wage components; and

(3) the formulas to calculate adjusted base wages and rates.

(b) Beginning January 15, 2026, and every two years thereafter, the commissioner shall
report to the chairs and ranking minority members of the legislative committees and divisions
with jurisdiction over health and human services finance and policy with a full report on
the information and data gathered under paragraph (a).

Subd. 5.

Cost reporting.

(a) As determined by the commissioner, in consultation with
stakeholders, a provider enrolled to provide services with rates determined under this chapter
must submit requested cost data to the commissioner to support evaluation of the rate
methodologies in this chapter. Requested cost data may include but is not limited to:

(1) worker wage costs;

(2) benefits paid;

(3) supervisor wage costs;

(4) executive wage costs;

(5) vacation, sick, and training time paid;

(6) taxes, workers' compensation, and unemployment insurance costs paid;

(7) administrative costs paid;

(8) program costs paid;

(9) transportation costs paid;

(10) vacancy rates; and

(11) other data relating to costs required to provide services requested by the
commissioner.

(b) At least once in any five-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall provide each provider a 90-day notice prior to the provider's submission due date. If
by 30 days after the required submission date a provider fails to submit required reporting
data, the commissioner shall provide notice to the provider, and if by 60 days after the
required submission date a provider has not provided the required data the commissioner
shall provide a second notice. The commissioner shall temporarily suspend payments to the
provider if cost data are not received 90 days after the required submission date. Withheld
payments must be made once data is received by the commissioner.

(c) The commissioner shall coordinate the cost reporting activities required under this
section with the cost reporting activities directed under section 256B.4914, subdivision 10a.

(d) The commissioner shall analyze cost documentation in paragraph (a) and, in
consultation with stakeholders, may submit recommendations on rate methodologies in this
chapter, including ways to monitor and enforce the spending requirements directed in
subdivision 3, through the reports directed by subdivision 4.

EFFECTIVE DATE.

Subdivisions 2 to 4 are effective January 1, 2024, or upon federal
approval, whichever is later. The commissioner of human services shall notify the revisor
of statutes when federal approval is obtained. Subdivision 5 is effective January 1, 2025.

Sec. 10.

Minnesota Statutes 2022, section 256S.214, is amended to read:

256S.214 RATE SETTING; ADJUSTED BASE WAGE.

(a) For the purposes of section 256S.215, the adjusted base wage for each position equals
the position's base wage under section 256S.212 plus:

(1) the position's base wage multiplied by the payroll taxes and benefits factor under
section 256S.213, subdivision 1;

(2) the position's base wage multiplied by the general and administrative factor under
section 256S.213, subdivision 2; and

(3) the position's base wage multiplied by the program plan support factor under section
256S.213, subdivision 3.

(b) If the base wage described in paragraph (a) is below $16.96, the base wage shall
equal $16.96.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 11.

Minnesota Statutes 2022, section 256S.215, subdivision 15, is amended to read:

Subd. 15.

Home-delivered meals rate.

The home-delivered meals rate equals $9.30 is
the rate in effect on July 1, 2023, adjusted by 15.8 percent. The commissioner shall increase
the home delivered meals rate every July 1 by the percent increase in the nursing facility
dietary per diem using the two most recent and available nursing facility cost reports.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 12.

Laws 2021, chapter 30, article 12, section 5, as amended by Laws 2021, First
Special Session chapter 7, article 17, section 2, is amended to read:

Sec. 5. GOVERNOR'S COUNCIL ON AN AGE-FRIENDLY MINNESOTA.

The Governor's Council on an Age-Friendly Minnesota, established in Executive Order
19-38, shall: (1) work to advance age-friendly policies; and (2) coordinate state, local, and
private partners' collaborative work on emergency preparedness, with a focus on older
adults, communities, and persons in zip codes most impacted by the COVID-19 pandemic.
The Governor's Council on an Age-Friendly Minnesota is extended and expires June 30,
2024 2027.

Sec. 13.

Laws 2021, First Special Session chapter 7, article 17, section 8, is amended to
read:

Sec. 8. AGE-FRIENDLY MINNESOTA.

Subdivision 1.

Age-friendly community grants.

(a) This act includes $0 in fiscal year
2022 and $875,000 in fiscal year 2023 for age-friendly community grants. The commissioner
of human services, in collaboration with the Minnesota Board on Aging and the Governor's
Council on an Age-Friendly Minnesota, established in Executive Order 19-38, shall develop
the age-friendly community grant program to help communities, including cities, counties,
other municipalities, Tribes, and collaborative efforts, to become age-friendly communities,
with an emphasis on structures, services, and community features necessary to support older
adult residents over the next decade, including but not limited to:

(1) coordination of health and social services;

(2) transportation access;

(3) safe, affordable places to live;

(4) reducing social isolation and improving wellness;

(5) combating ageism and racism against older adults;

(6) accessible outdoor space and buildings;

(7) communication and information technology access; and

(8) opportunities to stay engaged and economically productive.

The general fund base in this act for this purpose is $875,000 in fiscal year 2024 and $0
$3,000,000 in fiscal year 2025.

(b) All grant activities must be completed by March 31, 2024 2027.

(c) This subdivision expires June 30, 2024 2027.

Subd. 2.

Technical assistance grants.

(a) This act includes $0 in fiscal year 2022 and
$575,000 in fiscal year 2023 for technical assistance grants. The commissioner of human
services, in collaboration with the Minnesota Board on Aging and the Governor's Council
on an Age-Friendly Minnesota, established in Executive Order 19-38, shall develop the
age-friendly technical assistance grant program. The general fund base in this act for this
purpose is $575,000 in fiscal year 2024 and $0 $1,725,000 in fiscal year 2025.

(b) All grant activities must be completed by March 31, 2024 2027.

(c) This subdivision expires June 30, 2024 2027.

Sec. 14. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; CAREGIVER
RESPITE SERVICES GRANTS.

Beginning in fiscal year 2025, the commissioner of human services must continue the
respite services for older adults grant program established under Laws 2021, First Special
Session chapter 7, article 17, section 17, subdivision 3, under the authority granted under
Minnesota Statutes, section 256.9756. The commissioner may begin the grant application
process for awarding grants under Minnesota Statutes, section 256.9756, during fiscal year
2024 in order to facilitate the continuity of the grant program during the transition from a
temporary program to a permanent one.

Sec. 15. DIRECTION TO COMMISSIONER; FUTURE PACE IMPLEMENTATION
FUNDING.

(a) The commissioner of human services shall work collaboratively with stakeholders
to undertake an actuarial analysis of Medicaid costs for nursing home eligible beneficiaries
for the purposes of establishing a monthly Medicaid capitation rate for the program of
all-inclusive care for the elderly (PACE). The analysis must include all sources of state
Medicaid expenditures for nursing home eligible beneficiaries, including but not limited to
capitation payments to plans and additional state expenditures to skilled nursing facilities
consistent with Code of Federal Regulations, chapter 42, part 447, and long-term care costs.

(b) The commissioner shall also estimate the administrative costs associated with
implementing and monitoring PACE.

(c) The commissioner shall provide a report to the chairs and ranking minority members
of the legislative committees with jurisdiction over health care finance on the actuarial
analysis, proposed capitation rate, and estimated administrative costs by December 15,
2023. The commissioner shall recommend a financing mechanism and administrative
framework by July 1, 2024.

(d) By September 1, 2024, the commissioner shall inform the chairs and ranking minority
members of the legislative committees with jurisdiction over health care finance on the
commissioner's progress toward developing a recommended financing mechanism. For
purposes of this section, the commissioner may issue or extend a request for proposal to an
outside vendor.

Sec. 16. RATE INCREASE FOR CERTAIN HOME AND COMMUNITY-BASED
SERVICES.

The commissioner of human services shall increase payment rates for community living
assistance and family caregiver services under Minnesota Statutes, sections 256B.0913 and
256B.0922, and chapter 256S by 15.8 percent from the rates in effect on December 31,
2023.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 17. TEMPORARY GRANT FOR SMALL CUSTOMIZED LIVING
PROVIDERS.

The commissioner of human services must establish a temporary grant for customized
living providers that serve six or fewer people in a single-family home and that are
transitioning to community residential setting licensure or integrated community supports
licensure. Allowable uses of grant money include physical plant updates required for
community residential setting or integrated community supports licensure, technical
assistance to adapt business models and meet policy and regulatory guidance, and other
uses approved by the commissioner. License holders of eligible settings must apply for
grant money using an application process determined by the commissioner. Grant money
approved by the commissioner is a onetime award of up to $20,000 per eligible setting. To
be considered for grant money, eligible license holders must submit a grant application by
June 30, 2024. The commissioner may approve grant applications on a rolling basis.

Sec. 18. REVISOR INSTRUCTION.

The revisor of statutes shall change the headnote in Minnesota Statutes, section
256B.0917, from "HOME AND COMMUNITY-BASED SERVICES FOR OLDER
ADULTS" to "ELDERCARE DEVELOPMENT PARTNERSHIPS."

Sec. 19. REPEALER.

(a) Minnesota Statutes 2022, section 256S.2101, subdivisions 1 and 2, are repealed.

(b) Minnesota Statutes 2022, section 256B.0917, subdivisions 1a, 6, 7a, and 13, are
repealed.

EFFECTIVE DATE.

Paragraph (a) is effective January 1, 2024.

ARTICLE 3

BEHAVIORAL HEALTH

Section 1.

Minnesota Statutes 2022, section 4.046, subdivision 6, is amended to read:

Subd. 6.

Office of Addiction and recoveryRecovery; director.

The Office of Addiction
and Recovery is created in the Department of Management and Budget. The governor must
appoint an addiction and recovery director, who shall serve as chair of the subcabinet and
administer the Office of Addiction and Recovery. The director shall serve in the unclassified
service and shall report to the governor. The director must:

(1) make efforts to break down silos and work across agencies to better target the state's
role in addressing addiction, treatment, and recovery for youth and adults;

(2) assist in leading the subcabinet and the advisory council toward progress on
measurable goals that track the state's efforts in combatting addiction for youth and adults,
and preventing substance use and addiction among the state's youth population; and

(3) establish and manage external partnerships and build relationships with communities,
community leaders, and those who have direct experience with addiction to ensure that all
voices of recovery are represented in the work of the subcabinet and advisory council.

Sec. 2.

Minnesota Statutes 2022, section 4.046, subdivision 7, is amended to read:

Subd. 7.

Staff and administrative support.

The commissioner of human services
management and budget, in coordination with other state agencies and boards as applicable,
must provide staffing and administrative support to the Office of Addiction and Recovery,
the addiction and recovery director, the subcabinet, and the advisory council established in
this section.

Sec. 3.

Minnesota Statutes 2022, section 245.91, subdivision 4, is amended to read:

Subd. 4.

Facility or program.

"Facility" or "program" means a nonresidential or
residential program as defined in section 245A.02, subdivisions 10 and 14, and any agency,
facility, or program that provides services or treatment for mental illness, developmental
disability, substance use disorder, or emotional disturbance that is required to be licensed,
certified, or registered by the commissioner of human services, health, or education; a sober
home under section 254B.18; and an acute care inpatient facility that provides services or
treatment for mental illness, developmental disability, substance use disorder, or emotional
disturbance.

Sec. 4.

Minnesota Statutes 2022, section 245G.01, is amended by adding a subdivision to
read:

Subd. 4a.

American Society of Addiction Medicine criteria or ASAM
criteria.

"American Society of Addiction Medicine criteria" or "ASAM criteria" has the
meaning provided in section 254B.01, subdivision 2a.

Sec. 5.

Minnesota Statutes 2022, section 245G.01, is amended by adding a subdivision to
read:

Subd. 20c.

Protective factors.

"Protective factors" means the actions or efforts a person
can take to reduce the negative impact of certain issues, such as substance use disorders,
mental health disorders, and risk of suicide. Protective factors include connecting to positive
supports in the community, a nutritious diet, exercise, attending counseling or 12-step
groups, and taking appropriate medications.

Sec. 6.

Minnesota Statutes 2022, section 245G.02, subdivision 2, is amended to read:

Subd. 2.

Exemption from license requirement.

This chapter does not apply to a county
or recovery community organization that is providing a service for which the county or
recovery community organization is an eligible vendor under section 254B.05. This chapter
does not apply 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. A license holder providing the initial set of
substance use disorder services allowable under section 254A.03, subdivision 3, paragraph
(c), to an individual referred to a licensed nonresidential substance use disorder treatment
program after a positive screen for alcohol or substance misuse is exempt from sections
245G.05; 245G.06, subdivisions 1, 1a, 2, and 4; 245G.07, subdivisions 1, paragraph (a),
clauses (2) to (4), and 2, clauses (1) to (7); and 245G.17.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 7.

Minnesota Statutes 2022, section 245G.05, subdivision 1, is amended to read:

Subdivision 1.

Comprehensive assessment.

(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 five calendar days from the day of service initiation for a residential
program or within three calendar days on which a treatment session has been provided of
the day of service initiation for a client by the end of the fifth day on which a treatment
service is provided in a nonresidential program. The number of days to complete the
comprehensive assessment excludes the day of service initiation. If the comprehensive
assessment is not completed within the required time frame, the person-centered reason for
the delay and the planned completion date must be documented in the client's file. The
comprehensive assessment is complete upon a qualified staff member's dated signature. If
the client received a comprehensive assessment that authorized the treatment service, an
alcohol and drug counselor may use the comprehensive assessment for requirements of this
subdivision but must document a review of the comprehensive assessment and update the
comprehensive assessment as clinically necessary to ensure compliance with this subdivision
within applicable timelines. 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:

(1) age, sex, cultural background, sexual orientation, living situation, economic status,
and level of education;

(2) a description of the circumstances on the day of service initiation;

(3) a list of previous attempts at treatment for substance misuse or substance use disorder,
compulsive gambling, or mental illness;

(4) a list of 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
of the most recent use and address the absence or presence of previous withdrawal symptoms;

(5) specific problem behaviors exhibited by the client when under the influence of
substances;

(6) the client's desire for family involvement in the treatment program, family history
of substance use and misuse, history or presence of physical or sexual abuse, and level of
family support;

(7) physical and medical concerns or diagnoses, current medical treatment needed or
being received related to the diagnoses, and whether the concerns need to be referred to an
appropriate health care professional;

(8) mental health history, including symptoms and the effect on the client's ability to
function; current mental health treatment; 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;

(9) arrests and legal interventions related to substance use;

(10) a description of how the client's use affected the client's ability to function
appropriately in work and educational settings;

(11) ability to understand written treatment materials, including rules and the client's
rights;

(12) a description of any risk-taking behavior, including behavior that puts the client at
risk of exposure to blood-borne or sexually transmitted diseases;

(13) social network in relation to expected support for recovery;

(14) leisure time activities that are associated with substance use;

(15) whether the client is pregnant and, if so, the health of the unborn child and the
client's current involvement in prenatal care;

(16) whether the client recognizes needs related to substance use and is willing to follow
treatment recommendations; and

(17) information from a collateral contact may be included, but is not required.

(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:

(1) risks for opioid use disorder and dependence;

(2) treatment options, including the use of a medication for opioid use disorder;

(3) the risk of and recognizing opioid overdose; and

(4) the use, availability, and administration of naloxone to respond to opioid overdose.

(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.

(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:

(1) the client is in severe withdrawal and likely to be a danger to self or others;

(2) the client has severe medical problems that require immediate attention; or

(3) the client has severe emotional or behavioral symptoms that place the client or others
at risk of harm.

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. An alcohol and drug
counselor must sign and date the comprehensive assessment review and update.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 8.

Minnesota Statutes 2022, section 245G.05, is amended by adding a subdivision to
read:

Subd. 3.

Comprehensive assessment requirements.

(a) A comprehensive assessment
must meet the requirements under section 245I.10, subdivision 6, paragraphs (b) and (c).
It must also include:

(1) a diagnosis of a substance use disorder or a finding that the client does not meet the
criteria for a substance use disorder;

(2) a determination of whether the individual screens positive for co-occurring mental
health disorders using a screening tool approved by the commissioner pursuant to section
245.4863;

(3) a risk rating and summary to support the risk ratings within each of the dimensions
listed in section 254B.04, subdivision 4; and

(4) a recommendation for the ASAM level of care identified in section 254B.19,
subdivision 1.

(b) If the individual is assessed for opioid use disorder, the program must provide
educational material to the client within 24 hours of service initiation on:

(1) risks for opioid use disorder and dependence;

(2) treatment options, including the use of a medication for opioid use disorder;

(3) the risk and recognition of opioid overdose; and

(4) the use, availability, and administration of an opiate antagonist to respond to opioid
overdose.

If the client is identified as having opioid use disorder at a later point, the required educational
material must be provided at that point. The license holder must use the educational materials
that are approved by the commissioner to comply with this requirement.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 9.

Minnesota Statutes 2022, section 245G.06, subdivision 1, is amended to read:

Subdivision 1.

General.

Each client must have a person-centered individual treatment
plan developed by an alcohol and drug counselor within ten days from the day of service
initiation for a residential program and within five calendar days, by the end of the tenth
day on which a treatment session has been provided from the day of service initiation for
a client in a nonresidential program, not to exceed 30 days. Opioid treatment programs must
complete the individual treatment plan within 21 days from the day of service initiation.
The number of days to complete the individual treatment plan excludes the day of service
initiation. 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
individual treatment plan is developed upon the qualified staff member's dated signature.
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, the
client's level of participation, 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. If the
client chooses to have family or others involved in treatment services, the client's individual
treatment plan must include how the family or others will be involved in the client's treatment.
If a client is receiving treatment services or an assessment via telehealth and the alcohol
and drug counselor documents the reason the client's signature cannot be obtained, the
alcohol and drug counselor may document the client's verbal approval or electronic written
approval of the treatment plan or change to the treatment plan in lieu of the client's signature.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 10.

Minnesota Statutes 2022, section 245G.06, is amended by adding a subdivision
to read:

Subd. 1a.

Individual treatment plan contents and process.

(a) After completing a
client's comprehensive assessment, the license holder must complete an individual treatment
plan. The license holder must:

(1) base the client's individual treatment plan on the client's comprehensive assessment;

(2) use a person-centered, culturally appropriate planning process that allows the client's
family and other natural supports to observe and participate in the client's individual treatment
services, assessments, and treatment planning;

(3) identify the client's treatment goals in relation to any or all of the applicable ASAM
six dimensions identified in section 254B.04, subdivision 4, to ensure measurable treatment
objectives, a treatment strategy, and a schedule for accomplishing the client's treatment
goals and objectives;

(4) document in the treatment plan the ASAM level of care identified in section 254B.19,
subdivision 1, under which the client is receiving services;

(5) identify the participants involved in the client's treatment planning. The client must
participate in the client's treatment planning. If applicable, the license holder must document
the reasons that the license holder did not involve the client's family or other natural supports
in the client's treatment planning;

(6) identify resources to refer the client to when the client's needs will be addressed
concurrently by another provider; and

(7) identify maintenance strategy goals and methods designed to address relapse
prevention and to strengthen the client's protective factors.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 11.

Minnesota Statutes 2022, section 245G.06, subdivision 3, is amended to read:

Subd. 3.

Treatment plan review.

A treatment plan review must be entered in a client's
file weekly or after each treatment service, whichever is less frequent, completed by the
alcohol and drug counselor responsible for the client's treatment plan. 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 and must:

(1) address each goal in the document client goals addressed since the last treatment
plan review and whether the identified methods to address the goals are continue to be
effective;

(2) include document monitoring of any physical and mental health problems and include
toxicology results for alcohol and substance use, when available;

(3) document the participation of others involved in the individual's treatment planning,
including when services are offered to the client's family or significant others;

(4) if changes to the treatment plan are determined to be necessary, document staff
recommendations for changes in the methods identified in the treatment plan and whether
the client agrees with the change; and

(5) include a review and evaluation of the individual abuse prevention plan according
to section 245A.65.; and

(6) document any referrals made since the previous treatment plan review.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 12.

Minnesota Statutes 2022, section 245G.06, is amended by adding a subdivision
to read:

Subd. 3a.

Frequency of treatment plan reviews.

(a) A license holder must ensure that
the alcohol and drug counselor responsible for a client's treatment plan completes and
documents a treatment plan review that meets the requirements of subdivision 3 in each
client's file, according to the frequencies required in this subdivision. All ASAM levels
referred to in this chapter are those described in section 254B.19, subdivision 1.

