SF 2934

3rd Engrossment - 93rd Legislature (2023 - 2024) Posted on 05/21/2023 11:45am

A bill for an act
relating to human services; establishing an office of addiction and recovery;
establishing the Minnesota board of recovery services; establishing title protection
for sober homes; modifying provisions governing disability services, aging services,
and behavioral health; modifying medical assistance eligibility requirements for
certain populations; making technical and conforming changes; establishing certain
grants; requiring reports; appropriating money; amending Minnesota Statutes 2022,
sections 4.046, subdivisions 6, 7, by adding a subdivision; 179A.54, by adding a
subdivision; 241.021, subdivision 1; 241.31, subdivision 5; 241.415; 245A.03,
subdivision 7; 245A.11, subdivisions 7, 7a; 245D.04, subdivision 3; 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; 246.54, subdivisions 1a, 1b; 252.27, subdivision 2a; 254B.01,
subdivision 8, by adding subdivisions; 254B.04, by adding a subdivision; 254B.05,
subdivisions 1, 5; 256.043, subdivisions 3, 3a; 256.9754; 256B.04, by adding a
subdivision; 256B.056, subdivision 3; 256B.057, subdivision 9; 256B.0625,
subdivisions 17, 17a, 18h, 22, by adding a subdivision; 256B.0638, subdivisions
2, 4, 5; 256B.0659, subdivisions 1, 12, 19, 24; 256B.073, subdivision 3, by adding
a subdivision; 256B.0759, subdivision 2; 256B.0911, subdivision 13; 256B.0913,
subdivisions 4, 5; 256B.0917, subdivision 1b; 256B.0922, subdivision 1;
256B.0949, subdivision 15; 256B.14, subdivision 2; 256B.434, by adding a
subdivision; 256B.49, subdivisions 11, 28; 256B.4905, subdivision 5a; 256B.4911,
by adding a subdivision; 256B.4912, by adding subdivisions; 256B.4914,
subdivisions 3, as amended, 4, 5, 5a, 5b, 5c, 5d, 5e, 8, 9, 10, 10a, 10c, 12, 14, by
adding a subdivision; 256B.492; 256B.5012, by adding subdivisions; 256B.766;
256B.85, subdivision 7, by adding a subdivision; 256B.851, subdivisions 5, 6;
256I.05, by adding subdivisions; 256M.42; 256R.02, subdivision 19; 256R.17,
subdivision 2; 256R.25; 256R.47; 256R.481; 256R.53, by adding subdivisions;
256S.15, subdivision 2; 256S.18, by adding a subdivision; 256S.19, subdivision
3; 256S.203, subdivisions 1, 2; 256S.205, subdivisions 3, 5; 256S.21; 256S.2101,
subdivisions 1, 2, by adding subdivisions; 256S.211, by adding subdivisions;
256S.212; 256S.213; 256S.214; 256S.215, subdivisions 2, 3, 4, 7, 8, 9, 10, 11, 12,
13, 14, 15, 16, 17; Laws 2019, chapter 63, article 3, section 1, as amended; Laws
2021, First Special Session chapter 7, article 16, section 28, as amended; article
17, sections 16; 20; proposing coding for new law in Minnesota Statutes, chapters
121A; 144A; 245; 245D; 254B; 256; 256I; 256S; 325F; repealing Minnesota
Statutes 2022, sections 245G.05, subdivision 2; 246.18, subdivisions 2, 2a;
256B.0638, subdivisions 1, 2, 3, 4, 5, 6; 256B.0759, subdivision 6; 256B.0917,
subdivisions 1a, 6, 7a, 13; 256B.4914, subdivision 9a; 256S.19, subdivision 4.

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

ARTICLE 1

DISABILITY SERVICES

Section 1.

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 by the state to the Home Care Orientation Trust shall be made
by the state pursuant to a collective bargaining agreement negotiated under this section. All
such financial contributions by the state shall be held in trust for the purpose of paying,
from principal, from income, 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 of the
exclusive representative.

(c) Trust administrative, management, legal, and financial services may be provided to
the board of trustees by a third-party administrator, financial management institution, other
appropriate entity, or any combination thereof, 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, participation in, or both contributions to and participation
in the administration, management, or both the administration and management of the Home
Care Orientation Trust shall not be considered an unfair labor practice under section 179A.13
or in violation of Minnesota law.

Sec. 2.

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; or

(6) new foster care licenses or community residential setting licenses for a customized
living setting that is a single-family home in which customized living or 24-hour customized
living services were authorized and delivered on June 30, 2021, under the brain injury or
community access for disability inclusion waiver plans under section 256B.49 or the elderly
waiver under chapter 256S and 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 for any eligible setting licensed as an assisted living facility
under chapter 144G on or after August 1, 2021, if the assisted living licensee applies for a
license under chapter 245D before December 31, 2023. The initial licensed capacity of the
setting under this exception must be four. This exception is available when:

(i) the case manager of each resident of the customized living setting 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 about remaining
in the newly licensed setting; and

(ii) the estimated average cost of services provided in the licensed foster care or
community residential setting is less than or equal to the estimated average cost of 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 retroactively from July 1, 2021.

Sec. 3.

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. 4.

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. 5.

Minnesota Statutes 2022, section 245D.04, subdivision 3, is amended to read:

Subd. 3.

Protection-related rights.

(a) A person's protection-related rights include the
right to:

(1) have personal, financial, service, health, and medical information kept private, and
be advised of disclosure of this information by the license holder;

(2) access records and recorded information about the person in accordance with
applicable state and federal law, regulation, or rule;

(3) be free from maltreatment;

(4) be free from restraint, time out, seclusion, restrictive intervention, or other prohibited
procedure identified in section 245D.06, subdivision 5, or successor provisions, except for:
(i) emergency use of manual restraint to protect the person from imminent danger to self
or others according to the requirements in section 245D.061 or successor provisions; or (ii)
the use of safety interventions as part of a positive support transition plan under section
245D.06, subdivision 8, or successor provisions;

(5) receive services in a clean and safe environment when the license holder is the owner,
lessor, or tenant of the service site;

(6) be treated with courtesy and respect and receive respectful treatment of the person's
property;

(7) reasonable observance of cultural and ethnic practice and religion;

(8) be free from bias and harassment regarding race, gender, age, disability, spirituality,
and sexual orientation;

(9) be informed of and use the license holder's grievance policy and procedures, including
knowing how to contact persons responsible for addressing problems and to appeal under
section 256.045;

(10) know the name, telephone number, and the website, email, and street addresses of
protection and advocacy services, including the appropriate state-appointed ombudsman,
and a brief description of how to file a complaint with these offices;

(11) assert these rights personally, or have them asserted by the person's family,
authorized representative, or legal representative, without retaliation;

(12) give or withhold written informed consent to participate in any research or
experimental treatment;

(13) associate with other persons of the person's choice in the community;

(14) personal privacy, including the right to use the lock on the person's bedroom or unit
door;

(15) engage in chosen activities; and

(16) access to the person's personal possessions at any time, including financial resources.

(b) For a person residing in a residential site licensed according to chapter 245A, or
where the license holder is the owner, lessor, or tenant of the residential service site,
protection-related rights also include the right to:

(1) have daily, private access to and use of a non-coin-operated telephone for local calls
and long-distance calls made collect or paid for by the person;

(2) receive and send, without interference, uncensored, unopened mail or electronic
correspondence or communication;

(3) have use of and free access to common areas in the residence and the freedom to
come and go from the residence at will;

(4) choose the person's visitors and time of visits and have privacy for visits with the
person's spouse, next of kin, legal counsel, religious adviser, or others, in accordance with
section 363A.09 of the Human Rights Act, including privacy in the person's bedroom;

(5) have access to three nutritionally balanced meals and nutritious snacks between
meals each day;

(6) have freedom and support to access food and potable water at any time;

(7) have the freedom to furnish and decorate the person's bedroom or living unit;

(8) a setting that is clean and free from accumulation of dirt, grease, garbage, peeling
paint, mold, vermin, and insects;

(9) a setting that is free from hazards that threaten the person's health or safety; and

(10) a setting that meets the definition of a dwelling unit within a residential occupancy
as defined in the State Fire Code.

(c) Restriction of a person's rights under paragraph (a), clauses (13) to (16), or paragraph
(b) is allowed only if determined necessary to ensure the health, safety, and well-being of
the person. Any restriction of those rights must be documented in the person's support plan
or support plan addendum. The restriction must be implemented in the least restrictive
alternative manner necessary to protect the person and provide support to reduce or eliminate
the need for the restriction in the most integrated setting and inclusive manner. The
documentation must include the following information:

(1) the justification for the restriction based on an assessment of the person's vulnerability
related to exercising the right without restriction;

(2) the objective measures set as conditions for ending the restriction;

(3) a schedule for reviewing the need for the restriction based on the conditions for
ending the restriction to occur semiannually from the date of initial approval, at a minimum,
or more frequently if requested by the person, the person's legal representative, if any, and
case manager; and

(4) signed and dated approval for the restriction from the person, or the person's legal
representative, if any. A restriction may be implemented only when the required approval
has been obtained. Approval may be withdrawn at any time. If approval is withdrawn, the
right must be immediately and fully restored.

(d) Notwithstanding the authority of a guardian to restrict interaction with others under
section 524.5-120, clause (10), for a person subject to guardianship or a person subject to
conservatorship, restriction of the person's rights under paragraph (b), clause (4), is allowed
for no more than 14 days unless the written notice of the restrictions imposed that was
provided to the court by the guardian is acknowledged and the restrictions imposed affirmed
as appropriate by the court.