(b) For a client receiving residential ASAM level 3.3 or 3.5 high-intensity services or
residential hospital-based services, a treatment plan review must be completed once every
14 days.

(c) For a client receiving residential ASAM level 3.1 low-intensity services or any other
residential level not listed in paragraph (b), a treatment plan review must be completed once
every 30 days.

(d) For a client receiving nonresidential ASAM level 2.5 partial hospitalization services,
a treatment plan review must be completed once every 14 days.

(e) For a client receiving nonresidential ASAM level 1.0 outpatient or 2.1 intensive
outpatient services or any other nonresidential level not included in paragraph (d), a treatment
plan review must be completed once every 30 days.

(f) For a client receiving nonresidential opioid treatment program services according to
section 245G.22, a treatment plan review must be completed weekly for the ten weeks
following completion of the treatment plan and monthly thereafter. Treatment plan reviews
must be completed more frequently when clinical needs warrant.

(g) Notwithstanding paragraphs (e) and (f), for a client in a nonresidential program with
a treatment plan that clearly indicates less than five hours of skilled treatment services will
be provided to the client each month, a treatment plan review must be completed once every
90 days.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 13.

Minnesota Statutes 2022, section 245G.06, subdivision 4, is amended to read:

Subd. 4.

Service discharge summary.

(a) An alcohol and drug counselor must write a
service discharge summary for each client. The service discharge summary must be
completed within five days of the client's service termination. A copy of the client's service
discharge summary must be provided to the client upon the client's request.

(b) The service discharge summary must be recorded in the six dimensions listed in
section 245G.05, subdivision 2, paragraph (c) 254B.04, subdivision 4, and include the
following information:

(1) the client's issues, strengths, and needs while participating in treatment, including
services provided;

(2) the client's progress toward achieving each goal identified in the individual treatment
plan;

(3) a risk description according to section 245G.05 254B.04, subdivision 4;

(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 requirements in section 245G.14,
subdivision 3, clause (3);

(5) the client's living arrangements at service termination;

(6) 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; and

(7) service termination diagnosis.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 14.

Minnesota Statutes 2022, section 245G.09, subdivision 3, is amended to read:

Subd. 3.

Contents.

Client records must contain the following:

(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). If the client has an opioid use disorder, the record
must contain documentation that the client was provided educational information according
to section 245G.05, subdivision 1 3, paragraph (b);

(2) an initial services plan completed according to section 245G.04;

(3) a comprehensive assessment completed according to section 245G.05;

(4) an assessment summary completed according to section 245G.05, subdivision 2;

(5) (4) an individual abuse prevention plan according to sections 245A.65, subdivision
2, and 626.557, subdivision 14, when applicable;

(6) (5) an individual treatment plan according to section 245G.06, subdivisions 1 and
2;

(7) (6) documentation of treatment services, significant events, appointments, concerns,
and treatment plan reviews according to section 245G.06, subdivisions 2a, 2b, and 3, and
3a; and

(8) (7) a summary at the time of service termination according to section 245G.06,
subdivision 4.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 15.

Minnesota Statutes 2022, section 245G.22, subdivision 15, is amended to read:

Subd. 15.

Nonmedication treatment services; documentation.

(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 the day of service initiation, 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 meet the requirements in
section 245G.07, subdivision 1, paragraph (a), and must document each time the client was
offered an individual or group counseling service. If the individual or group counseling
service was offered but not provided to the client, the license holder must document the
reason the service was not provided. If the service was provided, the license holder must
ensure that the service is documented according to the requirements in section 245G.06,
subdivision 2a .

(b) Notwithstanding the requirements of comprehensive assessments in section 245G.05,
the assessment must be completed within 21 days from the day of service initiation.

(c) Notwithstanding the requirements of individual treatment plans set forth in section
:

(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;

(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; and

(3) for the ten weeks following the day of service initiation for all new admissions,
readmissions, and transfers, a weekly treatment plan review must be documented once the
treatment plan is completed. Subsequently, the counselor must document treatment plan
reviews in the six dimensions at least once monthly or, when clinical need warrants, more
frequently.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 16.

Minnesota Statutes 2022, section 245I.10, subdivision 6, is amended to read:

Subd. 6.

Standard diagnostic assessment; required elements.

(a) Only a mental health
professional or a clinical trainee may complete a standard diagnostic assessment of a client.
A standard diagnostic assessment of a client must include a face-to-face interview with a
client and a written evaluation of the client. The assessor must complete a client's standard
diagnostic assessment within the client's cultural context. An alcohol and drug counselor
may gather and document the information in paragraphs (b) and (c) when completing a
comprehensive assessment according to section 245G.05.

(b) When completing a standard diagnostic assessment of a client, the assessor must
gather and document information about the client's current life situation, including the
following information:

(1) the client's age;

(2) the client's current living situation, including the client's housing status and household
members;

(3) the status of the client's basic needs;

(4) the client's education level and employment status;

(5) the client's current medications;

(6) any immediate risks to the client's health and safety, including withdrawal symptoms,
medical conditions, and behavioral and emotional symptoms;

(7) the client's perceptions of the client's condition;

(8) the client's description of the client's symptoms, including the reason for the client's
referral;

(9) the client's history of mental health and substance use disorder treatment; and

(10) cultural influences on the client.; and

(11) substance use history, if applicable, including:

(i) amounts and types of substances, frequency and duration, route of administration,
periods of abstinence, and circumstances of relapse; and

(ii) the impact to functioning when under the influence of substances, including legal
interventions.

(c) If the assessor cannot obtain the information that this paragraph requires without
retraumatizing the client or harming the client's willingness to engage in treatment, the
assessor must identify which topics will require further assessment during the course of the
client's treatment. The assessor must gather and document information related to the following
topics:

(1) the client's relationship with the client's family and other significant personal
relationships, including the client's evaluation of the quality of each relationship;

(2) the client's strengths and resources, including the extent and quality of the client's
social networks;

(3) important developmental incidents in the client's life;

(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;

(5) the client's history of or exposure to alcohol and drug usage and treatment; and

(6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.

(d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.

(1) When completing a standard diagnostic assessment of a client who is five years of
age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood
published by Zero to Three.

(2) When completing a standard diagnostic assessment of a client who is six years of
age or older, the assessor must use the current edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.

(3) When completing a standard diagnostic assessment of a client who is five years of
age or younger, an assessor must administer the Early Childhood Service Intensity Instrument
(ECSII) to the client and include the results in the client's assessment.

(4) When completing a standard diagnostic assessment of a client who is six to 17 years
of age, an assessor must administer the Child and Adolescent Service Intensity Instrument
(CASII) to the client and include the results in the client's assessment.

(5) When completing a standard diagnostic assessment of a client who is 18 years of
age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the criteria
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association to screen and assess the client for a
substance use disorder.

(e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:

(1) the client's mental status examination;

(2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources;
vulnerabilities; safety needs, including client information that supports the assessor's findings
after applying a recognized diagnostic framework from paragraph (d); and any differential
diagnosis of the client; and

(3) an explanation of: (i) how the assessor diagnosed the client using the information
from the client's interview, assessment, psychological testing, and collateral information
about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths;
and (v) the client's responsivity factors.

(f) When completing a standard diagnostic assessment of a client, the assessor must
consult the client and the client's family about which services that the client and the family
prefer to treat the client. The assessor must make referrals for the client as to services required
by law.

Sec. 17.

Minnesota Statutes 2022, section 253B.10, subdivision 1, is amended to read:

Subdivision 1.

Administrative requirements.

(a) When a person is committed, the
court shall issue a warrant or an order committing the patient to the custody of the head of
the treatment facility, state-operated treatment program, or community-based treatment
program. The warrant or order shall state that the patient meets the statutory criteria for
civil commitment.

(b) The commissioner shall prioritize civilly committed patients who are determined by
the Office of Medical Director or a designee to require emergency admission to a
state-operated treatment program, as well as patients being admitted from jail or a correctional
institution who are:

(1) ordered confined in a state-operated treatment program for an examination under
Minnesota Rules of Criminal Procedure, rules 20.01, subdivision 4, paragraph (a), and
20.02, subdivision 2;

(2) under civil commitment for competency treatment and continuing supervision under
Minnesota Rules of Criminal Procedure, rule 20.01, subdivision 7;

(3) found not guilty by reason of mental illness under Minnesota Rules of Criminal
Procedure, rule 20.02, subdivision 8, and under civil commitment or are ordered to be
detained in a state-operated treatment program pending completion of the civil commitment
proceedings; or

(4) committed under this chapter to the commissioner after dismissal of the patient's
criminal charges.

Patients described in this paragraph must be admitted to a state-operated treatment program
within 48 hours of the Office of Medical Director or a designee determining that a medically
appropriate bed is available. The commitment must be ordered by the court as provided in
section 253B.09, subdivision 1, paragraph (d).

(c) Upon the arrival of a patient at the designated treatment facility, state-operated
treatment program, or community-based treatment program, the head of the facility or
program shall retain the duplicate of the warrant and endorse receipt upon the original
warrant or acknowledge receipt of the order. The endorsed receipt or acknowledgment must
be filed in the court of commitment. After arrival, the patient shall be under the control and
custody of the head of the facility or program.

(d) Copies of the petition for commitment, the court's findings of fact and conclusions
of law, the court order committing the patient, the report of the court examiners, and the
prepetition report, and any medical and behavioral information available shall be provided
at the time of admission of a patient to the designated treatment facility or program to which
the patient is committed. Upon a patient's referral to the commissioner of human services
for admission pursuant to subdivision 1, paragraph (b), any inpatient hospital, treatment
facility, jail, or correctional facility that has provided care or supervision to the patient in
the previous two years shall, when requested by the treatment facility or commissioner,
provide copies of the patient's medical and behavioral records to the Department of Human
Services for purposes of preadmission planning. This information shall be provided by the
head of the treatment facility to treatment facility staff in a consistent and timely manner
and pursuant to all applicable laws.

Sec. 18.

Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision
to read:

Subd. 2a.

American Society of Addiction Medicine criteria or ASAM
criteria.

"American Society of Addiction Medicine criteria" or "ASAM" means the clinical
guidelines for purposes of assessment, treatment, placement, and transfer or discharge of
individuals with substance use disorders. The ASAM criteria are contained in the current
edition of the ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and
Co-Occurring Conditions.

Sec. 19.

Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision
to read:

Subd. 9.

Skilled treatment services.

"Skilled treatment services" has the meaning given
for the "treatment services" described in section 245G.07, subdivisions 1, paragraph (a),
clauses (1) to (4), and 2, clauses (1) to (6). Skilled treatment services must be provided by
qualified professionals as identified in section 245G.07, subdivision 3.

Sec. 20.

Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision
to read:

Subd. 10.

Sober home.

A sober home is a cooperative living residence, a room and
board residence, an apartment, or any other living accommodation that:

(1) provides temporary housing to persons with substance use disorders;

(2) stipulates that residents must abstain from using alcohol or other illicit drugs or
substances not prescribed by a physician and meet other requirements as a condition of
living in the home;

(3) charges a fee for living there;

(4) does not provide counseling or treatment services to residents; and

(5) promotes sustained recovery from substance use disorders.

Sec. 21.

Minnesota Statutes 2022, section 254B.01, is amended by adding a subdivision
to read:

Subd. 11.

Comprehensive assessment.

"Comprehensive assessment" means a
person-centered, trauma-informed assessment that:

(1) is completed for a substance use disorder diagnosis, treatment planning, and
determination of client eligibility for substance use disorder treatment services;

(2) meets the requirements in section 245G.05; and

(3) is completed by an alcohol and drug counselor qualified according to section 245G.11,
subdivision 5.

Sec. 22.

Minnesota Statutes 2022, section 254B.04, is amended by adding a subdivision
to read:

Subd. 4.

Assessment criteria and risk descriptions.

(a) The level of care determination
must follow criteria approved by the commissioner.

(b) Dimension 1: Acute intoxication and withdrawal potential. A vendor must use the
following criteria in Dimension 1 to determine a client's acute intoxication and withdrawal
potential, the client's ability to cope with withdrawal symptoms, and the client's current
state of intoxication.

"0" The client displays full functioning with good ability to tolerate and cope with
withdrawal discomfort, and the client shows no signs or symptoms of intoxication or
withdrawal or diminishing signs or symptoms.

"1" The client can tolerate and cope with withdrawal discomfort. The client displays
mild-to-moderate intoxication or signs and symptoms interfering with daily functioning but
does not immediately endanger self or others. The client poses a minimal risk of severe
withdrawal.

"2" The client has some difficulty tolerating and coping with withdrawal discomfort.
The client's intoxication may be severe, but the client responds to support and treatment
such that the client does not immediately endanger self or others. The client displays moderate
signs and symptoms of withdrawal with moderate risk of severe withdrawal.

"3" The client tolerates and copes with withdrawal discomfort poorly. The client has
severe intoxication, such that the client endangers self or others, or intoxication has not
abated with less intensive services. The client displays severe signs and symptoms of
withdrawal, has a risk of severe-but-manageable withdrawal, or has worsening withdrawal
despite detoxification at a less intensive level.

"4" The client is incapacitated with severe signs and symptoms. The client displays
severe withdrawal and is a danger to self or others.

(c) Dimension 2: biomedical conditions and complications. The vendor must use the
following criteria in Dimension 2 to determine a client's 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. If the
client is pregnant, the provider must determine the impact of continued substance use on
the unborn child.

"0" The client displays full functioning with good ability to cope with physical discomfort.

"1" The client tolerates and copes with physical discomfort and is able to get the services
that the client needs.

"2" The client has difficulty tolerating and coping with physical problems or has other
biomedical problems that interfere with recovery and treatment. The client neglects or does
not seek care for serious biomedical problems.

"3" The client tolerates and copes poorly with physical problems or has poor general
health. The client neglects the client's medical problems without active assistance.

"4" The client is unable to participate in substance use disorder treatment and has severe
medical problems, has a condition that requires immediate intervention, or is incapacitated.

(d) Dimension 3: Emotional, behavioral, and cognitive conditions and complications.
The vendor must use the following criteria in Dimension 3 to determine a client's 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.

"0" The client has good impulse control and coping skills and presents no risk of harm
to self or others. The client functions in all life areas and displays no emotional, behavioral,
or cognitive problems or the problems are stable.

"1" The client has impulse control and coping skills. The client presents a mild to
moderate risk of harm to self or others or displays symptoms of emotional, behavioral, or
cognitive problems. The client has a mental health diagnosis and is stable. The client
functions adequately in significant life areas.

"2" The client has difficulty with impulse control and lacks coping skills. The client has
thoughts of suicide or harm to others without means, however, the thoughts may interfere
with participation in some activities. The client has difficulty functioning in significant life
areas. The client has moderate symptoms of emotional, behavioral, or cognitive problems.
The client is able to participate in most treatment activities.

"3" The client has a severe lack of impulse control and coping skills. The client also has
frequent thoughts of suicide or harm to others including a plan and the means to carry out
the plan. In addition, the client is severely impaired in significant life areas and has severe
symptoms of emotional, behavioral, or cognitive problems that interfere with the client's
participation in treatment activities.

"4" The client has severe emotional or behavioral symptoms that place the client or
others at acute risk of harm. The client also has intrusive thoughts of harming self or others.
The client is unable to participate in treatment activities.

(e) Dimension 4: Readiness for change. The vendor must use the following criteria in
Dimension 4 to determine a client's readiness for change and the support necessary to keep
the client involved in treatment services.

"0" The client admits problems and is cooperative, motivated, ready to change, committed
to change, and engaged in treatment as a responsible participant.

"1" The client is motivated with active reinforcement to explore treatment and strategies
for change but ambivalent about illness or need for change.

"2" The client displays verbal compliance but lacks consistent behaviors, has low
motivation for change, and is passively involved in treatment.

"3" The client displays inconsistent compliance, displays minimal awareness of either
the client's addiction or mental disorder, and is minimally cooperative.

"4" The client is:

(i) noncompliant with treatment and has no awareness of addiction or mental disorder
and does not want or is unwilling to explore change or is in total denial of the client's illness
and its implications; or

(ii) the client is dangerously oppositional to the extent that the client is a threat of
imminent harm to self and others.

(f) Dimension 5: Relapse, continued use, and continued problem potential. The vendor
must use the following criteria in Dimension 5 to determine a client's relapse, continued
use, and continued problem potential and the degree to which the client recognizes relapse
issues and has the skills to prevent relapse of either substance use or mental health problems.

"0" The client recognizes risk well and is able to manage potential problems.

"1" The client recognizes relapse issues and prevention strategies but displays some
vulnerability for further substance use or mental health problems.

"2" The client has:

(i) minimal recognition and understanding of relapse and recidivism issues and displays
moderate vulnerability for further substance use or mental health problems; or

(ii) some coping skills inconsistently applied.

"3" The client has poor recognition and understanding of relapse and recidivism issues
and displays moderately high vulnerability for further substance use or mental health
problems. The client has few coping skills and rarely applies coping skills.

"4" The client has no coping skills to arrest mental health or addiction illnesses or prevent
relapse. The client has no recognition or understanding of relapse and recidivism issues and
displays high vulnerability for further substance use disorder or mental health problems.

(g) Dimension 6: Recovery environment. The vendor must use the following criteria in
Dimension 6 to determine a client's recovery environment, whether the areas of the client's
life are supportive of or antagonistic to treatment participation and recovery.

"0" The client is engaged in structured meaningful activity and has a supportive significant
other, family, and living environment.

"1" The client has passive social network support, or family and significant other are
not interested in the client's recovery. The client is engaged in structured meaningful activity.

"2" The client is engaged in structured, meaningful activity, but peers, family, significant
other, and living environment are unsupportive, or there is criminal justice involvement by
the client or among the client's peers, by a significant other, or in the client's living
environment.

"3" The client is not engaged in structured meaningful activity, and the client's peers,
family, significant other, and living environment are unsupportive, or there is significant
criminal justice system involvement.

"4" The client has:

(i) a chronically antagonistic significant other, living environment, family, or peer group
or a long-term criminal justice involvement that is harmful to recovery or treatment progress;
or

(ii) an actively antagonistic significant other, family, work, or living environment that
poses an immediate threat to the client's safety and well-being.

Sec. 23.

Minnesota Statutes 2022, section 254B.05, subdivision 5, is amended to read:

Subd. 5.

Rate requirements.

(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.

(b) Eligible substance use disorder treatment services include:

(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license; those licensed, as applicable, according to chapter
245G or applicable Tribal license and provided according to the following ASAM levels
of care:

(i) ASAM level 0.5 early intervention services provided according to section 254B.19,
subdivision 1, clause (1);

(ii) ASAM level 1.0 outpatient services provided according to section 254B.19,
subdivision 1, clause (2);

(iii) ASAM level 2.1 intensive outpatient services provided according to section 254B.19,
subdivision 1, clause (3);

(iv) ASAM level 2.5 partial hospitalization services provided according to section
254B.19, subdivision 1, clause (4);

(v) ASAM level 3.1 clinically managed low-intensity residential services provided
according to section 254B.19, subdivision 1, clause (5);

(vi) ASAM level 3.3 clinically managed population-specific high-intensity residential
services provided according to section 254B.19, subdivision 1, clause (6); and

(vii) ASAM level 3.5 clinically managed high-intensity residential services provided
according to section 254B.19, subdivision 1, clause (7);

(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;

(3) care treatment coordination services provided according to section 245G.07,
subdivision 1, paragraph (a), clause (5);

(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);

(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;

(6) substance use disorder treatment services with medications for opioid use disorder
that are provided in an opioid treatment program licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;

(7) substance use disorder treatment with medications for opioid use disorder plus
enhanced treatment services that meet the requirements of clause (6) and provide nine hours
of clinical services each week;

(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;

(9) (7) hospital-based treatment services that are licensed according to sections 245G.01
to 245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;

(10) (8) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 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;

(11) high-intensity residential treatment (9) ASAM 3.5 clinically managed high-intensity
residential services that are licensed according to sections 245G.01 to 245G.17 and 245G.21
or applicable tribal license, which provide 30 hours of clinical services each week ASAM
level of care 3.5 according to section 254B.19, subdivision 1, clause (7), and is 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

(12) (10) 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 section 245G.19, subdivision 4; 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 or culturally responsive programs as defined in section 254B.01,
subdivision 4a;

(3) disability responsive programs as defined in section 254B.01, subdivision 4b;

(4) 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; or

(5) programs that offer services to individuals with co-occurring mental health and
substance use disorder problems if:

(i) the program meets the co-occurring requirements in section 245G.20;

(ii) 25 percent of the counseling staff are licensed mental health professionals under
section 245I.04, subdivision 2, or are students or licensing candidates under the supervision
of a licensed alcohol and drug counselor supervisor and mental health professional under
section 245I.04, subdivision 2, 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 use disorder
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 substance use disorder 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 section 245G.19.

(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, substance use disorder services that are otherwise covered
as direct face-to-face services may be provided via telehealth as defined in section 256B.0625,
subdivision 3b. The use of telehealth to deliver services 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.

(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.

(h) Payment for outpatient substance use disorder services that are licensed according
to sections 245G.01 to 245G.17 is limited to six hours per day or 30 hours per week unless
prior authorization of a greater number of hours is obtained from the commissioner.

(i) Payment for substance use disorder services under this section must start from the
day of service initiation, when the comprehensive assessment is completed within the
required timelines.

EFFECTIVE DATE.

Paragraph (b), clause (1), items (i) to (iv), are effective January
1, 2025, or upon federal approval, whichever is later. Paragraph (b), clause (1), items (v)
to (vii), are effective January 1, 2024, or upon federal approval, whichever is later. Paragraph
(b), clauses (2) to (10), are effective January 1, 2024.

Sec. 24.

[254B.17] WITHDRAWAL MANAGEMENT START-UP AND
CAPACITY-BUILDING GRANTS.

The commissioner must establish start-up and capacity-building grants for prospective
or new withdrawal management programs licensed under chapter 245F that will meet
medically monitored or clinically monitored levels of care. Grants may be used for expenses
that are not reimbursable under Minnesota health care programs, including but not limited
to:

(1) costs associated with hiring staff;

(2) costs associated with staff retention;

(3) the purchase of office equipment and supplies;

(4) the purchase of software;

(5) costs associated with obtaining applicable and required licenses;

(6) business formation costs;

(7) costs associated with staff training; and

(8) the purchase of medical equipment and supplies necessary to meet health and safety
requirements.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 25.

[254B.18] SOBER HOMES.

Subdivision 1.

Requirements.

All sober homes must comply with applicable state laws
and regulations and local ordinances related to maximum occupancy, fire safety, and
sanitation. All sober homes must register with the Department of Human Services. In
addition, all sober homes must:

(1) maintain a supply of an opiate antagonist in the home;

(2) have trained staff that can administer an opiate antagonist;

(3) have written policies regarding access to all prescribed medications;

(4) have written policies regarding evictions;

(5) have staff training and policies regarding co-occurring mental illnesses;

(6) not prohibit prescribed medications taken as directed by a licensed prescriber, such
as pharmacotherapies specifically approved by the Food and Drug Administration (FDA)
for treatment of opioid use disorder and other medications with FDA-approved indications
for the treatment of co-occurring disorders; and

(7) return all property and medications to a person discharged from the home and retain
the items for a minimum of 60 days if the person did not collect them upon discharge. The
owner must make every effort to contact persons listed as emergency contacts for the
discharged person so that the items are returned.

Subd. 2.

Certification.

(a) The commissioner shall establish a certification program for
sober homes. Certification is mandatory for sober homes receiving any federal, state, or
local funding. The certification requirements must include:

(1) health and safety standards, including separate sleeping and bathroom facilities for
people who identify as men and people who identify as women, written policies on how to
accommodate residents who do not identify as a man or woman, and verification that the
home meets fire and sanitation ordinances;

(2) intake admission procedures, including documentation of names and contact
information for persons to contact in case of an emergency or upon discharge and notification
of a family member, or other emergency contact designated by the resident under certain
circumstances, including but not limited to death due to an overdose;

(3) an assessment of potential resident needs and appropriateness of the residence to
meet these needs;

(4) a resident bill of rights, including a right to a refund if discharged;

(5) policies to address mental health and health emergencies, to prevent a person from
hurting themselves or others, including contact information for emergency resources in the
community;

(6) policies on staff qualifications and prohibition against fraternization;

(7) drug-testing procedures and requirements;

(8) policies to mitigate medication misuse, including policies for:

(i) securing medication;

(ii) house staff providing medication at specified times to residents;

(iii) medication counts with staff and residents;

(iv) storing and providing prescribed medications and documenting when a person
accesses their prescribed medications; and

(v) ensuring that medications cannot be accessed by other residents;

(9) a policy on medications for opioid use disorder;

(10) having an opiate antagonist on site and in a conspicuous location;

(11) prohibiting charging exorbitant fees above standard costs for lab tests;

(12) discharge procedures, including involuntary discharge procedures that ensure at
least a 24-hours notice prior to filing an eviction action. The notice must include the reasons
for the involuntary discharge and a warning that an eviction action may become public as
soon as it is filed, making finding future housing more difficult;

(13) a policy on referrals to substance use disorder treatment services, mental health
services, peer support services, and support groups;

(14) training for staff on opiate antagonists, mental health crises, de-escalation,
person-centered planning, creating a crisis plan, and becoming a culturally informed and
responsive sober home;

(15) a fee schedule and refund policy;

(16) copies of all forms provided to residents;

(17) rules for residents;

(18) background checks of staff and administrators;

(19) policies that promote recovery by requiring resident participation in treatment,
self-help groups or other recovery supports; and

(20) policies requiring abstinence from alcohol and illicit drugs.

(b) Certifications must be renewed every three years.

Subd. 3.

Registry.

The commissioner shall create a registry containing a listing of sober
homes that have met the certification requirements. The registry must include each sober
home city and zip code, maximum resident capacity, and whether the setting serves a specific
population based on race, ethnicity, national origin, sexual orientation, gender identity, or
physical ability.

Subd. 4.

Bill of rights.

An individual living in a sober home has the right to:

(1) access to an environment that supports recovery;

(2) access to an environment that is safe and free from alcohol and other illicit drugs or
substances;

(3) be free from physical and verbal abuse, neglect, financial exploitation, and all forms
of maltreatment covered under the Vulnerable Adults Act, sections 626.557 to 626.5572;

(4) be treated with dignity and respect and to have personal property treated with respect;

(5) have personal, financial, and medical information kept private and to be advised of
the sober home's policies and procedures regarding disclosure of such information;

(6) access, while living in the residence, to other community-based support services as
needed;

(7) be referred to appropriate services upon leaving the residence, if necessary;

(8) retain personal property that does not jeopardize safety or health;

(9) assert these rights personally or have them asserted by the individual's representative
or by anyone on behalf of the individual without retaliation;

(10) be provided with the name, address, and telephone number of the ombudsman for
mental health, substance use disorder, and developmental disabilities and information about
the right to file a complaint;

(11) be fully informed of these rights and responsibilities, as well as program policies
and procedures; and

(12) not be required to perform services for the residence that are not included in the
usual expectations for all residents.

Subd. 5.

Private right of action.

In addition to pursuing other remedies, an individual
may bring an action to recover damages caused by a violation of this section. The court
shall award a resident who prevails in an action under this section double damages, costs,
disbursements, reasonable attorney fees, and any equitable relief the court deems appropriate.

Subd. 6.

Complaints; ombudsman for mental health and developmental
disabilities.

Any complaints about a sober home may be made to and reviewed or
investigated by the ombudsman for mental health and developmental disabilities, pursuant
to sections 245.91 and 245.94.

Sec. 26.

[254B.19] AMERICAN SOCIETY OF ADDICTION MEDICINE
STANDARDS OF CARE.

Subdivision 1.

Level of care requirements.

For each client assigned an ASAM level
of care, eligible vendors must implement the standards set by the ASAM for the respective
level of care. Additionally, vendors must meet the following requirements:

(1) for ASAM level 0.5 early intervention targeting individuals who are at risk of
developing a substance-related problem but may not have a diagnosed substance use disorder,
early intervention services may include individual or group counseling, treatment
coordination, peer recovery support, screening brief intervention, and referral to treatment
provided according to section 254A.03, subdivision 3, paragraph (c).

(2) for ASAM level 1.0 outpatient clients, adults must receive up to eight hours per week
of skilled treatment services and adolescents must receive up to five hours per week. Services
must be licensed according to section 245G.20 and meet requirements under section
256B.0759. Peer recovery and treatment coordination may be provided beyond the hourly
skilled treatment service hours allowable per week.

(3) for ASAM level 2.1 intensive outpatient clients, adults must receive nine to 19 hours
per week of skilled treatment services and adolescents must receive six or more hours per
week. Vendors must be licensed according to section 245G.20 and must meet requirements
under section 256B.0759. Peer recovery services and treatment coordination may be provided
beyond the hourly skilled treatment service hours allowable per week. If clinically indicated
on the client's treatment plan, this service may be provided in conjunction with room and
board according to section 254B.05, subdivision 1a.

(4) for ASAM level 2.5 partial hospitalization clients, adults must receive 20 hours or
more of skilled treatment services. Services must be licensed according to section 245G.20
and must meet requirements under section 256B.0759. Level 2.5 is for clients who need
daily monitoring in a structured setting, as directed by the individual treatment plan and in
accordance with the limitations in section 254B.05, subdivision 5, paragraph (h). If clinically
indicated on the client's treatment plan, this service may be provided in conjunction with
room and board according to section 254B.05, subdivision 1a.

(5) for ASAM level 3.1 clinically managed low-intensity residential clients, programs
must provide at least 5 hours of skilled treatment services per week according to each client's
specific treatment schedule, as directed by the individual treatment plan. Programs must be
licensed according to section 245G.20 and must meet requirements under section 256B.0759.

(6) for ASAM level 3.3 clinically managed population-specific high-intensity residential
clients, programs must be licensed according to section 245G.20 and must meet requirements
under section 256B.0759. Programs must have 24-hour staffing coverage. Programs must
be enrolled as a disability responsive program as described in section 254B.01, subdivision
4b, and must specialize in serving persons with a traumatic brain injury or a cognitive
impairment so significant, and the resulting level of impairment so great, that outpatient or
other levels of residential care would not be feasible or effective. Programs must provide,
at minimum, daily skilled treatment services seven days a week according to each client's
specific treatment schedule, as directed by the individual treatment plan.

(7) for ASAM level 3.5 clinically managed high-intensity residential clients, services
must be licensed according to section 245G.20 and must meet requirements under section
256B.0759. Programs must have 24-hour staffing coverage and provide, at minimum, daily
skilled treatment services seven days a week according to each client's specific treatment
schedule, as directed by the individual treatment plan.

(8) for ASAM level withdrawal management 3.2 clinically managed clients, withdrawal
management must be provided according to chapter 245F.

(9) for ASAM level withdrawal management 3.7 medically monitored clients, withdrawal
management must be provided according to chapter 245F.

Subd. 2.

Patient referral arrangement agreement.

The license holder must maintain
documentation of a formal patient referral arrangement agreement for each of the following
ASAM levels of care not provided by the license holder:

(1) level 1.0 outpatient;

(2) level 2.1 intensive outpatient;

(3) level 2.5 partial hospitalization;

(4) level 3.1 clinically managed low-intensity residential;

(5) level 3.3 clinically managed population-specific high-intensity residential;

(6) level 3.5 clinically managed high-intensity residential;

(7) level withdrawal management 3.2 clinically managed residential withdrawal
management; and

(8) level withdrawal management 3.7 medically monitored inpatient withdrawal
management.

Subd. 3.

Evidence-based practices.

All services delivered within the ASAM levels of
care referenced in subdivision 1, clauses (1) to (7), must have documentation of the
evidence-based practices being utilized as referenced in the most current edition of the
ASAM criteria.

Subd. 4.

Program outreach plan.

Eligible vendors providing services under ASAM
levels of care referenced in subdivision 1, clauses (2) to (7), must have a program outreach
plan. The treatment director must document a review and update the plan annually. The
program outreach plan must include treatment coordination strategies and processes to
ensure seamless transitions across the continuum of care. The plan must include how the
provider will:

(1) increase the awareness of early intervention treatment services, including but not
limited to the services defined in section 254A.03, subdivision 3, paragraph (c);

(2) coordinate, as necessary, with certified community behavioral health clinics when
a license holder is located in a geographic region served by a certified community behavioral
health clinic;

(3) establish a referral arrangement agreement with a withdrawal management program
licensed under chapter 245F when a license holder is located in a geographic region in which
a withdrawal management program is licensed under chapter 245F. If a withdrawal
management program licensed under chapter 245F is not geographically accessible, the
plan must include how the provider will address the client's need for this level of care;

(4) coordinate with inpatient acute care hospitals, including emergency departments,
hospital outpatient clinics, urgent care centers, residential crisis settings, medical
detoxification inpatient facilities and ambulatory detoxification providers in the area served
by the provider to help transition individuals from emergency department or hospital settings
and minimize the time between assessment and treatment;

(5) develop and maintain collaboration with local county and Tribal human services
agencies; and

(6) collaborate with primary care and mental health settings.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 27.

Minnesota Statutes 2022, section 256B.0759, subdivision 2, is amended to read:

Subd. 2.

Provider participation.

(a) Outpatient Programs licensed by the Department
of Human Services as nonresidential substance use disorder treatment providers may elect
to participate in the demonstration project and meet the requirements of subdivision 3. To
participate, a provider must notify the commissioner of the provider's intent to participate
in a format required by the commissioner and enroll as a demonstration project provider
programs that receive payment under this chapter must enroll as demonstration project
providers and meet the requirements of subdivision 3 by January 1, 2025. Programs that do
not meet the requirements of this paragraph are ineligible for payment for services provided
under section 256B.0625.

(b) Programs licensed by the Department of Human Services as residential treatment
programs according to section 245G.21 that receive payment under this chapter must enroll
as demonstration project providers and meet the requirements of subdivision 3 by January
1, 2024. Programs that do not meet the requirements of this paragraph are ineligible for
payment for services provided under section 256B.0625.

(c) Programs licensed by the Department of Human Services as residential treatment
programs according to section 245G.21 that receive payment under this chapter and are
licensed as a hospital under sections 144.50 to 144.581 must enroll as demonstration project
providers and meet the requirements of subdivision 3 by January 1, 2025.

(c) (d) Programs licensed by the Department of Human Services as withdrawal
management programs according to chapter 245F that receive payment under this chapter
must enroll as demonstration project providers and meet the requirements of subdivision 3
by January 1, 2024. Programs that do not meet the requirements of this paragraph are
ineligible for payment for services provided under section 256B.0625.

(d) (e) Out-of-state residential substance use disorder treatment programs that receive
payment under this chapter must enroll as demonstration project providers and meet the
requirements of subdivision 3 by January 1, 2024. Programs that do not meet the requirements
of this paragraph are ineligible for payment for services provided under section 256B.0625.

(e) (f) Tribally licensed programs may elect to participate in the demonstration project
and meet the requirements of subdivision 3. The Department of Human Services must
consult with Tribal nations to discuss participation in the substance use disorder
demonstration project.

(f) (g) The commissioner shall allow providers enrolled in the demonstration project
before July 1, 2021, to receive applicable rate enhancements authorized under subdivision
4 for all services provided on or after the date of enrollment, except that the commissioner
shall allow a provider to receive applicable rate enhancements authorized under subdivision
4 for services provided on or after July 22, 2020, to fee-for-service enrollees, and on or after
January 1, 2021, to managed care enrollees, if the provider meets all of the following
requirements:

(1) the provider attests that during the time period for which the provider is seeking the
rate enhancement, the provider took meaningful steps in their plan approved by the
commissioner to meet the demonstration project requirements in subdivision 3; and

(2) the provider submits attestation and evidence, including all information requested
by the commissioner, of meeting the requirements of subdivision 3 to the commissioner in
a format required by the commissioner.

(g) (h) The commissioner may recoup any rate enhancements paid under paragraph (f)
(g) to a provider that does not meet the requirements of subdivision 3 by July 1, 2021.

Sec. 28.

EVIDENCE-BASED TRAINING.

The commissioner of human services must establish training opportunities for substance
use disorder treatment providers under Minnesota Statutes, chapters 245F and 245G, and
applicable Tribal licenses, to increase knowledge and develop skills to adopt evidence-based
and promising practices in substance use disorder treatment programs. Training opportunities
must support the transition to American Society of Addiction Medicine (ASAM) standards.
Training formats may include self or organizational assessments, virtual modules, one-to-one
coaching, self-paced courses, interactive hybrid courses, and in-person courses. Foundational
and skill-building training topics may include:

(1) ASAM criteria;

(2) person-centered and culturally responsive services;

(3) medical and clinical decision making;

(4) conducting assessments and appropriate level of care;

(5) treatment and service planning;

(6) identifying and overcoming systems challenges;

(7) conducting clinical case reviews; and

(8) appropriate and effective transfer and discharge.

Sec. 29. FAMILY TREATMENT START-UP AND CAPACITY-BUILDING
GRANTS.

The commissioner of human services must establish start-up and capacity-building grants
for prospective or new substance use disorder treatment programs that serve parents with
their children. Grants must be used for expenses that are not reimbursable under Minnesota
health care programs, including but not limited to:

(1) physical plant upgrades to support larger family units;

(2) supporting the expansion or development of programs that provide holistic services,
including trauma supports, conflict resolution, and parenting skills;

(3) increasing awareness, education, and outreach utilizing culturally responsive
approaches to develop relationships between culturally specific communities and clinical
treatment provider programs; and

(4) expanding culturally specific family programs and accommodating diverse family
units.

Sec. 30. SAFE RECOVERY SITES START-UP AND CAPACITY-BUILDING
GRANTS.

(a) The commissioner of human services must establish start-up and capacity-building
grants for current or prospective harm reduction organizations to promote health, wellness,
safety, and recovery to people who are in active stages of substance use disorder. Grants
must be used to establish safe recovery sites that offer harm reduction services and supplies,
including but not limited to:

(1) safe injection spaces;

(2) sterile needle exchange;

(3) opiate antagonist rescue kits;

(4) fentanyl and other drug testing;

(5) street outreach;

(6) educational and referral services;

(7) health, safety, and wellness services; and

(8) access to hygiene and sanitation.

(b) The commissioner must conduct local community outreach and engagement in
collaboration with newly established safe recovery sites. The commissioner must evaluate
the efficacy of safe recovery sites and collect data to measure health-related and public
safety outcomes.

(c) The commissioner must prioritize grant applications for organizations that are
culturally specific or culturally responsive and that commit to serving individuals from
communities that are disproportionately impacted by the opioid epidemic, including:

(1) Native American, American Indian, and Indigenous communities; and

(2) Black, African American, and African-born communities.

(d) For purposes of this section, a "culturally specific" or "culturally responsive"
organization is an organization that is designed to address the unique needs of individuals
who share a common language, racial, ethnic, or social background, and is governed with
significant input from individuals of that specific background.

Sec. 31.

PUBLIC AWARENESS CAMPAIGN.

(a) The commissioner of human services must establish a multitiered public awareness
and educational campaign on substance use disorders. The campaign must include strategies
to prevent substance use disorder, reduce stigma, and ensure people know how to access
treatment, recovery, and harm reduction services.

(b) The commissioner must consult with communities disproportionately impacted by
substance use disorder to ensure the campaign focuses on lived experience and equity. The
commissioner may also consult and establish relationships with media and communication
experts, behavioral health professionals, state and local agencies, and community
organizations to design and implement the campaign.

(c) The campaign must include awareness-raising and educational information using
multichannel marketing strategies, social media, virtual events, press releases, reports, and
targeted outreach. The commissioner must evaluate the effectiveness of the campaign and
modify outreach and strategies as needed.

Sec. 32. REVISED PAYMENT METHODOLOGY FOR OPIOID TREATMENT
PROGRAMS.

The commissioner of human services must revise the payment methodology for substance
use services with medications for opioid use disorder under Minnesota Statutes, section
254B.05, subdivision 5, paragraph (b), clause (6). Payment must occur only if the provider
renders the service or services billed on that date of service or, in the case of drugs and
drug-related services, within a week as defined by the commissioner. The revised payment
methodology must include a weekly bundled rate that includes the costs of drugs, drug
administration and observation, drug packaging and preparation, and nursing time. The
bundled weekly rate must be based on the Medicare rate. The commissioner must seek all
necessary waivers, state plan amendments, and federal authorities required to implement
the revised payment methodology.