Sec. 6.

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

Subdivision 1.

Definitions.

(a) For purposes of this section, the following terms have
the meanings given, 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 or 256B.092, 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) 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.

(c) 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.

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. 7.

[256.4761] 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 commissioner of management and budget and the
commissioner of the Department of 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. 8.

[256.4762] LONG-TERM CARE WORKFORCE GRANTS FOR NEW
AMERICANS.

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.

(a) 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;

(vi) mental health supports; or

(vii) 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. 9.

[256.4764] 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 that is:

(1) a provider of home and community-based services under 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, as
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.

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. 6.

Payments not to be considered income.

(a) For the purposes of this subdivision,
"subtraction" has the meaning given in section 290.0132, subdivision 1, paragraph (a), and
the rules in that subdivision apply to this subdivision. The definitions in section 290.01
apply to this subdivision.

(b) The amount of a payment received under this section is a subtraction.

(c) Payments under this section are excluded from income, as defined in sections
290.0674, subdivision 2a, and 290A.03, subdivision 3.

(d) Notwithstanding any law to the contrary, payments 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 chapter 119B;

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

(3) housing support under chapter 256I;

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

(5) economic assistance programs under chapter 256P.

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

Sec. 10.

[256.4771] SUPPORTED-DECISION-MAKING PROGRAMS.

Subdivision 1.

Authorization.

The commissioner of human services shall award general
operating grants to public and private nonprofit organizations, counties, and Tribes to provide
and promote supported decision making.

Subd. 2.

Definitions.

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

(b) "Supported decision making" has the meaning given in section 524.5-102, subdivision
16a.

(c) "Supported-decision-making services" means services provided to help an individual
consider, access, or develop supported decision making, potentially as an alternative to
more restrictive forms of decision making, including guardianship and conservatorship.
The services may be provided to the individual, family members, or trusted support people.
The individual may currently be a person subject to guardianship or conservatorship, but
the services must not be used to help a person access a guardianship or conservatorship.

Subd. 3.

Grants.

(a) The grants must be distributed as follows:

(1) at least 75 percent of the grant money must be used to fund programs or organizations
that provide supported-decision-making services;

(2) no more than 20 percent of the grant money may be used to fund county or Tribal
programs that provide supported-decision-making services; and

(3) no more than five percent of the grant money may be used to fund programs or
organizations that do not provide supported-decision-making services but do promote the
use and advancement of supported decision making.

(b) The grants must be distributed in a manner to promote racial and geographic diversity
in the populations receiving services as determined by the commissioner.

Subd. 4.

Evaluation and report.

By December 1, 2024, the commissioner must submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over human services finance and policy an interim report on the impact and outcomes of
the grants, including the number of grants awarded and the organizations receiving the
grants. The interim report must include any available evidence of how grantees were able
to increase utilization of supported decision making and reduce or avoid more restrictive
forms of decision making such as guardianship and conservatorship. By December 1, 2025,
the commissioner must submit to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services finance and policy a final report on the
impact and outcomes of the grants, including any updated information from the interim
report and the total number of people served by the grants. The final report must also detail
how the money was used to achieve the requirements in subdivision 3, paragraph (b).

Subd. 5.

Applications.

Any public or private nonprofit agency may apply to the
commissioner for a grant under subdivision 3, paragraph (a), clause (1) or (3). Any county
or Tribal agency in Minnesota may apply to the commissioner for a grant under subdivision
3, paragraph (a), clause (2). The application must be submitted in a form approved by the
commissioner.

Subd. 6.

Duties of grantees.

Every public or private nonprofit agency, county, or Tribal
agency that receives a grant to provide or promote supported decision making must comply
with rules related to the administration of the grants.

Sec. 11.

[256.4773] TECHNOLOGY FOR HOME GRANT.

Subdivision 1.

Establishment.

The commissioner must establish a technology for home
grant program that provides assistive technology consultations and resources for people
with disabilities who want to stay in their own home, move to their own home, or remain
in a less restrictive residential setting. The grant program may be administered using a team
approach that allows multiple professionals to assess and meet a person's assistive technology
needs. The team may include but is not limited to occupational therapists, physical therapists,
speech therapists, nurses, and engineers.

Subd. 2.

Eligible applicants.

An eligible applicant is a person who uses or is eligible
for home care services under section 256B.0651, home and community-based services under
section 256B.092 or 256B.49, personal care assistance under section 256B.0659, or
community first services and supports under section 256B.85, and who meets one of the
following conditions:

(1) lives in the applicant's own home and may benefit from assistive technology for
safety, communication, community engagement, or independence;

(2) is currently seeking to live in the applicant's own home and needs assistive technology
to meet that goal; or

(3) resides in a residential setting under section 256B.4914, subdivision 3, and is seeking
to reduce reliance on paid staff to live more independently in the setting.

Subd. 3.

Allowable grant activities.

The technology for home grant program must
provide at-home, in-person assistive technology consultation and technical assistance to
help people with disabilities live more independently. Allowable activities include but are
not limited to:

(1) consultations in people's homes, workplaces, or community locations;

(2) connecting people to resources to help them live in their own homes, transition to
their own homes, or live more independently in residential settings;

(3) conducting training for and set up and installation of assistive technology; and

(4) participating on a person's care team to develop a plan to ensure assistive technology
goals are met.

Subd. 4.

Data collection and outcomes.

Grantees must provide data summaries to the
commissioner for the purpose of evaluating the effectiveness of the grant program. The
commissioner must identify outcome measures to evaluate program activities to assess
whether the grant programs help people transition to or remain in the least restrictive setting.

Sec. 12.

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. 13.

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. 14.

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. 15.

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. 16.

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. 17.

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. 18.

Minnesota Statutes 2022, section 256B.49, subdivision 11, is amended to read:

Subd. 11.

Authority.

(a) The commissioner is authorized to apply for home and
community-based service waivers, as authorized under section 1915(c) of the federal Social
Security Act to serve persons under the age of 65 who are determined to require the level
of care provided in a nursing home and persons who require the level of care provided in a
hospital. The commissioner shall apply for the home and community-based waivers in order
to:

(1) promote the support of persons with disabilities in the most integrated settings;

(2) expand the availability of services for persons who are eligible for medical assistance;

(3) promote cost-effective options to institutional care; and

(4) obtain federal financial participation.

(b) The provision of waiver services to medical assistance recipients with disabilities
shall comply with the requirements outlined in the federally approved applications for home
and community-based services and subsequent amendments, including provision of services
according to a service plan designed to meet the needs of the individual, except when
applying a size limitation to a setting, the commissioner must treat residents under 55 years
of age who are receiving services under the brain injury or the community access for
disability inclusion waiver as if the residents are 55 years of age or older if the residents
lived and received services in the setting on or before March 1, 2023. For purposes of this
section, the approved home and community-based application is considered the necessary
federal requirement.

(c) The commissioner shall provide interested persons serving on agency advisory
committees, task forces, the Centers for Independent Living, and others who request to be
on a list to receive, notice of, and an opportunity to comment on, at least 30 days before
any effective dates, (1) any substantive changes to the state's disability services program
manual, or (2) changes or amendments to the federally approved applications for home and
community-based waivers, prior to their submission to the federal Centers for Medicare
and Medicaid Services.

(d) The commissioner shall seek approval, as authorized under section 1915(c) of the
federal Social Security Act, to allow medical assistance eligibility under this section for
children under age 21 without deeming of parental income or assets.

(e) The commissioner shall seek approval, as authorized under section 1915(c) of the
Social Act, to allow medical assistance eligibility under this section for individuals under
age 65 without deeming the spouse's income or assets.

(f) The commissioner shall comply with the requirements in the federally approved
transition plan for the home and community-based services waivers authorized under this
section, except when applying a size limitation to a setting, the commissioner must treat
residents under 55 years of age who are receiving services under the brain injury or the
community access for disability inclusion waiver as if the residents are 55 years of age or
older if the residents lived and received services in the setting on or before March 1, 2023.

(g) The commissioner shall seek federal approval to allow for the reconfiguration of the
1915(c) home and community-based waivers in this section, as authorized under section
1915(c) of the federal Social Security Act, to implement a two-waiver program structure.

(h) The commissioner shall seek federal approval for the 1915(c) home and
community-based waivers in this section, as authorized under section 1915(c) of the federal
Social Security Act, to implement an individual resource allocation methodology.

EFFECTIVE DATE.

This section is effective retroactively from January 11, 2021.

Sec. 19.

Minnesota Statutes 2022, section 256B.49, subdivision 28, is amended to read:

Subd. 28.

Customized living moratorium for brain injury and community access
for disability inclusion waivers.

(a) Notwithstanding section 245A.03, subdivision 2,
paragraph (a), clause (23), to prevent new development of customized living settings that
otherwise meet the residential program definition under section 245A.02, subdivision 14,
the commissioner shall not enroll new customized living settings serving four or fewer
people in a single-family home to deliver customized living services as defined under the
brain injury or community access for disability inclusion waiver plans under this section.

(b) The commissioner may approve an exception to paragraph (a) when an existing
customized living setting changes ownership at the same address and must approve an
exception to paragraph (a) when the same owner relocates an existing customized living
setting to a new address.

(c) Customized living settings operational on or before June 30, 2021, are considered
existing customized living settings.

(d) For any new customized living settings serving four or fewer people in a single-family
home to deliver customized living services as defined in paragraph (a) and that was not
operational on or before June 30, 2021, the authorizing lead agency is financially responsible
for all home and community-based service payments in the setting.