EFFECTIVE DATE.

This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.

Sec. 33. MEDICAL ASSISTANCE BEHAVIORAL HEALTH SYSTEM
TRANSFORMATION STUDY.

The commissioner of human services, in consultation with stakeholders, must evaluate
the feasibility, potential design, and federal authorities needed to cover traditional healing,
behavioral health services in correctional facilities, and contingency management under the
medical assistance program.

Sec. 34. REVISOR INSTRUCTION.

The revisor of statutes shall renumber Minnesota Statutes, section 245G.01, subdivision
20b, as Minnesota Statutes, section 245G.01, subdivision 20d, and make any other necessary
changes to subdivision numbers or cross-references.

Sec. 35. REPEALER.

(a) Minnesota Statutes 2022, sections 245G.06, subdivision 2; and 256B.0759, subdivision
6, are repealed.

(b) Minnesota Statutes 2022, section 246.18, subdivisions 2 and 2a, are repealed.

EFFECTIVE DATE.

Paragraph (a) is effective January 1, 2024. Paragraph (b) is
effective July 1, 2023.

ARTICLE 4

OPIOID OVERDOSE PREVENTION AND OPIATE EPIDEMIC RESPONSE

Section 1.

Minnesota Statutes 2022, section 16A.151, subdivision 2, is amended to read:

Subd. 2.

Exceptions.

(a) If a state official litigates or settles a matter on behalf of specific
injured persons or entities, this section does not prohibit distribution of money to the specific
injured persons or entities on whose behalf the litigation or settlement efforts were initiated.
If money recovered on behalf of injured persons or entities cannot reasonably be distributed
to those persons or entities because they cannot readily be located or identified or because
the cost of distributing the money would outweigh the benefit to the persons or entities, the
money must be paid into the general fund.

(b) Money recovered on behalf of a fund in the state treasury other than the general fund
may be deposited in that fund.

(c) This section does not prohibit a state official from distributing money to a person or
entity other than the state in litigation or potential litigation in which the state is a defendant
or potential defendant.

(d) State agencies may accept funds as directed by a federal court for any restitution or
monetary penalty under United States Code, title 18, section 3663(a)(3), or United States
Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue
account and are appropriated to the commissioner of the agency for the purpose as directed
by the federal court.

(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph
(t), may be deposited as provided in section 16A.98, subdivision 12.

(f) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, related
to alleged violations of consumer fraud laws in the marketing, sale, or distribution of opioids
in this state or other alleged illegal actions that contributed to the excessive use of opioids,
must be deposited in the settlement account established in the opiate epidemic response
fund under section 256.043, subdivision 1. This paragraph does not apply to attorney fees
and costs awarded to the state or the Attorney General's Office, to contract attorneys hired
by the state or Attorney General's Office, or to other state agency attorneys.

(g) Notwithstanding paragraph (f), if money is received from a settlement agreement or
an assurance of discontinuance entered into by the attorney general of the state or a court
order in litigation brought by the attorney general of the state on behalf of the state or a state
agency against a consulting firm working for an opioid manufacturer or opioid wholesale
drug distributor, the commissioner shall deposit any money received into the settlement
account established within the opiate epidemic response fund under section 256.042,
subdivision 1. Notwithstanding section 256.043, subdivision 3a, paragraph (a), any amount
deposited into the settlement account in accordance with this paragraph shall be appropriated
to the commissioner of human services to award as grants as specified by the opiate epidemic
response advisory council in accordance with section 256.043, subdivision 3a, paragraph
(d) as specified in section 256.043, subdivision 3a.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 2.

[121A.224] OPIATE ANTAGONISTS.

(a) A school district or charter school must maintain a supply of opiate antagonists, as
defined in section 604A.04, subdivision 1, at each school site to be administered in
compliance with section 151.37, subdivision 12.

(b) Each school building must have at least two doses of a nasal opiate antagonist
available on site.

(c) The commissioner of health must develop and disseminate to schools a short training
video about how and when to administer a nasal opiate antagonist. The person having control
of the school building must ensure that at least one staff member trained on how and when
to administer a nasal opiate antagonist is on site when the school building is open to students,
staff, or the public, including before school, after school, or during weekend activities.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 3.

Minnesota Statutes 2022, section 151.065, subdivision 7, is amended to read:

Subd. 7.

Deposit of fees.

(a) The license fees collected under this section, with the
exception of the fees identified in paragraphs (b) and (c), shall be deposited in the state
government special revenue fund.

(b) $5,000 of each fee collected under subdivision 1, clauses (6) to (9), and (11) to (15),
and subdivision 3, clauses (4) to (7), and (9) to (13), and $55,000 of each fee collected under
subdivision 1, clause (16), and subdivision 3, clause (14), shall be deposited in the opiate
epidemic response fund established in section 256.043.

(c) If the fees collected under subdivision 1, clause (16), or subdivision 3, clause (14),
are reduced under section 256.043, $5,000 of the reduced fee shall be deposited in the opiate
epidemic response fund in section 256.043.

Sec. 4.

Minnesota Statutes 2022, section 241.021, subdivision 1, is amended to read:

Subdivision 1.

Correctional facilities; inspection; licensing.

(a) Except as provided
in paragraph (b), the commissioner of corrections shall inspect and license all correctional
facilities throughout the state, whether public or private, established and operated for the
detention and confinement of persons confined or incarcerated therein according to law
except to the extent that they are inspected or licensed by other state regulating agencies.
The commissioner shall promulgate pursuant to chapter 14, rules establishing minimum
standards for these facilities with respect to their management, operation, physical condition,
and the security, safety, health, treatment, and discipline of persons confined or incarcerated
therein. These minimum standards shall include but are not limited to specific guidance
pertaining to:

(1) screening, appraisal, assessment, and treatment for persons confined or incarcerated
in correctional facilities with mental illness or substance use disorders;

(2) a policy on the involuntary administration of medications;

(3) suicide prevention plans and training;

(4) verification of medications in a timely manner;

(5) well-being checks;

(6) discharge planning, including providing prescribed medications to persons confined
or incarcerated in correctional facilities upon release;

(7) a policy on referrals or transfers to medical or mental health care in a noncorrectional
institution;

(8) use of segregation and mental health checks;

(9) critical incident debriefings;

(10) clinical management of substance use disorders and opioid overdose emergency
procedures;

(11) a policy regarding identification of persons with special needs confined or
incarcerated in correctional facilities;

(12) a policy regarding the use of telehealth;

(13) self-auditing of compliance with minimum standards;

(14) information sharing with medical personnel and when medical assessment must be
facilitated;

(15) a code of conduct policy for facility staff and annual training;

(16) a policy on death review of all circumstances surrounding the death of an individual
committed to the custody of the facility; and

(17) dissemination of a rights statement made available to persons confined or
incarcerated in licensed correctional facilities.

No individual, corporation, partnership, voluntary association, or other private
organization legally responsible for the operation of a correctional facility may operate the
facility unless it possesses a current license from the commissioner of corrections. Private
adult correctional facilities shall have the authority of section 624.714, subdivision 13, if
the Department of Corrections licenses the facility with the authority and the facility meets
requirements of section 243.52.

The commissioner shall review the correctional facilities described in this subdivision
at least once every two years, except as otherwise provided, to determine compliance with
the minimum standards established according to this subdivision or other Minnesota statute
related to minimum standards and conditions of confinement.

The commissioner shall grant a license to any facility found to conform to minimum
standards or to any facility which, in the commissioner's judgment, is making satisfactory
progress toward substantial conformity and the standards not being met do not impact the
interests and well-being of the persons confined or incarcerated in the facility. A limited
license under subdivision 1a may be issued for purposes of effectuating a facility closure.
The commissioner may grant licensure up to two years. Unless otherwise specified by
statute, all licenses issued under this chapter expire at 12:01 a.m. on the day after the
expiration date stated on the license.

The commissioner shall have access to the buildings, grounds, books, records, staff, and
to persons confined or incarcerated in these facilities. The commissioner may require the
officers in charge of these facilities to furnish all information and statistics the commissioner
deems necessary, at a time and place designated by the commissioner.

All facility administrators of correctional facilities are required to report all deaths of
individuals who died while committed to the custody of the facility, regardless of whether
the death occurred at the facility or after removal from the facility for medical care stemming
from an incident or need for medical care at the correctional facility, as soon as practicable,
but no later than 24 hours of receiving knowledge of the death, including any demographic
information as required by the commissioner.

All facility administrators of correctional facilities are required to report all other
emergency or unusual occurrences as defined by rule, including uses of force by facility
staff that result in substantial bodily harm or suicide attempts, to the commissioner of
corrections within ten days from the occurrence, including any demographic information
as required by the commissioner. The commissioner of corrections shall consult with the
Minnesota Sheriffs' Association and a representative from the Minnesota Association of
Community Corrections Act Counties who is responsible for the operations of an adult
correctional facility to define "use of force" that results in substantial bodily harm for
reporting purposes.

The commissioner may require that any or all such information be provided through the
Department of Corrections detention information system. The commissioner shall post each
inspection report publicly and on the department's website within 30 days of completing
the inspection. The education program offered in a correctional facility for the confinement
or incarceration of juvenile offenders must be approved by the commissioner of education
before the commissioner of corrections may grant a license to the facility.

(b) For juvenile facilities licensed by the commissioner of human services, the
commissioner may inspect and certify programs based on certification standards set forth
in Minnesota Rules. For the purpose of this paragraph, "certification" has the meaning given
it in section 245A.02.

(c) Any state agency which regulates, inspects, or licenses certain aspects of correctional
facilities shall, insofar as is possible, ensure that the minimum standards it requires are
substantially the same as those required by other state agencies which regulate, inspect, or
license the same aspects of similar types of correctional facilities, although at different
correctional facilities.

(d) Nothing in this section shall be construed to limit the commissioner of corrections'
authority to promulgate rules establishing standards of eligibility for counties to receive
funds under sections 401.01 to 401.16, or to require counties to comply with operating
standards the commissioner establishes as a condition precedent for counties to receive that
funding.

(e) The department's inspection unit must report directly to a division head outside of
the correctional institutions division.

Sec. 5.

Minnesota Statutes 2022, section 241.31, subdivision 5, is amended to read:

Subd. 5.

Minimum standards.

The commissioner of corrections shall establish minimum
standards for the size, area to be served, qualifications of staff, ratio of staff to client
population, and treatment programs for community corrections programs established pursuant
to this section. Plans and specifications for such programs, including proposed budgets must
first be submitted to the commissioner for approval prior to the establishment. Community
corrections programs must maintain a supply of opiate antagonists, as defined in section
604A.04, subdivision 1, at each correctional site to be administered in compliance with
section 151.37, subdivision 12. Each site must have at least two doses of an opiate antagonist
on site. Staff must be trained on how and when to administer opiate antagonists.

Sec. 6.

Minnesota Statutes 2022, section 241.415, is amended to read:

241.415 RELEASE PLANS; SUBSTANCE ABUSE.

The commissioner shall cooperate with community-based corrections agencies to
determine how best to address the substance abuse treatment needs of offenders who are
being released from prison. The commissioner shall ensure that an offender's prison release
plan adequately addresses the offender's needs for substance abuse assessment, treatment,
or other services following release, within the limits of available resources. The commissioner
must provide individuals with known or stated histories of opioid use disorder with
emergency opiate antagonist rescue kits upon release.

Sec. 7.

Minnesota Statutes 2022, section 245G.08, subdivision 3, is amended to read:

Subd. 3.

Standing order protocol Emergency overdose treatment.

A license holder
that maintains must maintain a supply of naloxone opiate antagonists as defined in section
604A.04, subdivision 1, available for emergency treatment of opioid overdose and must
have a written standing order protocol by a physician who is licensed under chapter 147,
advanced practice registered nurse who is licensed under chapter 148, or physician assistant
who is licensed under chapter 147A, that permits the license holder to maintain a supply of
naloxone opiate antagonists on site. A license holder must require staff to undergo training
in the specific mode of administration used at the program, which may include intranasal
administration, intramuscular injection, or both.

Sec. 8.

Minnesota Statutes 2022, section 256.042, subdivision 2, is amended to read:

Subd. 2.

Membership.

(a) The council shall consist of the following 19 30 voting
members, appointed by the commissioner of human services except as otherwise specified,
and three nonvoting members:

(1) two members of the house of representatives, appointed in the following sequence:
the first from the majority party appointed by the speaker of the house and the second from
the minority party appointed by the minority leader. Of these two members, one member
must represent a district outside of the seven-county metropolitan area, and one member
must represent a district that includes the seven-county metropolitan area. The appointment
by the minority leader must ensure that this requirement for geographic diversity in
appointments is met;

(2) two members of the senate, appointed in the following sequence: the first from the
majority party appointed by the senate majority leader and the second from the minority
party appointed by the senate minority leader. Of these two members, one member must
represent a district outside of the seven-county metropolitan area and one member must
represent a district that includes the seven-county metropolitan area. The appointment by
the minority leader must ensure that this requirement for geographic diversity in appointments
is met;

(3) one member appointed by the Board of Pharmacy;

(4) one member who is a physician appointed by the Minnesota Medical Association;

(5) one member representing opioid treatment programs, sober living programs, or
substance use disorder programs licensed under chapter 245G;

(6) one member appointed by the Minnesota Society of Addiction Medicine who is an
addiction psychiatrist;

(7) one member representing professionals providing alternative pain management
therapies, including, but not limited to, acupuncture, chiropractic, or massage therapy;

(8) one member representing nonprofit organizations conducting initiatives to address
the opioid epidemic, with the commissioner's initial appointment being a member
representing the Steve Rummler Hope Network, and subsequent appointments representing
this or other organizations;

(9) one member appointed by the Minnesota Ambulance Association who is serving
with an ambulance service as an emergency medical technician, advanced emergency
medical technician, or paramedic;

(10) one member representing the Minnesota courts who is a judge or law enforcement
officer;

(11) one public member who is a Minnesota resident and who is in opioid addiction
recovery;

(12) two 11 members representing Indian tribes, one representing the Ojibwe tribes and
one representing the Dakota tribes each of Minnesota's Tribal Nations;

(13) two members representing urban American Indian populations;

(13) (14) one public member who is a Minnesota resident and who is suffering from
chronic pain, intractable pain, or a rare disease or condition;

(14) (15) one mental health advocate representing persons with mental illness;

(15) (16) one member appointed by the Minnesota Hospital Association;

(16) (17) one member representing a local health department; and

(17) (18) the commissioners of human services, health, and corrections, or their designees,
who shall be ex officio nonvoting members of the council.

(b) The commissioner of human services shall coordinate the commissioner's
appointments to provide geographic, racial, and gender diversity, and shall ensure that at
least one-half one-third of council members appointed by the commissioner reside outside
of the seven-county metropolitan area. Of the members appointed by the commissioner, to
the extent practicable, at least one member must represent a community of color
disproportionately affected by the opioid epidemic.

(c) The council is governed by section 15.059, except that members of the council shall
serve three-year terms and shall receive no compensation other than reimbursement for
expenses. Notwithstanding section 15.059, subdivision 6, the council shall not expire.

(d) The chair shall convene the council at least quarterly, and may convene other meetings
as necessary. The chair shall convene meetings at different locations in the state to provide
geographic access, and shall ensure that at least one-half of the meetings are held at locations
outside of the seven-county metropolitan area.

(e) The commissioner of human services shall provide staff and administrative services
for the advisory council.

(f) The council is subject to chapter 13D.

Sec. 9.

Minnesota Statutes 2022, section 256.042, subdivision 4, is amended to read:

Subd. 4.

Grants.

(a) The commissioner of human services shall submit a report of the
grants proposed by the advisory council to be awarded for the upcoming calendar year to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services policy and finance, by December 1 of each year, beginning
December 1, 2022. This paragraph expires upon the expiration of the advisory council.

(b) The grants shall be awarded to proposals selected by the advisory council that address
the priorities in subdivision 1, paragraph (a), clauses (1) to (4), unless otherwise appropriated
by the legislature. The advisory council shall determine grant awards and funding amounts
based on the funds appropriated to the commissioner under section 256.043, subdivision 3,
paragraph (h), and subdivision 3a, paragraph (d). The commissioner shall award the grants
from the opiate epidemic response fund and administer the grants in compliance with section
16B.97. No more than ten percent of the grant amount may be used by a grantee for
administration. The commissioner must award at least 50 percent of grants to projects that
include a focus on addressing the opioid crisis in Black and Indigenous communities and
communities of color.

Sec. 10.

Minnesota Statutes 2022, section 256.043, subdivision 3, is amended to read:

Subd. 3.

Appropriations from registration and license fee account.

(a) The
appropriations in paragraphs (b) to (h) (k) shall be made from the registration and license
fee account on a fiscal year basis in the order specified.

(b) The appropriations specified in Laws 2019, chapter 63, article 3, section 1, paragraphs
(b), (f), (g), and (h), as amended by Laws 2020, chapter 115, article 3, section 35, shall be
made accordingly.

(c) $100,000 is appropriated to the commissioner of human services for grants for opiate
antagonist distribution. Grantees may utilize funds for opioid overdose prevention,
community asset mapping, education, and opiate antagonist distribution.

(d) $2,000,000 is appropriated to the commissioner of human services for grants to Tribal
nations and five urban Indian communities for traditional healing practices for American
Indians and to increase the capacity of culturally specific providers in the behavioral health
workforce.

(e) $277,000 in fiscal year 2024 and $321,000 each year thereafter is appropriated to
the commissioner of human services to administer the funding distribution and reporting
requirements in paragraph (j).

(c) (f) $300,000 is appropriated to the commissioner of management and budget for
evaluation activities under section 256.042, subdivision 1, paragraph (c).

(d) (g) $249,000 is in fiscal year 2023, $375,000 in fiscal year 2024, and $315,000 each
year thereafter are appropriated to the commissioner of human services for the provision
of administrative services to the Opiate Epidemic Response Advisory Council and for the
administration of the grants awarded under paragraph (h) (k).

(e) (h) $126,000 is appropriated to the Board of Pharmacy for the collection of the
registration fees under section 151.066.

(f) (i) $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.

(g) (j) After the appropriations in paragraphs (b) to (f) (i) are made, 50 percent of the
remaining amount is appropriated to the commissioner of human services for distribution
to county social service agencies and Tribal social service agency initiative projects
authorized under section 256.01, subdivision 14b, to provide child protection services to
children and families who are affected by addiction. The commissioner shall distribute this
money proportionally to county social service agencies and Tribal social service agency
initiative projects based on out-of-home placement episodes where parental drug abuse is
the primary reason for the out-of-home placement using data from the previous calendar
year. County social service agencies and Tribal social service agency initiative projects
receiving funds from the opiate epidemic response fund must annually report to the
commissioner on how the funds were used to provide child protection services, including
measurable outcomes, as determined by the commissioner. County social service agencies
and Tribal social service agency initiative projects must not use funds received under this
paragraph to supplant current state or local funding received for child protection services
for children and families who are affected by addiction.

(h) (k) After the appropriations in paragraphs (b) to (g) (j) are made, the remaining
amount in the account is appropriated to the commissioner of human services to award
grants as specified by the Opiate Epidemic Response Advisory Council in accordance with
section 256.042, unless otherwise appropriated by the legislature.

(i) (l) Beginning in fiscal year 2022 and each year thereafter, funds for county social
service agencies and Tribal social service agency initiative projects under paragraph (g) (j)
and grant funds specified by the Opiate Epidemic Response Advisory Council under
paragraph (h) (k) may be distributed on a calendar year basis.

(m) Notwithstanding section 16A.28, funds appropriated in paragraphs (c), (d), (j), and
(k) do not cancel.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 11.

Minnesota Statutes 2022, section 256.043, subdivision 3a, is amended to read:

Subd. 3a.

Appropriations from settlement account.

(a) The appropriations in paragraphs
(b) to (e) shall be made from the settlement account on a fiscal year basis in the order
specified.

(b) If the balance in the registration and license fee account is not sufficient to fully fund
the appropriations specified in subdivision 3, paragraphs (b) to (f), an amount necessary to
meet any insufficiency shall be transferred from the settlement account to the registration
and license fee account to fully fund the required appropriations.

(c) $209,000 in fiscal year 2023 and $239,000 in fiscal year 2024 and subsequent fiscal
years are appropriated to the commissioner of human services for the administration of
grants awarded under paragraph (e). $276,000 in fiscal year 2023 and $151,000 in fiscal
year 2024 and subsequent fiscal years are appropriated to the commissioner of human
services to collect, collate, and report data submitted and to monitor compliance with
reporting and settlement expenditure requirements by grantees awarded grants under this
section and municipalities receiving direct payments from a statewide opioid settlement
agreement as defined in section 256.042, subdivision 6.

(d) After any appropriations necessary under paragraphs (b) and (c) are made, an amount
equal to the calendar year allocation to Tribal social service agency initiative projects under
subdivision 3, paragraph (g), is appropriated from the settlement account to the commissioner
of human services for distribution to Tribal social service agency initiative projects to
provide child protection services to children and families who are affected by addiction.
The requirements related to proportional distribution, annual reporting, and maintenance
of effort specified in subdivision 3, paragraph (g), also apply to the appropriations made
under this paragraph.

(e) After making the appropriations in paragraphs (b), (c), and (d), the remaining amount
in the account is appropriated to the commissioner of human services to award grants as
specified by the Opiate Epidemic Response Advisory Council in accordance with section
256.042.

(f) Funds for Tribal social service agency initiative projects under paragraph (d) and
grant funds specified by the Opiate Epidemic Response Advisory Council under paragraph
(e) may be distributed on a calendar year basis.

(g) Notwithstanding section 16A.28, funds appropriated in paragraphs (d) and (e) do
not cancel.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 12.

[256I.052] OPIATE ANTAGONISTS.

(a) Site-based or group housing support settings must maintain a supply of opiate
antagonists as defined in section 604A.04, subdivision 1, at each housing site to be
administered in compliance with section 151.37, subdivision 12.

(b) Each site must have at least two doses of an opiate antagonist on site.

(c) Staff on site must have training on how and when to administer opiate antagonists.

Sec. 13.

Laws 2019, chapter 63, article 3, section 1, as amended by Laws 2020, chapter
115, article 3, section 35, and Laws 2022, chapter 53, section 12, is amended to read:

Section 1. APPROPRIATIONS.

(a) Board of Pharmacy; administration. $244,000 in fiscal year 2020 is appropriated
from the general fund to the Board of Pharmacy for onetime information technology and
operating costs for administration of licensing activities under Minnesota Statutes, section
151.066. This is a onetime appropriation.

(b) Commissioner of human services; administration. $309,000 in fiscal year 2020
is appropriated from the general fund and $60,000 in fiscal year 2021 is appropriated from
the opiate epidemic response fund to the commissioner of human services for the provision
of administrative services to the Opiate Epidemic Response Advisory Council and for the
administration of the grants awarded under paragraphs (f), (g), and (h). The opiate epidemic
response fund base for this appropriation is $60,000 in fiscal year 2022, $60,000 in fiscal
year 2023, $60,000 in fiscal year 2024, and $0 in fiscal year 2025.

(c) Board of Pharmacy; administration. $126,000 in fiscal year 2020 is appropriated
from the general fund to the Board of Pharmacy for the collection of the registration fees
under section 151.066.

(d) Commissioner of public safety; enforcement activities. $672,000 in fiscal year
2020 is appropriated from the general fund to the commissioner of public safety for the
Bureau of Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab
supplies and $288,000 is for special agent positions focused on drug interdiction and drug
trafficking.

(e) Commissioner of management and budget; evaluation activities. $300,000 in
fiscal year 2020 is appropriated from the general fund and $300,000 in fiscal year 2021 is
appropriated from the opiate epidemic response fund to the commissioner of management
and budget for evaluation activities under Minnesota Statutes, section 256.042, subdivision
1, paragraph (c).

(f) Commissioner of human services; grants for Project ECHO. $400,000 in fiscal
year 2020 is appropriated from the general fund and $400,000 in fiscal year 2021 is
appropriated from the opiate epidemic response fund to the commissioner of human services
for grants of $200,000 to CHI St. Gabriel's Health Family Medical Center for the
opioid-focused Project ECHO program and $200,000 to Hennepin Health Care for the
opioid-focused Project ECHO program. The opiate epidemic response fund base for this
appropriation is $400,000 in fiscal year 2022, $400,000 in fiscal year 2023, $400,000 in
fiscal year 2024, and $0 in fiscal year 2025.

(g) Commissioner of human services; opioid overdose prevention grant. $100,000
in fiscal year 2020 is appropriated from the general fund and $100,000 in fiscal year 2021
is appropriated from the opiate epidemic response fund to the commissioner of human
services for a grant to a nonprofit organization that has provided overdose prevention
programs to the public in at least 60 counties within the state, for at least three years, has
received federal funding before January 1, 2019, and is dedicated to addressing the opioid
epidemic. The grant must be used for opioid overdose prevention, community asset mapping,
education, and overdose antagonist distribution. The opiate epidemic response fund base
for this appropriation is $100,000 in fiscal year 2022, $100,000 in fiscal year 2023, $100,000
in fiscal year 2024, and $0 in fiscal year 2025.

(h) Commissioner of human services; traditional healing. $2,000,000 in fiscal year
2020 is appropriated from the general fund and $2,000,000 in fiscal year 2021 is appropriated
from the opiate epidemic response fund to the commissioner of human services to award
grants to Tribal nations and five urban Indian communities for traditional healing practices
to American Indians and to increase the capacity of culturally specific providers in the
behavioral health workforce. The opiate epidemic response fund base for this appropriation
is $2,000,000 in fiscal year 2022, $2,000,000 in fiscal year 2023, $2,000,000 in fiscal year
2024, and $0 in fiscal year 2025.

(i) Board of Dentistry; continuing education. $11,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Dentistry to
implement the continuing education requirements under Minnesota Statutes, section 214.12,
subdivision 6.

(j) Board of Medical Practice; continuing education. $17,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Medical Practice
to implement the continuing education requirements under Minnesota Statutes, section
214.12, subdivision 6.

(k) Board of Nursing; continuing education. $17,000 in fiscal year 2020 is appropriated
from the state government special revenue fund to the Board of Nursing to implement the
continuing education requirements under Minnesota Statutes, section 214.12, subdivision
6.

(l) Board of Optometry; continuing education. $5,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Optometry to
implement the continuing education requirements under Minnesota Statutes, section 214.12,
subdivision 6.

(m) Board of Podiatric Medicine; continuing education. $5,000 in fiscal year 2020
is appropriated from the state government special revenue fund to the Board of Podiatric
Medicine to implement the continuing education requirements under Minnesota Statutes,
section 214.12, subdivision 6.

(n) Commissioner of health; nonnarcotic pain management and wellness. $1,250,000
is appropriated in fiscal year 2020 from the general fund to the commissioner of health, to
provide funding for:

(1) statewide mapping and assessment of community-based nonnarcotic pain management
and wellness resources; and

(2) up to five demonstration projects in different geographic areas of the state to provide
community-based nonnarcotic pain management and wellness resources to patients and
consumers.

The demonstration projects must include an evaluation component and scalability analysis.
The commissioner shall award the grant for the statewide mapping and assessment, and the
demonstration project grants, through a competitive request for proposal process. Grants
for statewide mapping and assessment and demonstration projects may be awarded
simultaneously. In awarding demonstration project grants, the commissioner shall give
preference to proposals that incorporate innovative community partnerships, are informed
and led by people in the community where the project is taking place, and are culturally
relevant and delivered by culturally competent providers. This is a onetime appropriation.

(o) Commissioner of health; administration. $38,000 in fiscal year 2020 is appropriated
from the general fund to the commissioner of health for the administration of the grants
awarded in paragraph (n).

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 14. OPIOID OVERDOSE SURGE ALERT SYSTEM.

The commissioner of human services must establish a voluntary, statewide opioid
overdose surge text message alert system, to prevent opioid overdose by cautioning people
to refrain from substance use or to use harm reduction strategies when there is an overdose
surge in their surrounding area. The alert system may include other forms of electronic
alerts. The commissioner may collaborate with local agencies, other state agencies, and
harm reduction organizations to promote and improve the surge alert system.

Sec. 15. HARM REDUCTION AND CULTURALLY SPECIFIC GRANTS.

(a) The commissioner of human services must establish grants for Tribal Nations or
culturally specific organizations to enhance and expand capacity to address the impacts of
the opioid epidemic in their respective communities. Grants may be used to purchase and
distribute harm reduction supplies, develop organizational capacity, and expand culturally
specific services.

(b) Harm reduction grant funds must be used to promote safer practices and reduce the
transmission of infectious disease. Allowable expenses include syringes, fentanyl testing
supplies, disinfectants, opiate antagonist rescue kits, safe injection kits, safe smoking kits,
sharps disposal, wound-care supplies, medication lock boxes, FDA-approved home testing
kits for viral hepatitis and HIV, written educational and resource materials, and other supplies
approved by the commissioner.

(c) Culturally specific organizational capacity grant funds must be used to develop and
improve organizational infrastructure to increase access to culturally specific services and
community building. Allowable expenses include funds for organizations to hire staff or
consultants who specialize in fundraising, grant writing, business development, and program
integrity or other identified organizational needs as approved by the commissioner.

(d) Culturally specific service grant funds must be used to expand culturally specific
outreach and services. Allowable expenses include hiring or consulting with cultural advisors,
resources to support cultural traditions, and education to empower individuals and providers,
develop a sense of community, and develop a connection to ancestral roots.

Sec. 16. REPEALER.

Minnesota Statutes 2022, section 256.043, subdivision 4, is repealed.

EFFECTIVE DATE.

This section is effective July 1, 2023.

ARTICLE 5

OPIOID PRESCRIBING IMPROVEMENT PROGRAM

Section 1.

Minnesota Statutes 2022, section 256B.0638, subdivision 1, is amended to read:

Subdivision 1.

Program established.

The commissioner of human services, in
conjunction with the commissioner of health, shall coordinate and implement an opioid
prescribing improvement program to reduce opioid dependency and substance use by
Minnesotans due to the prescribing of opioid analgesics by health care providers and to
support patient-centered, compassionate care for Minnesotans who require treatment with
opioid analgesics.

Sec. 2.

Minnesota Statutes 2022, section 256B.0638, subdivision 2, is amended to read:

Subd. 2.

Definitions.

(a) For purposes of this section, the terms defined in this subdivision
have the meanings given them.

(b) "Commissioner" means the commissioner of human services.

(c) "Commissioners" means the commissioner of human services and the commissioner
of health.

(d) "DEA" means the United States Drug Enforcement Administration.

(e) "Minnesota health care program" means a public health care program administered
by the commissioner of human services under this chapter and chapter 256L, and the
Minnesota restricted recipient program.

(f) "Opioid disenrollment sanction standards" means parameters clinical indicators
defined by the Opioid Prescribing Work Group of opioid prescribing practices that fall
outside community standard thresholds for prescribing to such a degree that a provider must
be disenrolled may be subject to sanctions under section 256B.064 as a medical assistance
Minnesota health care program provider.

(g) "Opioid prescriber" means a licensed health care provider who prescribes opioids to
medical assistance Minnesota health care program and MinnesotaCare enrollees under the
fee-for-service system or under a managed care or county-based purchasing plan.

(h) "Opioid quality improvement standard thresholds" means parameters of opioid
prescribing practices that fall outside community standards for prescribing to such a degree
that quality improvement is required.

(i) "Program" means the statewide opioid prescribing improvement program established
under this section.

(j) "Provider group" means a clinic, hospital, or primary or specialty practice group that
employs, contracts with, or is affiliated with an opioid prescriber. Provider group does not
include a professional association supported by dues-paying members.

(k) "Sentinel measures" means measures of opioid use that identify variations in
prescribing practices during the prescribing intervals.

Sec. 3.

Minnesota Statutes 2022, section 256B.0638, subdivision 4, is amended to read:

Subd. 4.

Program components.

(a) The working group shall recommend to the
commissioners the components of the statewide opioid prescribing improvement program,
including, but not limited to, the following:

(1) developing criteria for opioid prescribing protocols, including:

(i) prescribing for the interval of up to four days immediately after an acute painful
event;

(ii) prescribing for the interval of up to 45 days after an acute painful event; and

(iii) prescribing for chronic pain, which for purposes of this program means pain lasting
longer than 45 days after an acute painful event;

(2) developing sentinel measures;

(3) developing educational resources for opioid prescribers about communicating with
patients about pain management and the use of opioids to treat pain;

(4) developing opioid quality improvement standard thresholds and opioid disenrollment
sanction standards for opioid prescribers and provider groups. In developing opioid
disenrollment standards, the standards may be described in terms of the length of time in
which prescribing practices fall outside community standards and the nature and amount
of opioid prescribing that fall outside community standards; and

(5) addressing other program issues as determined by the commissioners.

(b) The opioid prescribing protocols shall not apply to opioids prescribed for patients
who are experiencing pain caused by a malignant condition or who are receiving hospice
care or palliative care, or to opioids prescribed for substance use disorder treatment with
medications for opioid use disorder.

(c) All opioid prescribers who prescribe opioids to Minnesota health care program
enrollees must participate in the program in accordance with subdivision 5. Any other
prescriber who prescribes opioids may comply with the components of this program described
in paragraph (a) on a voluntary basis.

Sec. 4.

Minnesota Statutes 2022, section 256B.0638, subdivision 5, is amended to read:

Subd. 5.

Program implementation.

(a) The commissioner shall implement the programs
within the Minnesota health care quality improvement program to improve the health of
and quality of care provided to Minnesota health care program enrollees. The program must
be designed to support patient-centered care consistent with community standards of care.
The program must discourage unsafe tapering practices and patient abandonment by
providers. The commissioner shall annually collect and report to provider groups the sentinel
measures of data showing individual opioid prescribers' opioid prescribing patterns compared
to their anonymized peers. Provider groups shall distribute data to their affiliated, contracted,
or employed opioid prescribers.

(b) The commissioner shall notify an opioid prescriber and all provider groups with
which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing
pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber
and any provider group that receives a notice under this paragraph shall submit to the
commissioner a quality improvement plan for review and approval by the commissioner
with the goal of bringing the opioid prescriber's prescribing practices into alignment with
community standards. A quality improvement plan must include:

(1) components of the program described in subdivision 4, paragraph (a);

(2) internal practice-based measures to review the prescribing practice of the opioid
prescriber and, where appropriate, any other opioid prescribers employed by or affiliated
with any of the provider groups with which the opioid prescriber is employed or affiliated;
and

(3) appropriate use of the prescription monitoring program under section 152.126
demonstration of patient-centered care consistent with community standards of care.

(c) If, after a year from the commissioner's notice under paragraph (b), the opioid
prescriber's prescribing practices for treatment of acute or postacute pain do not improve
so that they are consistent with community standards, the commissioner shall may take one
or more of the following steps:

(1) require the prescriber, the provider group, or both, to monitor prescribing practices
more frequently than annually;

(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel
measures; or

(3) require the opioid prescriber to participate in additional quality improvement efforts,
including but not limited to mandatory use of the prescription monitoring program established
under section 152.126.

(d) Prescribers treating patients who are on chronic, high doses of opioids must meet
community standards of care, including performing regular assessments and addressing
unwarranted risks of opioid prescribing, but are not required to show measurable changes
in chronic pain prescribing thresholds within a certain period.

(e) The commissioner shall dismiss a prescriber from participating in the opioid
prescribing quality improvement program on an annual basis when the prescriber
demonstrates that the prescriber's practices are patient-centered and reflect community
standards for safe and compassionate treatment of patients experiencing pain.

(d) (f) The commissioner shall terminate from Minnesota health care programs may
investigate for possible sanctions under section 256B.064 all opioid prescribers and provider
groups whose prescribing practices fall within the applicable opioid disenrollment sanction
standards.

(e) (g) No physician, advanced practice registered nurse, or physician assistant, acting
in good faith based on the needs of the patient, may be disenrolled by the commissioner of
human services solely for prescribing a dosage that equates to an upward deviation from
morphine milligram equivalent dosage recommendations specified in state or federal opioid
prescribing guidelines or policies, or quality improvement thresholds established under this
section.

Sec. 5.

Minnesota Statutes 2022, section 256B.0638, is amended by adding a subdivision
to read:

Subd. 6a.

Waiver for certain provider groups.

(a) This section does not apply to
prescribers employed by, or under contract or affiliated with, a provider group for which
the commissioner has granted a waiver from the requirements of this section.

(b) The commissioner, in consultation with opioid prescribers, shall develop waiver
criteria for provider groups, and shall make waivers available beginning July 1, 2023. In
granting waivers, the commissioner shall consider whether the medical director of the
provider group and a majority of the practitioners within a provider group have specialty
training, fellowship training, or experience in treating chronic pain. Waivers under this
subdivision shall be granted on an annual basis.

Sec. 6. DIRECTION TO COMMISSIONER OF HUMAN SERVICES; OPIOID
PRESCRIBING IMPROVEMENT PROGRAM SUNSET.

The commissioner of human services shall recommend criteria to provide for a sunset
of the opioid prescribing improvement program under Minnesota Statutes, section 256B.0638.
In developing sunset criteria, the commissioner shall consult with stakeholders including
but not limited to clinicians that practice pain management, addiction medicine, or mental
health, and either current or former Minnesota health care program enrollees who use or
have used opioid therapy to manage chronic pain. By January 15, 2024, the commissioner
shall submit recommended criteria to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services finance and policy.

ARTICLE 6

DEPARTMENT OF DIRECT CARE AND TREATMENT

Section 1.

Minnesota Statutes 2022, section 15.01, is amended to read:

15.01 DEPARTMENTS OF THE STATE.

The following agencies are designated as the departments of the state government: the
Department of Administration;, the Department of Agriculture;, the Department of
Commerce;, the Department of Corrections;, the Department of Direct Care and Treatment,
the Department of Education;, the Department of Employment and Economic Development;,
the Department of Health;, the Department of Human Rights;, the Department of Human
Services, the Department of Information Technology Services;, the Department of Iron
Range Resources and Rehabilitation;, the Department of Labor and Industry;, the Department
of Management and Budget;, the Department of Military Affairs;, the Department of Natural
Resources;, the Department of Public Safety; the Department of Human Services;, the
Department of Revenue;, the Department of Transportation;, the Department of Veterans
Affairs;, and their successor departments.

EFFECTIVE DATE.

This section is effective January 1, 2025.

Sec. 2.

Minnesota Statutes 2022, section 15.06, subdivision 1, is amended to read:

Subdivision 1.

Applicability.

This section applies to the following departments or
agencies: the Departments of Administration, Agriculture, Commerce, Corrections, Direct
Care and Treatment, Education, Employment and Economic Development, Health, Human
Rights, Human Services, Labor and Industry, Management and Budget, Natural Resources,
Public Safety, Human Services, Revenue, Transportation, and Veterans Affairs; the Housing
Finance and Pollution Control Agencies; the Office of Commissioner of Iron Range
Resources and Rehabilitation; the Department of Information Technology Services; the
Bureau of Mediation Services; and their successor departments and agencies. The heads of
the foregoing departments or agencies are "commissioners."

EFFECTIVE DATE.

This section is effective January 1, 2025.

Sec. 3.

Minnesota Statutes 2022, section 43A.08, subdivision 1a, is amended to read:

Subd. 1a.

Additional unclassified positions.

Appointing authorities for the following
agencies may designate additional unclassified positions according to this subdivision: the
Departments of Administration;, Agriculture;, Commerce;, Corrections;, Direct Care and
Treatment, Education;, Employment and Economic Development;, Explore Minnesota
Tourism;, Management and Budget;, Health;, Human Rights;, Human Services, Labor and
Industry;, Natural Resources;, Public Safety;, Human Services; Revenue;, Transportation;,
and Veterans Affairs; the Housing Finance and Pollution Control Agencies; the State Lottery;
the State Board of Investment; the Office of Administrative Hearings; the Department of
Information Technology Services; the Offices of the Attorney General, Secretary of State,
and State Auditor; the Minnesota State Colleges and Universities; the Minnesota Office of
Higher Education; the Perpich Center for Arts Education; and the Minnesota Zoological
Board.