(e) For purposes of this subdivision, "operational" means customized living services are
authorized and delivered to a person in the customized living setting.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 20.

Minnesota Statutes 2022, section 256B.4905, subdivision 5a, is amended to read:

Subd. 5a.

Employment first implementation for disability waiver services.

(a) The
commissioner of human services shall ensure that:

(1) the disability waivers under sections 256B.092 and 256B.49 support the presumption
that all working-age Minnesotans with disabilities can work and achieve competitive
integrated employment with appropriate services and supports, as needed; and

(2) each waiver recipient of working age be offered, after an informed decision-making
process and during a person-centered planning process, the opportunity to work and earn a
competitive wage before being offered exclusively day services as defined in section
245D.03, subdivision 1, paragraph (c), clause (4), or successor provisions.

(b) Nothing in this subdivision prohibits a waiver recipient of working age, after an
informed decision-making process and during a person-centered planning process, from
choosing employment at a special minimum wage under a 14(c) certificate as provided by
Code of Federal Regulations, title 29, sections 525.1 to 525.24. For any waiver recipient
who chooses employment at a special minimum wage, the commissioner must not impose
any limitations on the length of disability services provided to support the recipient's informed
choice or limitations on the reimbursement rates for the disability waiver services provided
to support the recipient's informed choice.

Sec. 21.

Minnesota Statutes 2022, section 256B.4911, is amended by adding a subdivision
to read:

Subd. 6.

Services provided by parents and spouses.

(a) This subdivision limits medical
assistance payments under the consumer-directed community supports option for personal
assistance services provided by a parent to the parent's minor child or by a participant's
spouse. This subdivision applies to the consumer-directed community supports option
available under all of the following:

(1) alternative care program;

(2) brain injury waiver;

(3) community alternative care waiver;

(4) community access for disability inclusion waiver;

(5) developmental disabilities waiver;

(6) elderly waiver; and

(7) Minnesota senior health option.

(b) For the purposes of this subdivision, "parent" means a parent, stepparent, or legal
guardian of a minor.

(c) If multiple parents are providing personal assistance services to their minor child or
children, each parent may provide up to 40 hours of personal assistance services in any
seven-day period regardless of the number of children served. The total number of hours
of personal assistance services provided by all of the parents must not exceed 80 hours in
a seven-day period regardless of the number of children served.

(d) If only one parent is providing personal assistance services to a minor child or
children, the parent may provide up to 60 hours of personal assistance services in a seven-day
period regardless of the number of children served.

(e) If a participant's spouse is providing personal assistance services, the spouse may
provide up to 60 hours of personal assistance services in a seven-day period.

(f) This subdivision must not be construed to permit an increase in the total authorized
consumer-directed community supports budget for an individual.

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. 22.

Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
to read:

Subd. 1b.

Direct support professional annual labor market survey.

(a) The
commissioner shall develop and administer a survey of direct care staff who work for
organizations that provide services under the following programs:

(1) home and community-based services for seniors under chapter 256S and section
256B.0913, home and community-based services for people with developmental disabilities
under section 256B.092, and home and community-based services for people with disabilities
under section 256B.49;

(2) personal care assistance services under section 256B.0625, subdivision 19a;
community first services and supports under section 256B.85; nursing services and home
health services under section 256B.0625, subdivision 6a; home care nursing services under
section 256B.0625, subdivision 7; and

(3) financial management services for participants who directly employ direct-care staff
through consumer support grants under section 256.476; the personal care assistance choice
program under section 256B.0659, subdivisions 18 to 20; community first services and
supports under section 256B.85; and the consumer-directed community supports option
available under the alternative care program, the brain injury waiver, the community
alternative care waiver, the community access for disability inclusion waiver, the
developmental disabilities waiver, the elderly waiver, and the Minnesota senior health
option, except financial management services providers are not required to submit the data
listed in subdivision 1a, clauses (7) to (11).

(b) The survey must collect information about the individual experience of the direct-care
staff and any other information necessary to assess the overall economic viability and
well-being of the workforce.

(c) For purposes of this subdivision, "direct-care staff" means employees, including
self-employed individuals and individuals directly employed by a participant in a
consumer-directed service delivery option, providing direct service to participants under
this section. Direct-care staff does not include executive, managerial, or administrative staff.

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

(e) The commissioner shall analyze data submitted under this section annually to assess
the overall economic viability and well-being of the workforce and the impact of the state
of workforce on access to services.

Sec. 23.

Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
to read:

Subd. 1c.

Annual labor market report.

The commissioner shall publish annual reports
on provider and state-level labor market data, including but not limited to the data outlined
in subdivisions 1a and 1b.

Sec. 24.

Minnesota Statutes 2022, section 256B.4912, is amended by adding a subdivision
to read:

Subd. 16.

Rates established by the commissioner.

For homemaker services eligible
for reimbursement under the developmental disabilities waiver, the brain injury waiver, the
community alternative care waiver, and the community access for disability inclusion waiver,
the commissioner must establish rates equal to the rates established under sections 256S.21
to 256S.215 for the corresponding homemaker services.

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. 25.

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) night supervision;

(16) positive support services;

(17) prevocational services;

(18) residential support services;

(19) respite services;

(20) transportation services; and

(21) (20) 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, 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. 26.

Minnesota Statutes 2022, section 256B.4914, subdivision 4, is amended to read:

Subd. 4.

Data collection for rate determination.

(a) Rates for applicable home and
community-based waivered services, including customized rates under subdivision 12, are
set by the rates management system.

(b) Data and information in the rates management system must be used to calculate an
individual's rate.

(c) Service providers, with information from the support plan and oversight by lead
agencies, shall provide values and information needed to calculate an individual's rate in
the rates management system. The determination of service levels must be part of a discussion
with members of the support team as defined in section 245D.02, subdivision 34. This
discussion must occur prior to the final establishment of each individual's rate. The values
and information include:

(1) shared staffing hours;

(2) individual staffing hours;

(3) direct registered nurse hours;

(4) direct licensed practical nurse hours;

(5) staffing ratios;

(6) information to document variable levels of service qualification for variable levels
of reimbursement in each framework;

(7) shared or individualized arrangements for unit-based services, including the staffing
ratio;

(8) number of trips and miles for transportation services; and

(9) service hours provided through monitoring technology.

(d) Updates to individual data must include:

(1) data for each individual that is updated annually when renewing service plans; and

(2) requests by individuals or lead agencies to update a rate whenever there is a change
in an individual's service needs, with accompanying documentation.

(e) Lead agencies shall review and approve all services reflecting each individual's needs,
and the values to calculate the final payment rate for services with variables under
subdivisions 6 to 9a 9 for each individual. Lead agencies must notify the individual and the
service provider of the final agreed-upon values and rate, and provide information that is
identical to what was entered into the rates management system. If a value used was
mistakenly or erroneously entered and used to calculate a rate, a provider may petition lead
agencies to correct it. Lead agencies must respond to these requests. When responding to
the request, the lead agency must consider:

(1) meeting the health and welfare needs of the individual or individuals receiving
services by service site, identified in their support plan under section 245D.02, subdivision
4b, and any addendum under section 245D.02, subdivision 4c;

(2) meeting the requirements for staffing under subdivision 2, paragraphs (h), (n), and
(o); and meeting or exceeding the licensing standards for staffing required under section
245D.09, subdivision 1; and

(3) meeting the staffing ratio requirements under subdivision 2, paragraph (o), and
meeting or exceeding the licensing standards for staffing required under section 245D.31.

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. 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; and

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

(3) (2) on July 1, 2026 January 1, 2024, and every two years thereafter, based on wage
data by SOC from the Bureau of Labor Statistics available 30 24 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. 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 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);

(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 clinical, counseling, and school
psychologists (SOC code 21-1018 19-3031);

(9) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist, all other (SOC code 19-3031 19-3039);

(10) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians occupational therapist (SOC code 29-2053 29-1122);

(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) education, guidance, school, and vocational
counselor (SOC code 21-1012); 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); and

(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, 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. 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 9 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; and

(2) on November 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; and

(3) (2) on July January 1, 2026 2024, 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 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. 30.

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

Subd. 5c.

Removal of after-framework adjustments.

Any rate adjustments applied to
the service rates calculated under this section outside of the cost components and rate
methodology specified in this section shall be removed from rate calculations upon
implementation of the updates under subdivisions 5 and, 5b, and 5f.

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. 31.

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

Subd. 5d.

Unavailable data for updates and adjustments.

If Bureau of Labor Statistics
occupational codes or Consumer Price Index items specified in subdivision 5 or, 5b, or 5f
are unavailable in the future, the commissioner shall recommend to the legislature codes or
items to update and replace.

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. 32.

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

Subd. 5e.

Inflationary update spending requirement.

(a) At least 80 percent of the
marginal increase in revenue from the rate adjustment applied to the service rates adjustments
calculated under subdivisions 5 and 5b beginning on January 1, 2022, 5f for services rendered
between January 1, 2022, and March 31, 2024, on or after the day of implementation of the
adjustment must be used to increase compensation-related costs for employees directly
employed by the program on or after January 1, 2022.

(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 January 1, 2022 implementation of the applicable
rate adjustment, including retention and recruitment bonuses and tuition reimbursement.

(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 a rate 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 a rate adjustment 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 direct support professionals have access.
The posted distribution plan must include instructions regarding how to contact the
commissioner or commissioner's representative if an employee believes the employee has
not received the compensation-related increase described in the plan.