A position designated by an appointing authority according to this subdivision must
meet the following standards and criteria:

(1) the designation of the position would not be contrary to other law relating specifically
to that agency;

(2) the person occupying the position would report directly to the agency head or deputy
agency head and would be designated as part of the agency head's management team;

(3) the duties of the position would involve significant discretion and substantial
involvement in the development, interpretation, and implementation of agency policy;

(4) the duties of the position would not require primarily personnel, accounting, or other
technical expertise where continuity in the position would be important;

(5) there would be a need for the person occupying the position to be accountable to,
loyal to, and compatible with, the governor and the agency head, the employing statutory
board or commission, or the employing constitutional officer;

(6) the position would be at the level of division or bureau director or assistant to the
agency head; and

(7) the commissioner has approved the designation as being consistent with the standards
and criteria in this subdivision.

EFFECTIVE DATE.

This section is effective January 1, 2025.

Sec. 4.

[246C.01] TITLE.

This chapter may be cited as the "Department of Direct Care & Treatment Act."

Sec. 5.

[246C.02] DEPARTMENT OF DIRECT CARE AND TREATMENT;
ESTABLISHMENT.

(a) The Department of Direct Care and Treatment is created. An executive board shall
head the Department of Direct Care and Treatment. The executive board shall develop and
maintain direct care and treatment in a manner consistent with applicable law, including
chapters 13, 245, 246, 246B, 252, 253, 253B, 253C, 253D, 254A, 254B, and 256. The
Department of Direct Care and Treatment shall provide direct care and treatment services
in coordination with counties and other vendors. Direct care and treatment services shall
include specialized inpatient programs at secure treatment facilities as defined in sections
253B.02, subdivision 18a, and 253D.02, subdivision 13; community preparation services;
regional treatment centers; enterprise services; consultative services; aftercare services;
community-based services and programs; transition services; nursing home services; and
other services consistent with the mission of the Department of Direct Care and Treatment.

(b) "Community preparation services" means specialized inpatient or outpatient services
or programs operated outside of a secure environment but administered by a secure treatment
facility.

EFFECTIVE DATE.

This section is effective January 1, 2025.

Sec. 6.

[246C.03] TRANSITION OF AUTHORITY; DEVELOPMENT OF A BOARD.

Subdivision 1.

Authority until board is developed and powers defined.

Upon the
effective date of this act, the commissioner of human services shall continue to exercise all
authorities and responsibilities under chapters 13, 245, 246, 246B, 252, 253, 253B, 253C,
253D, 254A, 254B, and 256, until legislation is effective that develops the Department of
Direct Care and Treatment executive board and defines the responsibilities and powers of
the Department of Direct Care and Treatment and its executive board.

Subd. 2.

Development of Department of Direct Care and Treatment Board.

(a) The
commissioner of human services shall prepare legislation for introduction during the 2024
legislative session, with input from stakeholders the commissioner deems necessary,
proposing legislation for the creation and implementation of the Direct Care and Treatment
executive board and defining the responsibilities, powers, and function of the Department
of Direct Care and Treatment executive board.

(b) The Department of Direct Care and Treatment executive board shall consist of no
more than five members, all appointed by the governor.

(c) An executive board member's qualifications must be appropriate for overseeing a
complex behavioral health system, such as experience serving on a hospital or non-profit
board or working as a licensed health care provider, in an allied health profession, or in
health care administration.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 7.

[246C.04] TRANSFER OF DUTIES.

(a) Section 15.039 applies to the transfer of duties required by this chapter.

(b) The commissioner of administration, with the governor's approval, shall issue
reorganization orders under section 16B.37 as necessary to carry out the transfer of duties
required by section 246C.03. The provision of section 16B.37, subdivision 1, stating that
transfers under section 16B.37 may only be to an agency that has existed for at least one
year does not apply to transfers to an agency created by this chapter.

(c) The initial salary for the health systems chief executive officer of the Department of
Direct Care and Treatment is the same as the salary for the health systems chief executive
officer of direct care and treatment at the Department of Human Services immediately before
July 1, 2024.

Sec. 8.

[246C.05] EMPLOYEE PROTECTIONS FOR ESTABLISHING THE NEW
DEPARTMENT OF DIRECT CARE AND TREATMENT.

(a) Personnel whose duties relate to the functions assigned to the Department of Direct
Care and Treatment executive board in section 246C.03 are transferred to the Department
of Direct Care and Treatment effective 30 days after approval by the commissioner of direct
care and treatment.

(b) Before the Department of Direct Care and Treatment executive board is appointed,
personnel whose duties relate to the functions in this section may be transferred beginning
July 1, 2024, with 30 days' notice from the commissioner of management and budget.

(c) The following protections shall apply to employees who are transferred from the
Department of Human Services to the Department of Direct Care and Treatment:

(1) No transferred employee shall have their employment status and job classification
altered as a result of the transfer.

(2) Transferred employees who were represented by an exclusive representative prior
to the transfer shall continue to be represented by the same exclusive representative after
the transfer.

(3) The applicable collective bargaining agreements with exclusive representatives shall
continue in full force and effect for such transferred employees after the transfer.

(4) The state shall have the obligation to meet and negotiate with the exclusive
representatives of the transferred employees about any proposed changes affecting or relating
to the transferred employees' terms and conditions of employment to the extent such changes
are not addressed in the applicable collective bargaining agreement.

(5) When an employee in a temporary unclassified position is transferred to the
Department of Direct Care and Treatment, the total length of time that the employee has
served in the appointment shall include all time served in the appointment at the transferring
agency and the time served in the appointment at the Department of Direct Care and
Treatment. An employee in a temporary unclassified position who was hired by a transferring
agency through an open competitive selection process in accordance with a policy enacted
by Minnesota Management and Budget shall be considered to have been hired through such
process after the transfer.

(6) In the event that the state transfers ownership or control of any of the facilities,
services, or operations of the Department of Direct Care and Treatment to another entity,
whether private or public, by subcontracting, sale, assignment, lease, or other transfer, the
state shall require as a written condition of such transfer of ownership or control the following
provisions:

(i) Employees who perform work in transferred facilities, services, or operations must
be offered employment with the entity acquiring ownership or control before the entity
offers employment to any individual who was not employed by the transferring agency at
the time of the transfer.

(ii) The wage and benefit standards of such transferred employees must not be reduced
by the entity acquiring ownership or control through the expiration of the collective
bargaining agreement in effect at the time of the transfer or for a period of two years after
the transfer, whichever is longer.

(d) There is no liability on the part of, and no cause of action arises against, the state of
Minnesota or its officers or agents for any action or inaction of any entity acquiring ownership
or control of any facilities, services, or operations of the Department of Direct Care and
Treatment.

EFFECTIVE DATE.

This section is effective July 1, 2024.

Sec. 9. REVISOR INSTRUCTION.

The revisor of statutes, in consultation with staff from the House Research Department;
House Fiscal Analysis; the Office of Senate Counsel, Research and Fiscal Analysis; and
the respective departments shall prepare legislation for introduction in the 2024 legislative
session proposing the statutory changes necessary to implement the transfers of duties that
this article requires.

EFFECTIVE DATE.

This section is effective July 1, 2023.

ARTICLE 7

LICENSING

Section 1.

Minnesota Statutes 2022, section 245A.04, subdivision 7, is amended to read:

Subd. 7.

Grant of license; license extension.

(a) If the commissioner determines that
the program complies with all applicable rules and laws, the commissioner shall issue a
license consistent with this section or, if applicable, a temporary change of ownership license
under section 245A.043. At minimum, the license shall state:

(1) the name of the license holder;

(2) the address of the program;

(3) the effective date and expiration date of the license;

(4) the type of license;

(5) the maximum number and ages of persons that may receive services from the program;
and

(6) any special conditions of licensure.

(b) The commissioner may issue a license for a period not to exceed two years if:

(1) the commissioner is unable to conduct the evaluation or observation required by
subdivision 4, paragraph (a), clause (4), because the program is not yet operational;

(2) certain records and documents are not available because persons are not yet receiving
services from the program; and

(3) the applicant complies with applicable laws and rules in all other respects.

(c) A decision by the commissioner to issue a license does not guarantee that any person
or persons will be placed or cared for in the licensed program.

(d) Except as provided in paragraphs (f) and (g) (i) and (j), the commissioner shall not
issue or reissue a license if the applicant, license holder, or an affiliated controlling individual
has:

(1) been disqualified and the disqualification was not set aside and no variance has been
granted;

(2) been denied a license under this chapter, within the past two years;

(3) had a license issued under this chapter revoked within the past five years; or

(4) an outstanding debt related to a license fee, licensing fine, or settlement agreement
for which payment is delinquent; or

(5) (4) failed to submit the information required of an applicant under subdivision 1,
paragraph (f) or (g), after being requested by the commissioner.

When a license issued under this chapter is revoked under clause (1) or (3), the license
holder and each affiliated controlling individual with a revoked license may not hold any
license under chapter 245A for five years following the revocation, and other licenses held
by the applicant, or license holder, or licenses affiliated with each controlling individual
shall also be revoked.

(e) Notwithstanding paragraph (d), the commissioner may elect not to revoke a license
affiliated with a license holder or controlling individual that had a license revoked within
the past five years if the commissioner determines that (1) the license holder or controlling
individual is operating the program in substantial compliance with applicable laws and rules,
and (2) the program's continued operation is in the best interests of the community being
served.

(f) Notwithstanding paragraph (d), the commissioner may issue a new license in response
to an application that is affiliated with an applicant, license holder, or controlling individual
that had an application denied within the past two years or a license revoked within the past
five years if the commissioner determines that (1) the applicant or controlling individual
has operated one or more programs in substantial compliance with applicable laws and
rules, and (2) the program's operation would be in the best interests of the community to be
served.

(g) In determining whether a program's operation would be in the best interests of the
community to be served, the commissioner shall consider factors such as the number of
persons served, the availability of alternative services available in the surrounding
community, the management structure of the program, whether the program provides
culturally specific services, and other relevant factors.

(e) (h) The commissioner shall not issue or reissue a license under this chapter if an
individual living in the household where the services will be provided as specified under
section 245C.03, subdivision 1, has been disqualified and the disqualification has not been
set aside and no variance has been granted.

(f) (i) Pursuant to section 245A.07, subdivision 1, paragraph (b), when a license issued
under this chapter has been suspended or revoked and the suspension or revocation is under
appeal, the program may continue to operate pending a final order from the commissioner.
If the license under suspension or revocation will expire before a final order is issued, a
temporary provisional license may be issued provided any applicable license fee is paid
before the temporary provisional license is issued.

(g) (j) Notwithstanding paragraph (f) (i), when a revocation is based on the
disqualification of a controlling individual or license holder, and the controlling individual
or license holder is ordered under section 245C.17 to be immediately removed from direct
contact with persons receiving services or is ordered to be under continuous, direct
supervision when providing direct contact services, the program may continue to operate
only if the program complies with the order and submits documentation demonstrating
compliance with the order. If the disqualified individual fails to submit a timely request for
reconsideration, or if the disqualification is not set aside and no variance is granted, the
order to immediately remove the individual from direct contact or to be under continuous,
direct supervision remains in effect pending the outcome of a hearing and final order from
the commissioner.

(h) (k) For purposes of reimbursement for meals only, under the Child and Adult Care
Food Program, Code of Federal Regulations, title 7, subtitle B, chapter II, subchapter A,
part 226, relocation within the same county by a licensed family day care provider, shall
be considered an extension of the license for a period of no more than 30 calendar days or
until the new license is issued, whichever occurs first, provided the county agency has
determined the family day care provider meets licensure requirements at the new location.

(i) (l) Unless otherwise specified by statute, all licenses issued under this chapter expire
at 12:01 a.m. on the day after the expiration date stated on the license. A license holder must
apply for and be granted a new license to operate the program or the program must not be
operated after the expiration date.

(j) (m) The commissioner shall not issue or reissue a license under this chapter if it has
been determined that a tribal licensing authority has established jurisdiction to license the
program or service.

Sec. 2.

Minnesota Statutes 2022, section 245A.07, is amended by adding a subdivision to
read:

Subd. 2b.

Immediate suspension of residential programs.

For suspensions issued to
a licensed residential program as defined in section 245A.02, subdivision 14, the effective
date of the order may be delayed for up to 30 calendar days to provide for the continuity of
care of service recipients. The license holder must cooperate with the commissioner to
ensure service recipients receive continued care during the period of the delay and to facilitate
the transition of service recipients to new providers. In these cases, the suspension order
takes effect when all service recipients have been transitioned to a new provider or 30 days
after the suspension order was issued, whichever comes first.

Sec. 3.

Minnesota Statutes 2022, section 245A.07, is amended by adding a subdivision to
read:

Subd. 2c.

Immediate suspension for programs with multiple licensed service sites.

(a)
For license holders that operate more than one service site under a single license, the
suspension order must be specific to the service site or sites where the commissioner
determines an order is required under subdivision 2. The order must not apply to other
service sites operated by the same license holder unless the commissioner has included in
the order an articulable basis for applying the order to other service sites.

(b) If the commissioner has issued more than one license to the license holder under this
chapter, the suspension imposed under this section must be specific to the license for the
program at which the commissioner determines an order is required under subdivision 2.
The order must not apply to other licenses held by the same license holder if those programs
are being operated in substantial compliance with applicable law and rules.

Sec. 4.

Minnesota Statutes 2022, section 245A.10, subdivision 6, is amended to read:

Subd. 6.

License not issued until license or certification fee is paid.

The commissioner
shall not issue or reissue a license or certification until the license or certification fee is paid.
The commissioner shall send a bill for the license or certification fee to the billing address
identified by the license holder. If the license holder does not submit the license or
certification fee payment by the due date, the commissioner shall send the license holder a
past due notice. If the license holder fails to pay the license or certification fee by the due
date on the past due notice, the commissioner shall send a final notice to the license holder
informing the license holder that the program license will expire on December 31 unless
the license fee is paid before December 31. If a license expires, the program is no longer
licensed and, unless exempt from licensure under section 245A.03, subdivision 2, must not
operate after the expiration date. After a license expires, if the former license holder wishes
to provide licensed services, the former license holder must submit a new license application
and application fee under subdivision 3.

Sec. 5.

Minnesota Statutes 2022, section 245A.10, is amended by adding a subdivision to
read:

Subd. 9.

License not reissued until outstanding debt is paid.

The commissioner shall
not reissue a license or certification until the license holder has paid all outstanding debts
related to a licensing fine or settlement agreement for which payment is delinquent. If the
payment is past due, the commissioner shall send a past due notice informing the license
holder that the program license will expire on December 31 unless the outstanding debt is
paid before December 31. If a license expires, the program is no longer licensed and must
not operate after the expiration date. After a license expires, if the former license holder
wishes to provide licensed services, the former license holder must submit a new license
application and application fee under subdivision 3.

Sec. 6.

Minnesota Statutes 2022, section 245A.13, subdivision 1, is amended to read:

Subdivision 1.

Application.

(a) In addition to any other remedy provided by law, the
commissioner may petition the district court in Ramsey County for an order directing the
controlling individuals of a residential or nonresidential program licensed or certified by
the commissioner to show cause why the commissioner should not be appointed receiver
to operate the program. The petition to the district court must contain proof by affidavit that
one or more of the following circumstances exists: (1) that the commissioner has either
begun proceedings to suspend or revoke a license or certification, has suspended or revoked
a license or certification, or has decided to deny an application for licensure or certification
of the program; or (2) it appears to the commissioner that the health, safety, or rights of the
residents or persons receiving care from the program may be in jeopardy because of the
manner in which the program may close, the program's financial condition, or violations
committed by the program of federal or state laws or rules. If the license holder, applicant,
or controlling individual operates more than one program, the commissioner's petition must
specify and be limited to the program for which it seeks receivership. The affidavit submitted
by the commissioner must set forth alternatives to receivership that have been considered,
including rate adjustments. The order to show cause is returnable not less than five days
after service is completed and must provide for personal service of a copy to the program
administrator and to the persons designated as agents by the controlling individuals to accept
service on their behalf.

(1) the commissioner has commenced proceedings to suspend or revoke the program's
license or refused to renew the program's license;

(2) there is a threat of imminent abandonment by the program or its controlling
individuals;

(3) the program has shown a pattern of failure to meet ongoing financial obligations
such as failing to pay for food, pharmaceuticals, personnel costs, or required insurance;

(4) the health, safety, or rights of the residents or persons receiving care from the program
appear to be in jeopardy due to the manner in which the program may close, the program's
financial condition, or violations of federal or state law or rules committed by the program;
or

(5) the commissioner has notified the program or its controlling individuals that the
program's federal Medicare or Medicaid provider agreement will be terminated, revoked,
canceled, or not renewed.

(b) If the license holder, applicant, or controlling individual operates more than one
program, the commissioner's petition must specify and be limited to the program for which
it seeks receivership.

(c) The order to show cause shall be personally served on the program through its
authorized agent or, in the event the authorized agent cannot be located, on any controlling
individual for the program.

Sec. 7.

Minnesota Statutes 2022, section 245A.13, subdivision 2, is amended to read:

Subd. 2.

Appointment of receiver.

(a) If the court finds that involuntary receivership
is necessary as a means of protecting the health, safety, or rights of persons being served
by the program, the court shall appoint the commissioner as receiver to operate the program.
The commissioner as receiver may contract with another entity or group to act as the
managing agent during the receivership period. The managing agent will be responsible for
the day-to-day operations of the program subject at all times to the review and approval of
the commissioner. A managing agent shall not:

(1) be the license holder or controlling individual of the program;

(2) have a financial interest in the program at the time of the receivership;

(3) be otherwise affiliated with the program; or

(4) have had a licensed program that has been ordered into receivership.

(b) Notwithstanding state contracting requirements in chapter 16C, the commissioner
shall establish and maintain a list of qualified persons or entities with experience in delivering
services and with winding down programs under chapter 245A, 245D, or 245G, or other
service types licensed by the commissioner. The list shall be a resource for selecting a
managing agent, and the commissioner may update the list at any time.

Sec. 8.

Minnesota Statutes 2022, section 245A.13, subdivision 3, is amended to read:

Subd. 3.

Powers and duties of receiver.

Within 36 months after the receivership order,
the receiver shall provide for the orderly transfer of the persons served by the program to
other programs or make other provisions to protect their health, safety, and rights. The
receiver or the managing agent shall correct or eliminate deficiencies in the program that
the commissioner determines endanger the health, safety, or welfare of the persons being
served by the program unless the correction or elimination of deficiencies at a residential
program involves major alteration in the structure of the physical plant. If the correction or
elimination of the deficiencies at a residential program requires major alterations in the
structure of the physical plant, the receiver shall take actions designed to result in the
immediate transfer of persons served by the residential program. During the period of the
receivership, the receiver and the managing agent shall operate the residential or
nonresidential program in a manner designed to preserve the health, safety, rights, adequate
care, and supervision of the persons served by the program. The receiver or the managing
agent may make contracts and incur lawful expenses. The receiver or the managing agent
shall collect incoming payments from all sources and apply them to the cost incurred in the
performance of the functions of the receivership including the fee set under subdivision 4.
No security interest in any real or personal property comprising the program or contained
within it, or in any fixture of the physical plant, shall be impaired or diminished in priority
by the receiver or the managing agent. (a) A receiver appointed pursuant to this section
shall, within 18 months after the receivership order, determine whether to close the program
or to make other provisions with the intent to keep the program open. If the receiver
determines that program closure is appropriate, the commissioner shall provide for the
orderly transfer of individuals served by the program to other programs or make other
provisions to protect the health, safety, and rights of individuals served by the program.

(b) During the receivership, the receiver or the managing agent shall correct or eliminate
deficiencies in the program that the commissioner determines endanger the health, safety,
or welfare of the persons being served by the program unless the correction or elimination
of deficiencies at a residential program involves major alteration in the structure of the
physical plant. If the correction or elimination of the deficiencies at a residential program
requires major alterations in the structure of the physical plant, the receiver shall take actions
designed to result in the immediate transfer of persons served by the residential program.
During the period of the receivership, the receiver and the managing agent shall operate the
residential or nonresidential program in a manner designed to preserve the health, safety,
rights, adequate care, and supervision of the persons served by the program.

(c) The receiver or the managing agent may make contracts and incur lawful expenses.

(d) The receiver or the managing agent shall use the building, fixtures, furnishings, and
any accompanying consumable goods in the provision of care and services to the clients
during the receivership period. The receiver shall take action as is reasonably necessary to
protect or conserve the tangible assets or property during receivership.

(e) The receiver or the managing agent shall collect incoming payments from all sources
and apply them to the cost incurred in the performance of the functions of the receivership,
including the fee set under subdivision 4. No security interest in any real or personal property
comprising the program or contained within it, or in any fixture of the physical plant, shall
be impaired or diminished in priority by the receiver or the managing agent.

(f) The receiver has authority to hire, direct, manage, and discharge any employees of
the program, including management level staff for the program.

(g) The commissioner, as the receiver appointed by the court, may hire a managing agent
to work on the commissioner's behalf to operate the program during the receivership. The
managing agent is entitled to a reasonable fee. The receiver and managing agent shall be
liable only in an official capacity for injury to persons and property by reason of the
conditions of the program. The receiver and managing agent shall not be personally liable,
except for gross negligence or intentional acts. The commissioner shall assist the managing
agent in carrying out the managing agent's duties.

Sec. 9.

Minnesota Statutes 2022, section 245A.13, subdivision 6, is amended to read:

Subd. 6.

Emergency procedure.

(a) If it appears from the petition filed under subdivision
1, from an affidavit or affidavits filed with the petition, or from testimony of witnesses
under oath if the court determines it necessary, that there is probable cause to believe that
an emergency exists in a residential or nonresidential program, the court shall issue a
temporary order for appointment of a receiver within five two days after receipt of the
petition. Notice of the petition must be served on the program administrator and on the
persons designated as agents by the controlling individuals to accept service on their behalf.
A hearing on the petition must be held within five days after notice is served unless the
administrator or authorized agent consents to a later date. After the hearing, the court may
continue, modify, or terminate the temporary order.

(b) Notice of the petition must be served on the authorized agent of the program that is
subject to the receivership petition or, if the authorized agent is not immediately available
for service, on at least one of the controlling individuals for the program. A hearing on the
petition must be held within five days after notice is served unless the authorized agent or
other controlling individual consents to a later date. After the hearing, the court may continue,
modify, or terminate the temporary order.

Sec. 10.

Minnesota Statutes 2022, section 245A.13, subdivision 7, is amended to read:

Subd. 7.

Rate recommendation.

For any program receiving Medicaid funds and ordered
into receivership, the commissioner of human services may review rates of a residential or
nonresidential program participating in the medical assistance program which is in
receivership and that has needs or deficiencies documented by the Department of Health
or the Department of Human Services. If the commissioner of human services determines
that a review of the rate established under sections 256B.5012 and 256B.5013 is needed,
the commissioner shall:

(1) review the order or determination that cites the deficiencies or needs; and

(2) determine the need for additional staff, additional annual hours by type of employee,
and additional consultants, services, supplies, equipment, repairs, or capital assets necessary
to satisfy the needs or deficiencies.

Sec. 11.

Minnesota Statutes 2022, section 245A.13, subdivision 9, is amended to read:

Subd. 9.

Receivership accounting.

The commissioner may use adjust Medicaid rates
and use Medicaid funds, including but not limited to waiver funds, and the medical assistance
account and funds for receivership cash flow, receivership administrative fees, and accounting
purposes, to the extent permitted by the state's approved Medicaid plan.

ARTICLE 8

APPROPRIATIONS

Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

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 "2024" and "2025" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2024, or June 30, 2025, respectively.
"The first year" is fiscal year 2024. "The second year" is fiscal year 2025. "The biennium"
is fiscal years 2024 and 2025.

			APPROPRIATIONS
			Available for the Year
			Ending June 30
				2024		2025

Sec. 2. COMMISSIONER OF HUMAN SERVICES

Subdivision 1. Total Appropriation

$

6,834,184,000

$

7,252,890,000

Appropriations by Fund
	2024	2025
General	6,825,305,000	7,247,928,000
Lottery Prize	1,733,000	1,733,000
Opiate Epidemic Response	500,000	-0-

The amounts that may be spent for each
purpose are specified in the following
subdivisions.

Subd. 2. Central Office; Operations

Appropriations by Fund
General	85,879,000	16,057,000

(a) Staffing Costs. Appropriations for staffing
costs in this subdivision are available until
June 30, 2027.

(b) Base Level Adjustment. The general fund
base is $4,975,000 in fiscal year 2026 and
$4,868,000 in fiscal year 2027.

Subd. 3. Central Office; Children and Families

Appropriations by Fund
General	1,073,000	3,693,000

Staffing Costs. Appropriations for staffing
costs in this subdivision are available until
June 30, 2027.

Subd. 4. Central Office; Health Care

2,039,000

2,122,000

(a) Staffing Costs. Appropriations for staffing
costs in this subdivision are available until
June 30, 2027.

(b) Base Level Adjustment. The general fund
base is $900,000 in fiscal year 2026 and
$900,000 in fiscal year 2027.

(c) Initial PACE Implementation Funding.
$150,000 in fiscal year 2024 is to complete
the initial actuarial and administrative work
necessary to recommend a financing
mechanism for the operation of PACE under
Minnesota Statutes, section 256B.69,
subdivision 23, paragraph (e). This is a
onetime appropriation.

Subd. 5. Central Office; Continuing Care for Older Adults

14,120,000

21,666,000

(a) Staffing Costs. Appropriations for staffing
costs in this subdivision are available until
June 30, 2027.

(b) Research on Access to Long-Term Care
Services. $700,000 in fiscal year 2024 is to
support an actuarial research study of public
and private financing options for long-term
services and supports reform to increase access
across the state. This is a onetime
appropriation.

(c) Employment Supports Alignment Study.
$50,000 in fiscal year 2024 and $200,000 in
fiscal year 2025 are to conduct an interagency
employment supports alignment study. The
base for this appropriation is $150,000 in fiscal
year 2026 and $100,000 in fiscal year 2027.

(d) Case Management Training
Curriculum. $377,000 in fiscal year 2024 and
$377,000 fiscal year 2025 are to develop and
implement a curriculum and training plan to
ensure all lead agency assessors and case
managers have the knowledge and skills
necessary to fulfill support planning and
coordination responsibilities for individuals
who use home and community-based disability
services and live in own-home settings. These
are onetime appropriations.

(e) Parent-to-Parent Programs. (1) $625,000
in fiscal year 2024 and $625,000 in fiscal year
2025 are for grants to organizations supporting
the organizations' parent-to-parent programs
for families of children with special health
care needs. This is a onetime appropriation
and is available until June 30, 2025.

(2) Of this amount, $500,000 in fiscal year
2024 and $500,000 in fiscal year 2025 are for
grants to organizations that provide services
to underserved communities with a high
prevalence of autism spectrum disorder. The
commissioner shall give priority to
organizations that provide culturally specific
and culturally responsive services.

(3) Eligible organizations must:

(i) conduct outreach and provide support to
newly identified parents or guardians of a child
with special health care needs;

(ii) provide training to educate parents and
guardians in ways to support their child and
navigate the health, education, and human
services systems;

(iii) facilitate ongoing peer support for parents
and guardians from trained volunteer support
parents; and

(iv) communicate regularly with other
parent-to-parent programs and national
organizations to ensure that best practices are
implemented.

(4) Grant recipients must use grant money for
the activities identified in clause (3).

(5) For purposes of this section, "special health
care needs" means disabilities, chronic
illnesses or conditions, health-related
educational or behavioral problems, or the risk
of developing disabilities, illnesses, conditions,
or problems.

(6) Each grant recipient must report to the
commissioner of human services annually by
January 15 with measurable outcomes from
programs and services funded by this
appropriation the previous year including the
number of families served and the number of
volunteer support parents trained by the
organization's parent-to-parent program.

(f) Direct Care Service Corps Pilot Project.
$500,000 in fiscal year 2024 is for a grant to
HealthForce Minnesota at Winona State
University for purposes of the direct care
service corps pilot project. Up to $25,000 may
be used by HealthForce Minnesota for
administrative costs. This is a onetime
appropriation.

(g) Native American Elder Coordinator.
$441,000 in fiscal year 2024 and $441,000 in
fiscal year 2025 are for the Native American
elder coordinator position under Minnesota
Statutes, section 256.975, subdivision 6. The
base for this appropriation is $441,000 in fiscal
year 2026 and $441,000 in fiscal year 2027.

(h) Office of Ombudsman for Long-Term
Care. $500,000 in fiscal year 2024 and
$500,000 in fiscal year 2025 are for additional
staff and associated costs in the Office of
Ombudsman for Long-Term Care.

(i) Base Level Adjustment. The general fund
base is $6,476,000 in fiscal year 2026 and
$6,378,000 in fiscal year 2027.

Subd. 6. Central Office; Behavioral Health, Housing, and Deaf and Hard of Hearing Services

6,390,000

7,838,000

(a) Staffing Costs. Appropriations for staffing
costs in this subdivision are available until
June 30, 2027.

(b) Competency-based Training Funding
for Substance Use Disorder Provider
Community. $300,000 in fiscal year 2024 and
$300,000 in fiscal year 2025 are for provider
participation in clinical training for the
transition to American Society of Addiction
Medicine standards. This is a onetime
appropriation.

(c) Public Awareness Campaign. $1,200,000
in fiscal year 2024 is to develop and establish
a public awareness campaign targeting the
stigma of opioid use disorders with the goal
of prevention and education of youth on the
dangers of opioids and other substance use.
This is a onetime appropriation.

(d) Bad Batch Overdose Surge Text Alert
System. $1,000,000 in fiscal year 2024 and
$250,000 in fiscal year 2025 are for
development and ongoing funding for a text
alert system notifying the public in real time
of bad batch overdoses. This is a onetime
appropriation.

(e) Evaluation of Recovery Site Grants.
$300,000 in fiscal year 2025 is to provide
funding for evaluating the effectiveness of
recovery site grant efforts. This is a onetime
appropriation.

(f) Office of Addiction and Recovery.
$750,000 in fiscal year 2024 and $750,000 in
fiscal year 2025 are for the Office of Addiction
and Recovery.

(g) Base Level Adjustment. The general fund
base is $2,667,000 in fiscal year 2026 and
$2,567,000 in fiscal year 2027.

Subd. 7. Forecasted Programs; Medical Assistance

5,654,567,000

6,359,586,000

Subd. 8. Forecasted Programs; Alternative Care

47,793,000

51,035,000

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.

Subd. 9. Forecasted Programs; Behavioral Health Fund

96,387,000

98,417,000

Subd. 10. Grant Programs; Children and Economic Support Grants

1,000,000

-0-

Minnesota Alliance for Volunteer
Advancement. (1) $1,000,000 in fiscal year
2024 is for a grant to the Minnesota Alliance
for Volunteer Advancement to administer
needs-based volunteerism subgrants that:

(i) target underresourced nonprofit
organizations in greater Minnesota to support
selected organizations' ongoing efforts to
address and minimize disparities in access to
human services through increased
volunteerism; and

(ii) demonstrate that the populations to be
served by the subgrantee are considered
underserved or suffer from or are at risk of
homelessness, hunger, poverty, lack of access
to health care, or deficits in education.

(2) The Minnesota Alliance for Volunteer
Advancement shall give priority to
organizations that are serving the needs of
vulnerable populations. By December 15,
2025, the Minnesota Alliance for Volunteer
Advancement shall report data on outcomes
from the subgrants and recommendations for
improving and sustaining volunteer efforts
statewide to the chairs and ranking minority
members of the legislative committees and
divisions with jurisdiction over human
services. This is a onetime appropriation and
is available until June 30, 2025.

Subd. 11. Grant Programs; Refugee Services Grants

3,000,000

5,000,000

New American Legal and Social Services
Workforce Grant Program. $3,000,000 in
fiscal year 2024 and $5,000,000 in fiscal year
2025 are for legal and social services grants.
This is a onetime appropriation.

Subd. 12. Grant Programs; Other Long-Term Care Grants

44,772,000

38,925,000

(a) Provider Capacity Grants for Rural and
Underserved Communities. $24,000,000 in
fiscal year 2025 is for provider capacity grants
for rural and underserved communities. This
is a onetime appropriation.

(b) Supporting New Americans in the
Long-Term Care Workforce Grants.
$25,759,000 in fiscal year 2024 and
$13,000,000 in fiscal year 2025 are for
supporting new Americans in the long-term
care workforce grants. This is a onetime
appropriation.

(c) Base Level Adjustment. The general fund
base is $1,925,000 in fiscal year 2026 and
$1,925,000 in fiscal year 2027.

Subd. 13. Grant Programs; Aging and Adult Services Grants

87,599,000

39,520,000

(a) Age-Friendly Community Grants.
$1,000,000 in fiscal year 2025 is for the
continuation of age-friendly community grants
under Laws 2021, First Special Session
chapter 7, article 17, section 8, subdivision 1.
The base for this appropriation is $1,000,000
in fiscal year 2026, $1,000,000 in fiscal year
2027, and $0 in fiscal year 2028. This
appropriation is available until June 30, 2027.

(b) Age-Friendly Technical Assistance
Grants. $575,000 in fiscal year 2025 is for
the continuation of age-friendly technical
assistance grants under Laws 2021, First
Special Session chapter 7, article 17, section
8, subdivision 2. The base for this
appropriation is $575,000 in fiscal year 2026,
$575,000 in fiscal year 2027, and $0 in fiscal
year 2028. This appropriation is available until
June 30, 2027.

(c) Senior Nutrition Program. $4,500,000
in fiscal year 2024 is for the senior nutrition
program under Minnesota Statutes, section
256.9752. This is a onetime appropriation and
is available until June 30, 2025.

(d) Live Well at Home Grants. $4,500,000
in fiscal year 2024 is for live well at home
grants under Minnesota Statutes, section
256.9754. This is a onetime appropriation and
is available until June 30, 2025.

(e) Caregiver Respite Services Grants.
$1,800,000 in fiscal year 2025 is for caregiver
respite services grants under Minnesota
Statutes, section 256.9756. This is a onetime
appropriation.

(f) Base Level Adjustment. The general fund
base is $32,995,000 in fiscal year 2026 and
$32,995,000 in fiscal year 2027.

Subd. 14. Grant Programs; Deaf and Hard of Hearing Grants

2,886,000

2,886,000

Subd. 15. Grant Programs; Disabilities Grants

160,792,000

29,533,000

(a) Transition Grants for Small Customized
Living Providers. $8,450,000 in fiscal year
2024 is for grants to assist transitions of small
customized living providers as defined under
Minnesota Statutes, section 245D.24. This is
a onetime appropriation and is available
through June 30, 2025.

(b) Lead Agency Capacity Building Grants.
$500,000 in fiscal year 2024 and $2,500,000
in fiscal year 2025 are for grants to assist
organizations, counties, and Tribes to build
capacity for employment opportunities for
people with disabilities.

(c) Employment and Technical Assistance
Center Grants. $450,000 in fiscal year 2024
and $1,800,000 in fiscal year 2025 are for
employment and technical assistance grants
to assist organizations and employers in
promoting a more inclusive workplace for
people with disabilities.

(d) Case Management Training Grants.
$37,000 in fiscal year 2024 and $123,000 in
fiscal year 2025 are for grants to provide case
management training to organizations and
employers to support the state's disability
employment supports system. The base for
this appropriation is $45,000 in fiscal year
2026 and $45,000 in fiscal year 2027.

(e) Electronic Visit Verification Stipends.
$6,095,000 in fiscal year 2024 is for onetime
stipends of $200 to bargaining members to
offset the potential costs related to people
using individual devices to access the
electronic visit verification system. $5,600,000
of the appropriation is for stipends and the
remaining amount is for administration of the
stipends. This is a onetime appropriation and
is available until June 30, 2025.

(f) Self-Directed Collective Bargaining
Agreement; Temporary Rate Increase
Memorandum of Understanding. $1,600,000
in fiscal year 2024 is for onetime stipends for
individual providers covered by the SEIU
collective bargaining agreement based on the
memorandum of understanding related to the
temporary rate increase in effect between
December 1, 2020, and February 7, 2021.
$1,400,000 of the appropriation is for stipends
and the remaining amount is for administration
of the stipends. This is a onetime
appropriation.

(g) Self-Directed Collective Bargaining
Agreement; Retention Bonuses. $50,750,000
in fiscal year 2024 is for onetime retention
bonuses covered by the SEIU collective
bargaining agreement. $50,000,000 of the
appropriation is for retention bonuses and the
remaining amount is for administration of the
bonuses. This is a onetime appropriation and
is available until June 30, 2025.

(h) Training Stipends. $2,100,000 in fiscal
year 2024 and $100,000 in fiscal year 2025
are for onetime stipends of $500 for collective
bargaining unit members who complete
designated, voluntary trainings made available
through or recommended by the State Provider
Cooperation Committee. $2,000,000 of the
appropriation is for stipends and the remaining
amount in both fiscal year 2024 and fiscal
2025 is for the administration of stipends. This
is a onetime appropriation.

(i) Orientation Program. $2,000,000 in fiscal
year 2024 and $2,000,000 in fiscal year 2025
are for onetime $100 payments for collective
bargaining unit members who complete
voluntary orientation requirements. $1,500,000
in fiscal year 2024 and $1,500,000 in fiscal
year 2025 are for the onetime payments, while
$500,000 in fiscal year 2024 and $500,000 in
fiscal year 2025 are for orientation-related
costs. This is a onetime appropriation.

(j) HIV/AIDS Support Services. $24,200,000
in fiscal year 2024 is for grants to
community-based HIV/AIDS support services
providers and for payment of allowed health
care costs as defined in Minnesota Statutes,
section 256.9365. This is a onetime
appropriation and is available through June
30, 2027.

(k) Home Care Orientation Trust.
$1,000,000 in fiscal year 2024 is for the Home
Care Orientation Trust in Article 10 of the
2023-2025 collective bargaining agreement
between the state of Minnesota and Service
Employees International Union Healthcare
Minnesota and Iowa. The commissioner shall
disburse the appropriation to the board of
trustees of the Home Care Orientation Trust
for deposit into an account designed by the
board of trustees outside of the state treasury
and state's accounting system. This is a
onetime appropriation.

(l) Home and Community-Based Workforce
Incentive Fund Grants. $33,300,000 in fiscal
year 2024 is for home and community-based
workforce incentive fund grants. This is a
onetime appropriation and is available until
June 30, 2026.

(m) Community Residential Setting
Transition. $500,000 in fiscal year 2024 is
for a grant to Hennepin County to expedite
approval of community residential setting
licenses subject to the corporate foster care
moratorium exception under Minnesota
Statutes, section 245A.03, subdivision 7,
paragraph (a), clause (5).

(n) Base Level Adjustment. The base is
$27,355,000 in fiscal year 2026 and
$27,030,000 in fiscal year 2027.

Subd. 16. Grant Programs; Adult Mental Health Grants

1,500,000

1,500,000

African American Child Wellness Institute.
$3,000,000 in fiscal year 2024 is for a grant
to the African American Child Wellness
Institute, a culturally specific African
American mental health service provider that
is a licensed community mental health center
specializing in services for African American
children and families of all ages. The grant
must be used to support the center in offering
culturally specific, comprehensive,
trauma-informed, practice- and
evidence-based, person- and family-centered
mental health and substance use disorder
services; supervision and training; and care
coordination regardless of ability to pay or
place of residence. This is a onetime
appropriation.

Subd. 17. Grant Programs; Chemical Dependency Treatment Support Grants

Appropriations by Fund
General	89,788,000	6,497,000
Lottery Prize	1,733,000	1,733,000
Opiate Epidemic Response	500,000	-0-

(a) Safe Recovery Sites. $55,491,000 in fiscal
year 2024 is from the general fund for start-up
and capacity-building grants for organizations
to establish safe recovery sites. This
appropriation is onetime and is available until
June 30, 2025.

(b) Culturally Specific Services Grants.
$4,000,000 in fiscal year 2024 is from the
general fund for grants to culturally specific
providers for technical assistance navigating
culturally specific and responsive substance
use and recovery programs. This is a onetime
appropriation.

(c) Culturally Specific Grant Development
Trainings. $200,000 in fiscal year 2024 and
$200,000 in fiscal year 2025 are from the
general fund for up to four trainings for
community members and culturally specific
providers for grant writing training for
substance use and recovery programs. This is
onetime appropriation.

(d) Harm Reduction Supplies for Tribal
and Culturally Specific Programs.
$8,000,000 in fiscal year 2024 is from the
general fund to provide sole source grants to
culturally specific communities to purchase
syringes, testing supplies, and opiate
antagonists. This is a onetime appropriation.