(e) This subdivision expires June 30, 2024.

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.

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

Subd. 5f.

Competitive workforce factor adjustments.

(a) On January 1, 2024, and
every two years thereafter, the commissioner shall update all competitive workforce factors
to equal the differential between:

(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential support services and direct care staff for day programs;
and

(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations.

(b) For each update of the competitive workforce factor, the update must not decrease
the competitive workforce factor by more than 2.0. If the competitive workforce factor is
less than or equal to zero, then the competitive workforce factor is zero.

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. 34.

Minnesota Statutes 2022, section 256B.4914, subdivision 8, is amended to read:

Subd. 8.

Unit-based services with programming; component values and calculation
of payment rates.

(a) For the purpose of this section, unit-based services with programming
include employment exploration services, employment development services, employment
support services, individualized home supports with family training, individualized home
supports with training, and positive support services provided to an individual outside of
any service plan for a day program or residential support service.

(b) Component values for unit-based services with programming 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) program plan support ratio: 15.5 percent;

(6) client programming and support ratio: 4.7 percent, updated as specified in subdivision
5b;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 6.1 percent; and

(9) absence and utilization factor ratio: 3.9 percent.

(c) A unit of service for unit-based services with programming is 15 minutes.

(d) Payments for unit-based services with programming must be calculated as follows,
unless the services are reimbursed separately as part of a residential support services or day
program payment rate:

(1) determine the number of units of service to meet a recipient's needs;

(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 direct staffing hours by the appropriate staff wage;

(6) multiply the number of direct staffing 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), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;

(11) this is the subtotal rate;

(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 amount;

(14) for services provided in a shared manner, divide the total payment in clause (13)
as follows:

(i) for employment exploration services, divide by the number of service recipients, not
to exceed five;

(ii) for employment support services, divide by the number of service recipients, not to
exceed six; and

(iii) for individualized home supports with training and individualized home supports
with family training, divide by the number of service recipients, not to exceed two three;
and

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

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. 35.

Minnesota Statutes 2022, section 256B.4914, subdivision 9, is amended to read:

Subd. 9.

Unit-based services without programming; component values and
calculation of payment rates.

(a) For the purposes of this section, unit-based services
without programming include individualized home supports without training and night
supervision provided to an individual outside of any service plan for a day program or
residential support service. Unit-based services without programming do not include respite.

(b) Component values for unit-based services without programming 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) program plan support ratio: 7.0 percent;

(6) client programming and support ratio: 2.3 percent, updated as specified in subdivision
5b;

(7) general administrative support ratio: 13.25 percent;

(8) program-related expense ratio: 2.9 percent; and

(9) absence and utilization factor ratio: 3.9 percent.

(c) A unit of service for unit-based services without programming is 15 minutes.

(d) Payments for unit-based services without programming must be calculated as follows
unless the services are reimbursed separately as part of a residential support services or day
program payment rate:

(1) determine the number of units of service to meet a recipient's needs;

(2) determine the appropriate hourly staff wage rates derived by the commissioner as
provided in subdivisions 5 to 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 direct staffing hours by the appropriate staff wage;

(6) multiply the number of direct staffing 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), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio. This is defined as the direct staffing
rate;

(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio;

(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio;

(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio;

(11) this is the subtotal rate;

(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 amount;

(14) for individualized home supports without training provided in a shared manner,
divide the total payment amount in clause (13) by the number of service recipients, not to
exceed two three; and

(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.

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.4914, subdivision 10, is amended to read:

Subd. 10.

Evaluation of information and data.

(a) The commissioner shall, within
available resources, conduct research and gather data and information from existing state
systems or other outside sources on the following items:

(1) differences in the underlying cost to provide services and care across the state;

(2) mileage, vehicle type, lift requirements, incidents of individual and shared rides, and
units of transportation for all day services, which must be collected from providers using
the rate management worksheet and entered into the rates management system; and

(3) the distinct underlying costs for services provided by a license holder under sections
245D.05, 245D.06, 245D.07, 245D.071, 245D.081, and 245D.09, and for services provided
by a license holder certified under section 245D.33.

(b) The commissioner, in consultation with stakeholders, shall review and evaluate the
following values already in subdivisions 6 to 9a 9, or issues that impact all services, including,
but not limited to:

(1) values for transportation rates;

(2) values for services where monitoring technology replaces staff time;

(3) values for indirect services;

(4) values for nursing;

(5) values for the facility use rate in day services, and the weightings used in the day
service ratios and adjustments to those weightings;

(6) values for workers' compensation as part of employee-related expenses;

(7) values for unemployment insurance as part of employee-related expenses;

(8) direct care workforce labor market measures;

(9) any changes in state or federal law with a direct impact on the underlying cost of
providing home and community-based services;

(10) outcome measures, determined by the commissioner, for home and community-based
services rates determined under this section; and

(11) different competitive workforce factors by service, as determined under subdivision
10b.

(c) The commissioner shall report to the chairs and the ranking minority members of
the legislative committees and divisions with jurisdiction over health and human services
policy and finance with the information and data gathered under paragraphs (a) and (b) on
January 15, 2021, with a full report, and a full report once every four years thereafter.

(d) Beginning July 1, 2022, the commissioner shall renew analysis and implement
changes to the regional adjustment factors once every six years. Prior to implementation,
the commissioner shall consult with stakeholders on the methodology to calculate the
adjustment.

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. 37.

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 9 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.

(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).

(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.

(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, 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. 38.

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

Subd. 10c.

Reporting and analysis of competitive workforce factor.

(a) Beginning
February 1, 2021 2025, 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 policy and finance an analysis of the competitive
workforce factor.

(b) The report must include recommendations to update the competitive workforce factor
using:

(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;

(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and

(3) workforce data as required under subdivision 10b.

(c) The commissioner shall not recommend an increase or decrease of the competitive
workforce factor from the current value by more than two percentage points. If, after a
biennial analysis for the next report, the competitive workforce factor is less than or equal
to zero, the commissioner shall recommend a competitive workforce factor of zero. This
subdivision expires upon submission of the calendar year 2030 report.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 39.

Minnesota Statutes 2022, section 256B.4914, subdivision 12, is amended to read:

Subd. 12.

Customization of rates for individuals.

(a) For persons determined to have
higher needs based on being deaf or hard-of-hearing, the direct-care costs must be increased
by an adjustment factor prior to calculating the rate under subdivisions 6 to 9a 9. The
customization rate with respect to deaf or hard-of-hearing persons shall be $2.50 per hour
for waiver recipients who meet the respective criteria as determined by the commissioner.

(b) For the purposes of this section, "deaf and hard-of-hearing" means:

(1) the person has a developmental disability and:

(i) an assessment score which indicates a hearing impairment that is severe or that the
person has no useful hearing;

(ii) an expressive communications score that indicates the person uses single signs or
gestures, uses an augmentative communication aid, or does not have functional
communication, or the person's expressive communications is unknown; and

(iii) a communication score which indicates the person comprehends signs, gestures,
and modeling prompts or does not comprehend verbal, visual, or gestural communication,
or that the person's receptive communication score is unknown; or

(2) the person receives long-term care services and has an assessment score that indicates
the person hears only very loud sounds, the person has no useful hearing, or a determination
cannot be made; and the person receives long-term care services and has an assessment that
indicates the person communicates needs with sign language, symbol board, written
messages, gestures, or an interpreter; communicates with inappropriate content, makes
garbled sounds or displays echolalia, or does not communicate needs.

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. 40.

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 9 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 9;

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

(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).

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. 41.

Minnesota Statutes 2022, section 256B.492, is amended to read:

256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE WITH
DISABILITIES.

(a) Individuals receiving services under a home and community-based waiver under
section 256B.092 or 256B.49 may receive services in the following settings:

(1) home and community-based settings that comply with:

(i) all requirements identified by the federal Centers for Medicare and Medicaid Services
in the Code of Federal Regulations, title 42, section 441.301(c),; and

with (ii) the requirements of the federally approved transition plan and waiver plans for
each home and community-based services waiver except when applying a size limitation
to a setting, the commissioner must treat residents under 55 years of age who are receiving
services under the brain injury or the community access for disability inclusion waiver as
if the residents are 55 years of age or older if the residents lived and received services in
the setting on or before March 1, 2023; and

(2) settings required by the Housing Opportunities for Persons with AIDS Program.

(b) The settings in paragraph (a) must not have the qualities of an institution which
include, but are not limited to: regimented meal and sleep times, limitations on visitors, and
lack of privacy. Restrictions agreed to and documented in the person's individual service
plan shall not result in a residence having the qualities of an institution as long as the
restrictions for the person are not imposed upon others in the same residence and are the
least restrictive alternative, imposed for the shortest possible time to meet the person's needs.

Sec. 42.

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

Subd. 19.

ICF/DD rate increase effective July 1, 2023.

(a) Effective July 1, 2023, the
daily operating payment rate for a class A intermediate care facility for persons with
developmental disabilities is increased by $50.

(b) Effective July 1, 2023, the daily operating payment rate for a class B intermediate
care facility for persons with developmental disabilities is increased by $50.

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. 43.

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

Subd. 20.

ICF/DD minimum daily operating payment rates.

(a) The minimum daily
operating payment rate for a class A intermediate care facility for persons with developmental
disabilities is $300.

(b) The minimum daily operating payment rate for a class B intermediate care facility
for persons with developmental disabilities is $400.

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. 44.

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

Subd. 21.

Spending requirements.

(a) At least 80 percent of the marginal increase in
revenue resulting from implementation of the rate increases under subdivisions 19 and 20
for services rendered on or after the day of implementation of the increases must be used
to increase compensation-related costs for employees directly employed by the facility.

(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 implementation of the rate increases.

(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 rate methodology or any rate adjustment 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 direct support professionals 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.

Sec. 45.

Minnesota Statutes 2022, section 256B.85, subdivision 7, is amended to read:

Subd. 7.

Community first services and supports; covered services.

Services and
supports covered under CFSS include:

(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and health-related procedures and tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task;

(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
accomplish activities of daily living, instrumental activities of daily living, or health-related
tasks;

(3) expenditures for items, services, supports, environmental modifications, or goods,
including assistive technology. These expenditures must:

(i) relate to a need identified in a participant's CFSS service delivery plan; and

(ii) increase independence or substitute for human assistance, to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;

(4) observation and redirection for behavior or symptoms where there is a need for
assistance;

(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
to ensure continuity of the participant's services and supports;

(6) services provided by a consultation services provider as defined under subdivision
17, that is under contract with the department and enrolled as a Minnesota health care
program provider;

(7) services provided by an FMS provider as defined under subdivision 13a, that is an
enrolled provider with the department;

(8) CFSS services provided by a support worker who is a parent, stepparent, or legal
guardian of a participant under age 18, or who is the participant's spouse. These support
workers shall not: Covered services under this clause are subject to the limitations described
in subdivision 7b; and

(i) provide any medical assistance home and community-based services in excess of 40
hours per seven-day period regardless of the number of parents providing services,
combination of parents and spouses providing services, or number of children who receive
medical assistance services; and

(ii) have a wage that exceeds the current rate for a CFSS support worker including the
wage, benefits, and payroll taxes; and

(9) worker training and development services as described in subdivision 18a.

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. 46.

Minnesota Statutes 2022, section 256B.85, is amended by adding a subdivision
to read:

Subd. 7b.

Services provided by parents and spouses.

(a) This subdivision applies to
services and supports described in subdivision 7, clause (8).

(b) If multiple parents are support workers providing CFSS services to their minor child
or children, each parent may provide up to 40 hours of medical assistance home and
community-based services in any seven-day period regardless of the number of children
served. The total number of hours of medical assistance home and community-based services
provided by all of the parents must not exceed 80 hours in a seven-day period regardless of
the number of children served.

(c) If only one parent is a support worker providing CFSS services to the parent's minor
child or children, the parent may provide up to 60 hours of medical assistance home and
community-based services in a seven-day period regardless of the number of children served.

(d) If a participant's spouse is a support worker providing CFSS services, the spouse
may provide up to 60 hours of medical assistance home and community-based services in
a seven-day period.

(e) Paragraphs (b) to (d) must not be construed to permit an increase in either the total
authorized service budget for an individual or the total number of authorized service units.

(f) A parent or participant's spouse must not receive a wage that exceeds the current rate
for a CFSS support worker, including wages, benefits, and payroll taxes.

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. 47.

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 percent; 88.19 percent;

(2) enhanced rate personal care assistance services and enhanced rate CFSS: 75.45 88.19
percent; and

(3) qualified professional services and CFSS worker training and development: 75.45
88.19 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: 92.10 percent;

(2) enhanced rate personal care assistance services and enhanced rate CFSS: 92.10
percent; and

(3) qualified professional services and CFSS worker training and development: 92.10
percent.

(d) Beginning January 1, 2025, 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 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 90 days after federal approval, whichever is later. Paragraph (b) expires January 1, 2025,
or 90 days after federal approval of paragraph (c), whichever is later. Paragraphs (c), (d),
and (e) are 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. 48.

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 a staff retention component
as specified under subdivision 5 by multiplying the total adjusted payment rate by one plus
the appropriate staff retention component under subdivision 5. This is the total payment
rate.

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

EFFECTIVE DATE.

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

Sec. 49.

Minnesota Statutes 2022, section 256S.2101, subdivision 1, is amended to read:

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 must be the sum of ten 21.6 percent
of the rates calculated under sections 256S.211 to 256S.215 and 90 78.4 percent of the rates
calculated using the rate methodology in effect as of June 30, 2017.

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. 50.

Laws 2021, First Special Session chapter 7, article 17, section 20, is amended to
read:

Sec. 20. HCBS WORKFORCE DEVELOPMENT GRANT.

Subdivision 1.

Appropriation.

(a) This act includes $0 in fiscal year 2022 and $5,588,000
in fiscal year 2023 to address challenges related to attracting and maintaining direct care
workers who provide home and community-based services for people with disabilities and
older adults. The general fund base included in this act for this purpose is $5,588,000 in
fiscal year 2024 and $0 in fiscal year 2025.

(b) At least 90 percent of funding for this provision must be directed to workers who
earn 200 300 percent or less of the most current federal poverty level issued by the United
States Department of Health and Human Services.

(c) The commissioner must consult with stakeholders to finalize a report detailing the
final plan for use of the funds. The commissioner must publish the report by March 1, 2022,
and notify the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance.

Subd. 2.

Public assistance eligibility.

Notwithstanding any law to the contrary, workforce
development grant money received under this section is not 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.

Subd. 3.

Medical assistance eligibility.

Notwithstanding any law to the contrary,
workforce development grant money received under this section is not income or assets for
the purposes of determining eligibility for medical assistance under Minnesota Statutes,
section 256B.056, subdivision 1a, paragraph (a), 3, or 3c; or 256B.057, subdivision 3, 3a,
3b, 4, or 9.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 51. MEMORANDUMS OF UNDERSTANDING.

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

Sec. 52. 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 Commissioner on February 27, 2023, is ratified.

Sec. 53. 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. 54. DIRECT CARE SERVICE CORPS PILOT PROJECT.

Subdivision 1.

Establishment.

The Metropolitan Center for Independent Living must
develop a pilot project establishing the Minnesota Direct Care Service Corps. The pilot
project must utilize financial incentives to attract postsecondary students to work as personal
care assistants or direct support professionals. The Metropolitan Center for Independent
Living must establish the financial incentives and minimum work requirements to be eligible
for incentive payments. The financial incentive must increase with each semester that the
student participates in the Minnesota Direct Care Service Corps.

Subd. 2.

Pilot sites.

(a) Pilot sites must include one postsecondary institution in the
seven-county metropolitan area and at least one postsecondary institution outside of the
seven-county metropolitan area. If more than one postsecondary institution outside the
metropolitan area is selected, one must be located in northern Minnesota and the other must
be located in southern Minnesota.

(b) After satisfactorily completing the work requirements for a semester, the pilot site
or its fiscal agent must pay students the financial incentive developed for the pilot project.

Subd. 3.

Evaluation and report.

(a) The Metropolitan Center for Independent Living
must contract with a third party to evaluate the pilot project's impact on health care costs,
retention of personal care assistants, and patients' and providers' satisfaction of care. The
evaluation must include the number of participants, the hours of care provided by participants,
and the retention of participants from semester to semester.

(b) By January 15, 2025, the Metropolitan Center for Independent Living must report
the findings under paragraph (a) to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services policy and finance.

Sec. 55. EMERGENCY GRANT PROGRAM FOR AUTISM SPECTRUM
DISORDER TREATMENT AGENCIES.

Subdivision 1.

Definitions.

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

(b) "Autism spectrum disorder" has the meaning given to "autism spectrum disorder or
a related condition" in Minnesota Statutes, section 256B.0949, subdivision 2, paragraph
(d).

(c) "Autism spectrum disorder treatment services" means treatment delivered under
Minnesota Statutes, section 256B.0949.

(d) "Qualified early intensive developmental and behavioral intervention agency" or
"qualified EIDBI agency" has the meaning given in Minnesota Statutes, section 256B.0949,
subdivision 2, paragraph (c).

Subd. 2.

Emergency grant program for autism spectrum disorder treatment
agencies.

The commissioner of human services shall award emergency grant money to
eligible qualified EIDBI agencies to support the stability of the autism spectrum disorder
treatment provider sector.

Subd. 3.

Eligible agencies.

Qualified EIDBI agencies that have been delivering autism
spectrum disorder treatment services for a minimum of six months are eligible to receive
emergency grants under this section.

Subd. 4.

Allocation of grants.

The commissioner of human services must distribute the
amount appropriated in each year for the purposes under this section to qualified EIDBI
agencies eligible to receive emergency grants under this section in proportion to each
qualified EIDBI agency's share of unique individuals who received autism spectrum disorder
treatment services in the base year, not to exceed $750,000 per year. The base year for
distributions in fiscal year 2024 is fiscal year 2022. The base year for distributions in fiscal
year 2025 is fiscal year 2023. The commissioner must make the distributions in each fiscal
year as soon as practicable, but no later than September 1 of each year.

Sec. 56. RATE INCREASE FOR CERTAIN HOME CARE SERVICES.

(a) Effective January 1, 2024, or upon federal approval, whichever is later, the
commissioner of human services must increase payment rates for home health aide visits
by 14 percent from the rates in effect on December 31, 2023. The commissioner must apply
the annual rate increases under Minnesota Statutes, section 256B.0653, subdivision 8, to
the rates resulting from the application of the rate increases under this paragraph.