(e) Families and family Treatment
Capacity-building and Start-up Grants.
$10,000,000 in fiscal year 2024 is from the
general fund for start-up and capacity-building
grants for family substance use disorder
treatment programs. Any unexpended funds
are available until June 30, 2029. This is a
onetime appropriation.

(f) Minnesota State University, Mankato
Community Behavioral Health Center.
$750,000 in fiscal year 2024 and $750,000 in
fiscal year 2025 are from the general fund for
a grant to the Center for Rural Behavioral
Health at Minnesota State University, Mankato
to establish a community behavioral health
center and training clinic. The community
behavioral health center must provide
comprehensive, culturally specific,
trauma-informed, practice- and
evidence-based, person- and family-centered
mental health and substance use disorder
treatment services in Blue Earth County and
the surrounding region. The center must
provide the services to individuals of all ages,
regardless of ability to pay or place of
residence. The community behavioral health
center and training clinic must also provide
training and workforce development
opportunities to students enrolled in the
university's training programs in the fields of
social work, counseling and student personnel,
alcohol and drug studies, psychology, and
nursing. The commissioner shall make
information regarding the use of this grant
funding available to the chairs and ranking
minority members of the legislative
committees with jurisdiction over health and
human services. Any unspent money from the
fiscal year 2024 appropriation is available in
fiscal year 2025. These are onetime
appropriations.

(g) Wellness in the Woods. $250,000 in fiscal
year 2024 and $250,000 in fiscal year 2025
are from the general fund for a grant to
Wellness in the Woods for daily peer support
and special sessions for individuals who are
in substance use disorder recovery, are
transitioning out of incarceration, or who have
experienced trauma. These are onetime
appropriations.

(h) Recovery Community Organization
Grants. $4,300,000 in fiscal year 2024 is from
the general fund for grants to recovery
community organizations, as defined in
Minnesota Statutes, section 254B.01,
subdivision 8, that are current grantees as of
June 30, 2023. This is a onetime appropriation
and is available until June 30, 2025.

(i) Opioid Overdose Prevention Grants.
$500,000 in fiscal year 2024 and $500,000 in
fiscal year 2025 are from the general fund for
a grant to Ka Joog, a nonprofit organization
in Minneapolis, Minnesota, to be used for
collaborative outreach, education, and training
on opioid use and overdose, and distribution
of opiate antagonist kits in East African and
Somali communities in Minnesota. This is a
onetime appropriation.

(j) Problem Gambling. $225,000 in fiscal
year 2024 and $225,000 in fiscal year 2025
are from the lottery prize fund for a grant to a
state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
training for individuals and organizations that
provide effective treatment services to problem
gamblers and their families, and research
related to problem gambling.

(k) Project ECHO. $1,500,000 in fiscal year
2024 and $1,500,000 in fiscal year 2025 are
from the general fund for a grant to Hennepin
Healthcare to expand the Project ECHO
program. The grant must be used to establish
at least four substance use disorder-focused
Project ECHO programs at Hennepin
Healthcare, expanding the grantee's capacity
to improve health and substance use disorder
outcomes for diverse populations of
individuals enrolled in medical assistance,
including but not limited to immigrants,
individuals who are homeless, individuals
seeking maternal and perinatal care, and other
underserved populations. The Project ECHO
programs funded under this section must be
culturally responsive, and the grantee must
contract with culturally and linguistically
appropriate substance use disorder service
providers who have expertise in focus areas,
based on the populations served. Grant funds
may be used for program administration,
equipment, provider reimbursement, and
staffing hours. This is a onetime appropriation.

(l) Base Level Adjustment. The general fund
base is $3,247,000 in fiscal year 2026 and
$3,247,000 in fiscal year 2027.

Subd. 18. Direct Care and Treatment - Transfer Authority

(a) Money appropriated for budget activities
under subdivisions 19 to 23 may be transferred
between budget activities and between years
of the biennium with the approval of the
commissioner of management and budget.

(b) Ending balances in obsolete accounts in
the special revenue fund and other dedicated
accounts within direct care and treatment may
be transferred to other dedicated and gift fund
accounts within direct care and treatment for
client use and other client activities, with
approval of the commissioner of management
and budget. These transactions must be
completed by August 1, 2023.

Subd. 19. Direct Care and Treatment - Mental Health and Substance Abuse

169,962,000

177,152,000

The commissioner responsible for operations
of direct care and treatment services, with the
approval of the commissioner of management
and budget, may transfer any balance in the
enterprise fund established for the community
addiction recovery enterprise program to the
general fund appropriation within this
subdivision. Any balance remaining after June
30, 2025, cancels to the general fund.

Subd. 20. Direct Care and Treatment - Community-Based Services

20,386,000

21,164,,000

Base Level Adjustment. The general fund
base is $20,452,000 in fiscal year 2026 and
$20,452,000 in fiscal year 2027.

Subd. 21. Direct Care and Treatment - Forensic Services

141,020,000

148,513,000

Subd. 22. Direct Care and Treatment - Sex Offender Program

115,920,000

121,726,000

Subd. 23. Direct Care and Treatment - Operations

78,432,000

95,098,000

The general fund base is $65,263,000 in fiscal
year 2026 and $65,263,000 in fiscal year 2027.

Sec. 3. COUNCIL ON DISABILITY

$

1,902,000

$

2,282,000

(a) Council on Disability; Accessibility
Standards Training. (1) $250,000 in fiscal
year 2024 and $250,000 in fiscal year 2025
are for the Minnesota Council on Disability
to select, appoint, and compensate employees
to perform the following tasks:

(i) in consultation with the League of
Minnesota Cities and the Association of
Minnesota Counties, provide a statewide
training module for cities and counties on how
to conform local government websites to
accessibility standards;

(ii) provide outreach, training, and technical
assistance for local government officials and
staff on website accessibility; and

(iii) track and compile information about the
outcomes of the activities described in clauses
(1) and (2) and the costs of implementation
for cities and counties to make website
accessibility improvements.

(2) The training module described under
paragraph (a), clause (1), must be developed
and made available to counties and cities on
or before July 1, 2024.

(3) This is a onetime appropriation.

(b) Base Level Adjustment. The general fund
base is $2,032,000 in fiscal year 2026 and
$2,032,000 in fiscal year 2027.

Sec. 4. OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES

$

3,441,000

$

3,644,000

Sec. 5. MINNESOTA MANAGEMENT AND BUDGET

1,000,000

1,000,000

(a) Office of Addiction and Recovery.
$750,000 in fiscal year 2024 and $750,000 in
fiscal year 2025 are for the Office of Addiction
and Recovery.

(b) Youth Substance Use and Addiction
Recovery Office. $250,000 in fiscal year 2024
and $250,000 in fiscal year 2025 are for the
Youth Substance Use and Addiction Recovery
Office.

Sec. 6.

Laws 2021, First Special Session chapter 7, article 16, section 28, as amended by
Laws 2022, chapter 40, section 1, is amended to read:

Sec. 28. CONTINGENT APPROPRIATIONS.

Any appropriation in this act for a purpose included in Minnesota's initial state spending
plan as described in guidance issued by the Centers for Medicare and Medicaid Services
for implementation of section 9817 of the federal American Rescue Plan Act of 2021 is
contingent upon the initial approval of that purpose by the Centers for Medicare and Medicaid
Services, except for the rate increases specified in article 11, sections 12 and 19. This section
expires June 30, 2024.

Sec. 7. DIRECT CARE AND TREATMENT FISCAL YEAR 2023
APPROPRIATION.

$4,829,000 is appropriated in fiscal year 2023 to the commissioner of human services
for operation of direct care and treatment programs. This is a onetime appropriation.

Sec. 8. TRANSFERS.

Subdivision 1.

Grants.

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, 2025, within fiscal years among the MFIP; general
assistance; medical assistance; MinnesotaCare; MFIP child care assistance under Minnesota
Statutes, section 119B.05; Minnesota supplemental aid program; housing support program;
the entitlement portion of Northstar Care for Children under Minnesota Statutes, chapter
256N; and the entitlement portion of the behavioral health fund between fiscal years of the
biennium. The commissioner shall inform the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services quarterly about
transfers made under this subdivision.

Subd. 2.

Administration.

Positions, salary money, and nonsalary administrative money
may be transferred within the Department of Human Services as the commissioner considers
necessary, with the advance approval of the commissioner of management and budget. The
commissioners shall inform the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services finance quarterly about transfers
made under this section.

Sec. 9. APPROPRIATIONS GIVEN EFFECT ONCE.

If an appropriation or transfer in this article is enacted more than once during the 2023
regular session, the appropriation or transfer must be given effect once.

Sec. 10. FINANCIAL REVIEW OF NONPROFIT GRANT RECIPIENTS
REQUIRED.

Subdivision 1.

Financial review required.

(a) Before awarding a competitive,
legislatively named, single-source, or sole-source grant to a nonprofit organization under
this act, the grantor must require the applicant to submit financial information sufficient for
the grantor to document and assess the applicant's current financial standing and management.
Items of significant concern must be addressed with the applicant and resolved to the
satisfaction of the grantor before a grant is awarded. The grantor must document the material
requested and reviewed; whether the applicant had a significant operating deficit, a deficit
in unrestricted net assets, or insufficient internal controls; whether and how the applicant
resolved the grantor's concerns; and the grantor's final decision. This documentation must
be maintained in the grantor's files.

(b) At a minimum, the grantor must require each applicant to provide the following
information:

(1) the applicant's most recent Form 990, Form 990-EZ, or Form 990-N filed with the
Internal Revenue Service. If the applicant has not been in existence long enough or is not
required to file Form 990, Form 990-EZ, or Form 990-N, the applicant must demonstrate
to the grantor that the applicant is exempt and must instead submit documentation of internal
controls and the applicant's most recent financial statement prepared in accordance with
generally accepted accounting principles and approved by the applicant's board of directors
or trustees, or if there is no such board, by the applicant's managing group;

(2) evidence of registration and good standing with the secretary of state under Minnesota
Statutes, chapter 317A, or other applicable law;

(3) unless exempt under Minnesota Statutes, section 309.515, evidence of registration
and good standing with the attorney general under Minnesota Statutes, chapter 309; and

(4) if required under Minnesota Statutes, section 309.53, subdivision 3, the applicant's
most recent audited financial statement prepared in accordance with generally accepted
accounting principles.

Subd. 2.

Authority to postpone or forgo.

Notwithstanding any contrary provision in
this act, a grantor that identifies an area of significant concern regarding the financial standing
or management of a legislatively named applicant may postpone or forgo awarding the
grant.

Subd. 3.

Authority to award subject to additional assistance and oversight.

A grantor
that identifies an area of significant concern regarding an applicant's financial standing or
management may award a grant to the applicant if the grantor provides or the grantee
otherwise obtains additional technical assistance, as needed, and the grantor imposes
additional requirements in the grant agreement. Additional requirements may include but
are not limited to enhanced monitoring, additional reporting, or other reasonable requirements
imposed by the grantor to protect the interests of the state.

Subd. 4.

Relation to other law and policy.

The requirements in this section are in
addition to any other requirements imposed by law, the commissioner of administration
under Minnesota Statutes, sections 16B.97 and 16B.98, or agency policy.

Sec. 11. EXPIRATION OF UNCODIFIED LANGUAGE.

All uncodified language contained in this article expires on June 30, 2025, unless a
different expiration date is explicit.

APPENDIX

Repealed Minnesota Statutes: UES2934-1

245G.06 INDIVIDUAL TREATMENT PLAN.

Subd. 2.

Plan contents.

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:

(1) specific goals and methods to address each identified need in the comprehensive assessment summary, 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;

(2) resources to refer the client to when the client's needs are to be addressed concurrently by another provider; and

(3) goals the client must reach to complete treatment and terminate services.

246.18 DISPOSAL OF FUNDS.

Subd. 2.

Behavioral health fund.

Money received by a substance use disorder treatment facility operated by a regional treatment center or nursing home under the jurisdiction of the commissioner of human services must be deposited in the state treasury and credited to the behavioral health fund. Money in the behavioral health fund is appropriated to the commissioner to operate substance use disorder programs.

Subd. 2a.

Disposition of interest for the behavioral health fund.

Beginning July 1, 1991, interest earned on cash balances on deposit with the commissioner of management and budget derived from receipts from substance use disorder programs affiliated with state-operated facilities under the commissioner of human services must be deposited in the state treasury and credited to a substance use disorder account under subdivision 2. Any interest earned is appropriated to the commissioner to operate substance use disorder programs according to subdivision 2.

256B.0759 SUBSTANCE USE DISORDER DEMONSTRATION PROJECT.

Subd. 6.

Medium intensity residential program participation.

Medium intensity residential programs that qualify to participate in the demonstration project shall use the specified base payment rate of $132.90 per day, and shall be eligible for the rate increases specified in subdivision 4.

256B.0917 HOME AND COMMUNITY-BASED SERVICES FOR OLDER ADULTS.

Subd. 1a.

Home and community-based services for older adults.

(a) The purpose of projects selected by the commissioner of human services under this section is to make strategic changes in the long-term services and supports system for older adults including statewide capacity for local service development and technical assistance, and statewide availability of home and community-based services for older adult services, caregiver support and respite care services, and other supports in the state of Minnesota. These projects are intended to create incentives for new and expanded home and community-based services in Minnesota in order to:

(1) reach older adults early in the progression of their need for long-term services and supports, providing them with low-cost, high-impact services that will prevent or delay the use of more costly services;

(2) support older adults to live in the most integrated, least restrictive community setting;

(3) support the informal caregivers of older adults;

(4) develop and implement strategies to integrate long-term services and supports with health care services, in order to improve the quality of care and enhance the quality of life of older adults and their informal caregivers;

(5) ensure cost-effective use of financial and human resources;

(6) build community-based approaches and community commitment to delivering long-term services and supports for older adults in their own homes;

(7) achieve a broad awareness and use of lower-cost in-home services as an alternative to nursing homes and other residential services;

(8) strengthen and develop additional home and community-based services and alternatives to nursing homes and other residential services; and

(9) strengthen programs that use volunteers.

(b) The services provided by these projects are available to older adults who are eligible for medical assistance and the elderly waiver under chapter 256S, the alternative care program under section 256B.0913, or essential community supports grant under section 256B.0922, and to persons who have their own funds to pay for services.

Subd. 6.

Caregiver support and respite care projects.

(a) The commissioner shall establish projects to expand the availability of caregiver support and respite care services for family and other caregivers. The commissioner shall use a request for proposals to select nonprofit entities to administer the projects. Projects shall:

(1) establish a local coordinated network of volunteer and paid respite workers;

(2) coordinate assignment of respite care services to caregivers of older adults;

(3) assure the health and safety of the older adults;

(4) identify at-risk caregivers;

(5) provide information, education, and training for caregivers in the designated community; and

(6) demonstrate the need in the proposed service area particularly where nursing facility closures have occurred or are occurring or areas with service needs identified by section 144A.351. Preference must be given for projects that reach underserved populations.

(b) Projects must clearly describe:

(1) how they will achieve their purpose;

(2) the process for recruiting, training, and retraining volunteers; and

(3) a plan to promote the project in the designated community, including outreach to persons needing the services.

(c) Funds for all projects under this subdivision may be used to:

(1) hire a coordinator to develop a coordinated network of volunteer and paid respite care services and assign workers to clients;

(2) recruit and train volunteer providers;

(3) provide information, training, and education to caregivers;

(4) advertise the availability of the caregiver support and respite care project; and

(5) purchase equipment to maintain a system of assigning workers to clients.

(d) Project funds may not be used to supplant existing funding sources.

Subd. 7a.

Core home and community-based services.

The commissioner shall select and contract with core home and community-based services providers for projects to provide services and supports to older adults both with and without family and other informal caregivers using a request for proposals process. Projects must:

(1) have a credible, public, or private nonprofit sponsor providing ongoing financial support;

(2) have a specific, clearly defined geographic service area;

(3) use a practice framework designed to identify high-risk older adults and help them take action to better manage their chronic conditions and maintain their community living;

(4) have a team approach to coordination and care, ensuring that the older adult participants, their families, and the formal and informal providers are all part of planning and providing services;

(5) provide information, support services, homemaking services, counseling, and training for the older adults and family caregivers;

(6) encourage service area or neighborhood residents and local organizations to collaborate in meeting the needs of older adults in their geographic service areas;

(7) recruit, train, and direct the use of volunteers to provide informal services and other appropriate support to older adults and their caregivers; and

(8) provide coordination and management of formal and informal services to older adults and their families using less expensive alternatives.

Subd. 13.

Community service grants.

The commissioner shall award contracts for grants to public and private nonprofit agencies to establish services that strengthen a community's ability to provide a system of home and community-based services for elderly persons. The commissioner shall use a request for proposal process. The commissioner shall give preference when awarding grants under this section to areas where nursing facility closures have occurred or are occurring or to areas with service needs identified under section 144A.351.

256B.4914 HOME AND COMMUNITY-BASED SERVICES WAIVERS; RATE SETTING.

Subd. 6b.

Family residential services; component values and calculation of payment rates.

(a) Component values for family residential services are:

(1) competitive workforce factor: 4.7 percent;

(2) supervisory span of control ratio: 11 percent;

(3) employee vacation, sick, and training allowance ratio: 8.71 percent;

(4) employee-related cost ratio: 23.6 percent;

(5) general administrative support ratio: 3.3 percent;

(6) program-related expense ratio: 1.3 percent; and

(7) absence factor: 1.7 percent.

(b) Payments for family residential services must be calculated as follows:

(1) determine the number of shared direct staffing and individual direct staffing hours to meet a recipient's needs provided on site or through monitoring technology;

(2) determine the appropriate hourly staff wage rates derived by the commissioner as provided in subdivisions 5 and 5a;

(3) except for subdivision 5a, clauses (1) to (4), multiply the result of clause (2) by the product of one plus the competitive workforce factor;

(4) 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 (3);

(5) multiply the number of shared direct staffing and individual direct staffing hours provided on site or through monitoring technology and nursing hours by the appropriate staff wages;

(6) multiply the number of shared direct staffing and individual direct staffing hours provided on site or through monitoring technology and nursing hours by the product of the supervisory span of control ratio and the appropriate supervisory staff wage in subdivision 5a, clause (1);

(7) combine the results of clauses (5) and (6), excluding any shared direct staffing and individual direct staffing hours provided through monitoring technology, and multiply the result by one plus the employee vacation, sick, and training allowance ratio. This is defined as the direct staffing cost;

(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared and individual direct staffing hours provided through monitoring technology, by one plus the employee-related cost ratio;

(9) for client programming and supports, add $2,260.21 divided by 365. The commissioner shall update the amount in this clause as specified in subdivision 5b;

(10) for transportation, if provided, add $1,742.62 divided by 365, or $3,111.81 divided by 365 if customized for adapted transport, based on the resident with the highest assessed need. The commissioner shall update the amounts in this clause as specified in subdivision 5b;

(11) subtotal clauses (8) to (10) and the direct staffing cost of any shared direct staffing and individual direct staffing hours provided through monitoring technology that was excluded in clause (8);

(12) sum the standard general administrative support ratio, the program-related expense ratio, and the absence and utilization factor ratio;

(13) divide the result of clause (11) by one minus the result of clause (12). This is the total payment rate; 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.

256S.2101 RATE SETTING; PHASE-IN.

Subdivision 1.

Phase-in for disability waiver customized living rates.

All rates and rate components for community access for disability inclusion customized living and brain injury customized living under section 256B.4914 shall be the sum of ten percent of the rates calculated under sections 256S.211 to 256S.215 and 90 percent of the rates calculated using the rate methodology in effect as of June 30, 2017.

Subd. 2.

Phase-in for elderly waiver rates.

Except for home-delivered meals as described in section 256S.215, subdivision 15, all rates and rate components for elderly waiver, elderly waiver customized living, and elderly waiver foster care under this chapter; alternative care under section 256B.0913; and essential community supports under section 256B.0922 shall be the sum of 18.8 percent of the rates calculated under sections 256S.211 to 256S.215, and 81.2 percent of the rates calculated using the rate methodology in effect as of June 30, 2017. The rate for home-delivered meals shall be the sum of the service rate in effect as of January 1, 2019, and the increases described in section 256S.215, subdivision 15.