(b) Effective January 1, 2024, or upon federal approval, whichever is later, the
commissioner must increase payment rates for respiratory therapy under Minnesota Rules,
part 9505.0295, subpart 2, item E, and for home health services and home care nursing
services, except home health aide visits, under Minnesota Statutes, section 256B.0651,
subdivision 2, clauses (1) to (3), by 55 percent from the rates in effect on December 31,
2023. The commissioner must apply the annual rate increases under Minnesota Statutes,
sections 256B.0653, subdivision 8, and 256B.0654, subdivision 5, to the rates resulting
from the application of the rate increase under this paragraph.

Sec. 57. SPECIALIZED EQUIPMENT AND SUPPLIES LIMIT INCREASE.

Upon federal approval, the commissioner 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. 58. STUDY TO EXPAND ACCESS TO SERVICES FOR PEOPLE WITH
CO-OCCURRING BEHAVIORAL HEALTH CONDITIONS AND DISABILITIES.

The commissioner, 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 surveying community providers as to the barriers to meeting people's
needs and 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. 59. TEMPORARY GRANT FOR SMALL CUSTOMIZED LIVING
PROVIDERS.

(a) The commissioner must establish a temporary grant for:

(1) customized living providers that serve six or fewer people in a single-family home
and that are transitioning to a community residential services licensure or integrated
community supports licensure; and

(2) community residential service providers and integrated community supports providers
who transitioned from providing customized living or 24-hour customized living on or after
June 30, 2021.

(b) Allowable uses of grant money include physical plant updates required for community
residential services or integrated community supports licensure, technical assistance to adapt
business models and meet policy and regulatory guidance, and other uses approved by the
commissioner. Allowable uses of grant money also include reimbursement for eligible costs
incurred by a community residential service provider or integrated community supports
provider directly related to the provider's transition from providing customized living or
24-hour customized living. 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. 60. DIRECTION TO COMMISSIONER; SUPPORTED-DECISION-MAKING
REIMBURSEMENT STUDY.

By December 15, 2024, the commissioner shall issue a report to the governor and the
chairs and ranking minority members of the legislative committees with jurisdiction over
human services detailing how medical assistance service providers could be reimbursed for
providing supported-decision-making services. The report must detail recommendations
for all medical assistance programs, including all home and community-based programs,
to provide for reimbursement for supported-decision-making services. The report must
develop detailed provider requirements for reimbursement, including the criteria necessary
to provide high-quality services. In developing provider requirements, the commissioner
shall consult with all relevant stakeholders, including organizations currently providing
supported-decision-making services. The report must also include strategies to promote
equitable access to supported-decision-making services to individuals who are Black,
Indigenous, or People of Color; people from culturally specific communities; people from
rural communities; and other people who may experience barriers to accessing medical
assistance home and community-based services.

Sec. 61. DIRECTION TO COMMISSIONER; APPLICATION OF INTERMEDIATE
CARE FACILITIES FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
RATE INCREASES.

The commissioner of human services shall apply the rate increases under Minnesota
Statutes, section 256B.5012, subdivisions 19 and 20, as follows:

(1) apply Minnesota Statutes, section 256B.5012, subdivision 19; and

(2) apply any required rate increase as required under Minnesota Statutes, section
256B.5012, subdivision 20, to the results of clause (1).

Sec. 62. DIRECTION TO COMMISSIONER; SHARED SERVICES.

(a) By December 1, 2023, the commissioner of human services shall seek any necessary
changes to home and community-based services waiver plans regarding sharing services in
order to:

(1) permit shared services for additional services, including chore, homemaker, and
night supervision;

(2) permit existing shared services at higher ratios, including individualized home
supports without training, individualized home supports with training, and individualized
home supports with family training at a ratio of one staff person to three recipients;

(3) ensure that individuals who are seeking to share services permitted under the waiver
plans in an own-home setting are not required to live in a licensed setting in order to share
services so long as all other requirements are met; and

(4) issue guidance for shared services, including:

(i) informed choice for all individuals sharing the services;

(ii) guidance for when multiple shared services by different providers occur in one home
and how lead agencies and individuals shall determine that shared service is appropriate to
meet the needs, health, and safety of each individual for whom the lead agency provides
case management or care coordination; and

(iii) guidance clarifying that an individual's decision to share services does not reduce
any determination of the individual's overall or assessed needs for services.

(b) The commissioner shall develop or provide guidance outlining:

(1) instructions for shared services support planning;

(2) person-centered approaches and informed choice in shared services support planning;
and

(3) required contents of shared services agreements.

(c) The commissioner shall seek and utilize stakeholder input for any proposed changes
to waiver plans and any shared services guidance.

Sec. 63. DIRECTION TO COMMISSIONER; DISABILITY WAIVER SHARED
SERVICES RATES.

The commissioner of human services shall establish a rate system for shared homemaker
services and shared chore services provided under Minnesota Statutes, sections 256B.092
and 256B.49. For two persons sharing services, the rate paid to a provider must not exceed
1-1/2 times the rate paid for serving a single individual, and for three persons sharing
services, the rate paid to a provider must not exceed two times the rate paid for serving a
single individual. These rates apply only when all of the criteria for the shared service have
been met.

Sec. 64. DIRECTION TO COMMISSIONER; LIFE-SHARING SERVICES.

Subdivision 1.

Recommendations required.

The commissioner of human services shall
develop recommendations for establishing life sharing as a covered medical assistance
waiver service.

Subd. 2.

Definition.

For the purposes of this section, "life sharing" means a
relationship-based living arrangement between an adult with a disability and an individual
or family in which they share their lives and experiences while the adult with a disability
receives support from the individual or family using person-centered practices.

Subd. 3.

Stakeholder engagement and consultation.

(a) The commissioner must
proactively solicit participation in the development of the life-sharing medical assistance
service through a robust stakeholder engagement process that results in the inclusion of a
racially, culturally, and geographically diverse group of interested stakeholders from each
of the following groups:

(1) providers currently providing or interested in providing life-sharing services;

(2) people with disabilities accessing or interested in accessing life-sharing services;

(3) disability advocacy organizations; and

(4) lead agencies.

(b) The commissioner must proactively seek input into and assistance with the
development of recommendations for establishing the life-sharing service from interested
stakeholders.

(c) The first meeting must occur before July 31, 2023. The commissioner must meet
with stakeholders at least monthly through December 31, 2023. All meetings must be
accessible.

Subd. 4.

Required topics to be discussed during development of the
recommendations.

The commissioner and the interested stakeholders must discuss the
following topics:

(1) the distinction between life sharing, adult family foster care, family residential
services, and community residential services;

(2) successful life-sharing models used in other states;

(3) services and supports that could be included in a life-sharing service;

(4) potential barriers to providing or accessing life-sharing services;

(5) solutions to remove identified barriers to providing or accessing life-sharing services;

(6) requirements of a life-sharing agency;

(7) medical assistance payment methodologies for life-sharing providers and life-sharing
agencies;

(8) expanding awareness of the life-sharing model; and

(9) draft language for legislation necessary to further define and implement life-sharing
services.

Subd. 5.

Report to the legislature.

By December 31, 2024, the commissioner must
provide to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over direct care services any draft legislation necessary to
implement the rates and requirements for life-sharing services.

Sec. 65. DIRECTION TO COMMISSIONER; FOSTER CARE MORATORIUM
EXCEPTION APPLICATIONS.

(a) The commissioner must expedite the processing and review of all new and pending
applications for an initial foster care or community residential setting license under Minnesota
Statutes, section 245A.03, subdivision 7, paragraph (a), clauses (5) and (6).

(b) The commissioner must include on the application materials for an initial foster care
or community residential setting license under Minnesota Statutes, section 245A.03,
subdivision 7, paragraph (a), clauses (5) and (6), an opportunity for applicants to signify
that they are seeking an initial foster care or community residential setting license in order
to transition an existing operational customized living setting to a foster care or community
residential setting. "Operational" has the meaning given in section 256B.49, subdivision
28, paragraph (e).

(c) For any pending applications for a license under Minnesota Statutes, section 245A.03,
subdivision 7, paragraph (a), clause (5), the commissioner must determine if the applicant
is eligible for an exception under Minnesota Statutes, section 245A.03, subdivision 7,
paragraph (a), clause (6), and if so, act upon the application under clause (6) rather than
clause (5).

(d) The commissioner must increase to four the licensed capacity of any setting for
which the commissioner issued a license under Minnesota Statutes, section 245A.03,
subdivision 7, paragraph (a), clause (5), before the final enactment of this act.

(e) This section expires December 31, 2023.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 66. AWARENESS-BUILDING CAMPAIGN FOR THE RECRUITMENT OF
DIRECT CARE PROFESSIONALS.

Subdivision 1.

Grant program established.

The commissioner of employment and
economic development shall develop and implement paid advertising as part of a
comprehensive awareness-building campaign aimed at recruiting direct care professionals
to provide long-term care services.

Subd. 2.

Definition.

For purposes of this section, "direct care professionals" means
long-term care services employees who provide direct support or care to people using aging,
disability, or behavioral health services.

Subd. 3.

Request for proposals; allowable uses of grant money.

(a) The commissioner
shall publish a request for proposals to select an outside vendor or vendors to conduct the
awareness-building campaign for the recruitment of direct care professionals.

(b) Grant money received under this section may be used:

(1) for the development of recruitment materials for the direct care workforce to be
featured on:

(i) television;

(ii) streaming services;

(iii) radio;

(iv) social media;

(v) billboards; and

(vi) other print materials;

(2) for the development of materials and strategies to highlight and promote the positive
aspects of the direct care workforce;

(3) for the purchase of media time or space to feature recruitment materials for the direct
care workforce; and

(4) for administrative costs necessary to implement this grant program.

(c) The Department of Employment and Economic Development may collaborate with
relevant state agencies for the purposes of the development and implementation of this
campaign and is authorized to transfer administrative money to such agencies to cover any
associated administrative costs.

Sec. 67. REPEALER.

Minnesota Statutes 2022, section 256B.4914, subdivision 9a, is repealed.

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.

ARTICLE 2

AGING SERVICES

Section 1.

[144A.141] VOLUNTARY RECEIVERSHIP.

A majority in interest of the controlling persons of a nursing home may at any time
request the commissioner of health to assume the operation of the nursing home through
appointment of a receiver. Upon receiving a request for a receiver, the commissioner of
health may, if the commissioner deems receivership desirable, enter into an agreement with
a majority in interest of the controlling persons, providing for the appointment of a receiver
to take charge of the facility under conditions deemed appropriate by both parties. The
agreement shall specify all terms and conditions of the receivership and shall preserve all
rights of the facility residents as granted by law. A receivership initiated in accordance with
this section shall terminate at the time specified by the parties or at the time when either
party notifies the other in writing that the party wishes to terminate the receivership
agreement.

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. 3f.

Live well at home grants extension.

(a) A community or organization that
has previously received a grant under subdivision 3, except any grants or portion of a grant
for capital or other onetime costs, or subdivisions 3c to 3e, for a project that has proven to
be successful and that is no longer eligible for funding under subdivision 3, 3c, 3d, or 3e
may apply to the commissioner to receive ongoing funding to sustain the project.

(b) The commissioner must use a request for proposals process and may use a two-year
grant cycle.

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 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, 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 and divisions with jurisdiction over human services.
The progress report must include metrics of the use of grant program money. This subdivision
expires upon submission of the report. The commissioner shall inform the revisor of statutes
when the report is submitted.

Sec. 4.

Minnesota Statutes 2022, section 256B.0913, subdivision 4, is amended to read:

Subd. 4.

Eligibility for funding for services for nonmedical assistance recipients.

(a)
Funding for services under the alternative care program is available to persons who meet
the following criteria:

(1) the person is a citizen of the United States or a United States national;

(2) the person has been determined by a community assessment under section 256B.0911
to be a person who would require the level of care provided in a nursing facility, as
determined under section 256B.0911, subdivision 26, but for the provision of services under
the alternative care program;

(3) the person is age 65 or older;

(4) the person would be eligible for medical assistance within 135 days of admission to
a nursing facility;

(5) the person is not ineligible for the payment of long-term care services by the medical
assistance program due to an asset transfer penalty under section 256B.0595 or equity
interest in the home exceeding $500,000 as stated in section 256B.056;

(6) the person needs long-term care services that are not funded through other state or
federal funding, or other health insurance or other third-party insurance such as long-term
care insurance;

(7) except for individuals described in clause (8), the monthly cost of the alternative
care services funded by the program for this person does not exceed 75 percent of the
monthly limit described under section 256S.18. This monthly limit does not prohibit the
alternative care client from payment for additional services, but in no case may the cost of
additional services purchased under this section exceed the difference between the client's
monthly service limit defined under section 256S.04, and the alternative care program
monthly service limit defined in this paragraph. If care-related supplies and equipment or
environmental modifications and adaptations are or will be purchased for an alternative
care services recipient, the costs may be prorated on a monthly basis for up to 12 consecutive
months beginning with the month of purchase. If the monthly cost of a recipient's other
alternative care services exceeds the monthly limit established in this paragraph, the annual
cost of the alternative care services shall be determined. In this event, the annual cost of
alternative care services shall not exceed 12 times the monthly limit described in this
paragraph;

(8) for individuals assigned a case mix classification A as described under section
256S.18, with (i) no dependencies in activities of daily living, or (ii) up to two dependencies
in bathing, dressing, grooming, walking, and eating when the dependency score in eating
is three or greater as determined by an assessment performed under section 256B.0911, the
monthly cost of alternative care services funded by the program cannot exceed $593 per
month for all new participants enrolled in the program on or after July 1, 2011. This monthly
limit shall be applied to all other participants who meet this criteria at reassessment. This
monthly limit shall be increased annually as described in section 256S.18. This monthly
limit does not prohibit the alternative care client from payment for additional services, but
in no case may the cost of additional services purchased exceed the difference between the
client's monthly service limit defined in this clause and the limit described in clause (7) for
case mix classification A; and

(9) the person is making timely payments of the assessed monthly fee. A person is
ineligible if payment of the fee is over 60 days past due, unless the person agrees to:

(i) the appointment of a representative payee;

(ii) automatic payment from a financial account;

(iii) the establishment of greater family involvement in the financial management of
payments; or

(iv) another method acceptable to the lead agency to ensure prompt fee payments.; and

(10) for a person participating in consumer-directed community supports, the person's
monthly service limit must be equal to the monthly service limits in clause (7), except that
a person assigned a case mix classification L must receive the monthly service limit for
case mix classification A.

(b) The lead agency may extend the client's eligibility as necessary while making
arrangements to facilitate payment of past-due amounts and future premium payments.
Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
reinstated for a period of 30 days.

(c) Alternative care funding under this subdivision is not available for a person who is
a medical assistance recipient or who would be eligible for medical assistance without a
spenddown or waiver obligation. A person whose initial application for medical assistance
and the elderly waiver program is being processed may be served under the alternative care
program for a period up to 60 days. If the individual is found to be eligible for medical
assistance, medical assistance must be billed for services payable under the federally
approved elderly waiver plan and delivered from the date the individual was found eligible
for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
care funds may not be used to pay for any service the cost of which: (i) is payable by medical
assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to pay a
medical assistance income spenddown for a person who is eligible to participate in the
federally approved elderly waiver program under the special income standard provision.

(d) Alternative care funding is not available for a person who resides in a licensed nursing
home, certified boarding care home, hospital, or intermediate care facility, except for case
management services which are provided in support of the discharge planning process for
a nursing home resident or certified boarding care home resident to assist with a relocation
process to a community-based setting.

(e) Alternative care funding is not available for a person whose income is greater than
the maintenance needs allowance under section 256S.05, but equal to or less than 120 percent
of the federal poverty guideline effective July 1 in the fiscal year for which alternative care
eligibility is determined, who would be eligible for the elderly waiver with a waiver
obligation.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 5.

Minnesota Statutes 2022, section 256B.0913, subdivision 5, is amended to read:

Subd. 5.

Services covered under alternative care.

Alternative care funding may be
used for payment of costs of:

(1) adult day services and adult day services bath;

(2) home care;

(3) homemaker services;

(4) personal care;

(5) case management and conversion case management;

(6) respite care;

(7) specialized supplies and equipment;

(8) home-delivered meals;

(9) nonmedical transportation;

(10) nursing services;

(11) chore services;

(12) companion services;

(13) nutrition services;

(14) family caregiver training and education;

(15) coaching and counseling;

(16) telehome care to provide services in their own homes in conjunction with in-home
visits;

(17) consumer-directed community supports under the alternative care programs which
are available statewide and limited to the average monthly expenditures representative of
all alternative care program participants for the same case mix resident class assigned in
the most recent fiscal year for which complete expenditure data is available;

(18) environmental accessibility and adaptations; and

(19) discretionary services, for which lead agencies may make payment from their
alternative care program allocation for services not otherwise defined in this section or
section 256B.0625, following approval by the commissioner.

Total annual payments for discretionary services for all clients served by a lead agency
must not exceed 25 percent of that lead agency's annual alternative care program base
allocation, except that when alternative care services receive federal financial participation
under the 1115 waiver demonstration, funding shall be allocated in accordance with
subdivision 17.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 6.

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) "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. 7.

Minnesota Statutes 2022, section 256B.0922, subdivision 1, is amended to read:

Subdivision 1.

Essential community supports.

(a) The purpose of the essential
community supports program is to provide targeted services to persons age 65 and older
who need essential community support, but whose needs do not meet the level of care
required for nursing facility placement under section 144.0724, subdivision 11.

(b) Essential community supports are available not to exceed $400 $600 per person per
month. Essential community supports may be used as authorized within an authorization
period not to exceed 12 months. Services must be available to a person who:

(1) is age 65 or older;

(2) is not eligible for medical assistance;

(3) has received a community assessment under section 256B.0911, subdivisions 17 to
21, 23, 24, or 27, and does not require the level of care provided in a nursing facility;

(4) meets the financial eligibility criteria for the alternative care program under section
256B.0913, subdivision 4;

(5) has an assessment summary; and

(6) has been determined by a community assessment under section 256B.0911,
subdivisions 17 to 21, 23, 24, or 27, to be a person who would require provision of at least
one of the following services, as defined in the approved elderly waiver plan, in order to
maintain their community residence:

(i) adult day services;

(ii) caregiver support, including respite care;

(iii) homemaker support;

(iv) adult companion services;

(iv) (v) chores;

(v) (vi) a personal emergency response device or system;

(vi) (vii) home-delivered meals; or

(vii) (viii) community living assistance as defined by the commissioner.

(c) The person receiving any of the essential community supports in this subdivision
must also receive service coordination, not to exceed $600 in a 12-month authorization
period, as part of their assessment summary.

(d) A person who has been determined to be eligible for essential community supports
must be reassessed at least annually and continue to meet the criteria in paragraph (b) to
remain eligible for essential community supports.

(e) The commissioner is authorized to use federal matching funds for essential community
supports as necessary and to meet demand for essential community supports as outlined in
subdivision 2, and that amount of federal funds is appropriated to the commissioner for this
purpose.

Sec. 8.

Minnesota Statutes 2022, section 256B.434, is amended by adding a subdivision
to read:

Subd. 4k.

Property rate increase for certain nursing facilities.

(a) A rate increase
under this subdivision ends upon the effective date of the transition of the facility's property
rate to a property payment rate under section 256R.26, subdivision 8.

(b) The commissioner shall increase the property rate of a nursing facility located in the
city of Saint Paul at 1415 Almond Avenue in Ramsey County by $10.65 on September 1,
2023.

(c) The commissioner shall increase the property rate of a nursing facility located in the
city of Duluth at 3111 Church Place in St. Louis County by $20.81 on September 1, 2023.

(d) The commissioner shall increase the property rate of a nursing facility located in the
city of Chatfield at 1102 Liberty Street SE in Fillmore County by $21.35 on September 1,
2023.

EFFECTIVE DATE.

This section is effective September 1, 2023.

Sec. 9.

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 paragraph (a), the commissioner must not award a county 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 that has
applied to the commissioner and has 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 provision of a
performance improvement plan and additional remedies identified by the commissioner.
The commissioner may redirect up to 20 percent of a county's money under this section
toward the performance improvement plan.

Subd. 6.

American Indian adult protection.

Tribal Nations receiving money under
this section must 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. 10.

Minnesota Statutes 2022, section 256R.02, subdivision 19, is amended to read:

Subd. 19.

External fixed costs.

"External fixed costs" means costs related to the nursing
home surcharge under section 256.9657, subdivision 1; licensure fees under section 144.122;
family advisory council fee under section 144A.33; scholarships under section 256R.37;
planned closure rate adjustments under section 256R.40; consolidation rate adjustments
under section 144A.071, subdivisions 4c, paragraph (a), clauses (5) and (6), and 4d;
single-bed room incentives under section 256R.41; property taxes, special assessments, and
payments in lieu of taxes; employer health insurance costs; quality improvement incentive
payment rate adjustments under section 256R.39; performance-based incentive payments
under section 256R.38; special dietary needs under section 256R.51; Public Employees
Retirement Association employer costs; and border city facility-specific rate adjustments
modifications under section 256R.481.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 11.

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. 12.

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).

(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 facility-specific
rate modifications 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.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 13.

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 facilities 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
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.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 14.

Minnesota Statutes 2022, section 256R.481, is amended to read:

256R.481 FACILITY-SPECIFIC RATE ADJUSTMENTS FOR BORDER CITY
FACILITIES MODIFICATIONS.

Subdivision 1.

Border city facilities.

(a) The commissioner shall allow each nonprofit
nursing facility located within the boundaries of the city of Breckenridge or Moorhead prior
to January 1, 2015, to apply once annually for a rate add-on to the facility's external fixed
costs payment rate.

(b) A facility seeking an add-on to its external fixed costs payment rate under this section
must apply annually to the commissioner to receive the add-on. A facility must submit the
application within 60 calendar days of the effective date of any add-on under this section.
The commissioner may waive the deadlines required by this paragraph under extraordinary
circumstances.

(c) The commissioner shall provide the add-on to each eligible facility that applies by
the application deadline.

(d) The add-on to the external fixed costs payment rate is the difference on January 1
of the median total payment rate for case mix classification PA1 of the nonprofit facilities
located in an adjacent city in another state and in cities contiguous to the adjacent city minus
the eligible nursing facility's total payment rate for case mix classification PA1 as determined
under section 256R.22, subdivision 4.

Subd. 2.

Nursing facility in Chisholm; temporary rate add-on.

Effective July 1, 2023,
through December 31, 2027, the commissioner shall provide an external fixed rate add-on
for the nursing facility in the city of Chisholm in the amount of $11.81. If this nursing
facility completes a moratorium exception project that is approved after March 27, 2023,
this subdivision expires the day before the effective date of that moratorium rate adjustment
or December 31, 2027, whichever is earlier. The commissioner of human services shall
notify the revisor of statutes if this subdivision expires prior to December 31, 2027.

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. 15.

Minnesota Statutes 2022, section 256R.53, is amended by adding a subdivision
to read:

Subd. 3.

Nursing facility in Fergus Falls.

Notwithstanding sections 256B.431, 256B.434,
and 256R.26, subdivision 9, a nursing facility located in the city of Fergus Falls licensed
for 105 beds on September 1, 2021, must have the property portion of its total payment rate
determined according to sections 256R.26 to 256R.267.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 16.

Minnesota Statutes 2022, section 256R.53, is amended by adding a subdivision
to read:

Subd. 4.

Nursing facility in Red Wing.

The operating payment rate for a facility located
in the city of Red Wing at 1412 West 4th Street is the sum of its direct care costs per
standardized day, its other care-related costs per resident day, and its other operating costs
per day.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 17.

Minnesota Statutes 2022, section 256S.15, subdivision 2, is amended to read:

Subd. 2.

Foster care limit.

The elderly waiver payment for the foster care service in
combination with the payment for all other elderly waiver services, including case
management, must not exceed the monthly case mix budget cap for the participant as
specified in sections 256S.18, subdivision 3, and 256S.19, subdivisions subdivision 3 and
4.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 18.

Minnesota Statutes 2022, section 256S.18, is amended by adding a subdivision
to read:

Subd. 3a.

Monthly case mix budget caps for consumer-directed community
supports.

The monthly case mix budget caps for each case mix classification for
consumer-directed community supports must be equal to the monthly case mix budget caps
in subdivision 3.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 19.

Minnesota Statutes 2022, section 256S.19, subdivision 3, is amended to read:

Subd. 3.

Calculation of monthly conversion budget cap without consumer-directed
community supports caps.

(a) The elderly waiver monthly conversion budget cap for the
cost of elderly waiver services without consumer-directed community supports must be
based on the nursing facility case mix adjusted total payment rate of the nursing facility
where the elderly waiver applicant currently resides for the applicant's case mix classification
as determined according to section 256R.17.

(b) The elderly waiver monthly conversion budget cap for the cost of elderly waiver
services without consumer-directed community supports shall must be calculated by
multiplying the applicable nursing facility case mix adjusted total payment rate by 365,
dividing by 12, and subtracting the participant's maintenance needs allowance.

(c) A participant's initially approved monthly conversion budget cap for elderly waiver
services without consumer-directed community supports shall must be adjusted at least
annually as described in section 256S.18, subdivision 5.

(d) Conversion budget caps for individuals participating in consumer-directed community
supports must be set as described in paragraphs (a) to (c).

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 20.

Minnesota Statutes 2022, section 256S.203, subdivision 1, is amended to read:

Subdivision 1.

Capitation payments.

The commissioner must adjust the elderly waiver
capitation payment rates for managed care organizations paid to reflect the monthly service
rate limits for customized living services and 24-hour customized living services established
under section 256S.202 and, the rate adjustments for disproportionate share facilities under
section 256S.205, and the assisted living facility closure payments under section 256S.206.

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. 21.

Minnesota Statutes 2022, section 256S.203, subdivision 2, is amended to read:

Subd. 2.

Reimbursement rates.

Medical assistance rates paid to customized living
providers by managed care organizations under this chapter must not exceed the monthly
service rate limits and component rates as determined by the commissioner under sections
256S.15 and 256S.20 to 256S.202, plus any rate adjustment or special payment under section
256S.205 or 256S.206.

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. 22.

Minnesota Statutes 2022, section 256S.205, subdivision 3, is amended to read:

Subd. 3.

Rate adjustment eligibility criteria.

Only facilities satisfying all of the
following conditions on September 1 of the application year are eligible for designation as
a disproportionate share facility:

(1) at least 83.5 80 percent of the residents of the facility are customized living residents;
and

(2) at least 70 50 percent of the customized living residents are elderly waiver participants.

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. 23.

Minnesota Statutes 2022, section 256S.205, subdivision 5, is amended to read:

Subd. 5.

Rate adjustment; rate floor.

(a) Notwithstanding the 24-hour customized
living monthly service rate limits under section 256S.202, subdivision 2, and the component
service rates established under section 256S.201, subdivision 4, the commissioner must
establish a rate floor equal to $119 $139 per resident per day for 24-hour customized living
services provided to an elderly waiver participant in a designated disproportionate share
facility.

(b) The commissioner must apply the rate floor to the services described in paragraph
(a) provided during the rate year.

(c) The commissioner must adjust the rate floor by the same amount and at the same
time as any adjustment to the 24-hour customized living monthly service rate limits under
section 256S.202, subdivision 2.

(d) The commissioner shall not implement the rate floor under this section if the
customized living rates established under sections 256S.21 to 256S.215 will be implemented
at 100 percent on January 1 of the year following an application year.

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. 24.

[256S.206] ASSISTED LIVING FACILITY CLOSURE PAYMENTS.

Subdivision 1.

Assisted living facility closure payments provided.

The commissioner
of human services shall establish a special payment program to support licensed assisted
living facilities who serve waiver participants under section 256B.49 and chapter 256S
when the assisted living facility is acting to close the facility as outlined in section 144G.57.
The payments must support the facility to meet the health and safety needs of residents
during facility occupancy and revenue decline.

Subd. 2.

Definitions.

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

(b) "Closure period" means the number of days in the approved closure plan for the
eligible facility as determined by the commissioner of health under section 144G.57, not to
exceed 60 calendar days.

(c) "Eligible claim" means a claim for customized living services and 24-hour customized
living services provided to waiver participants under section 256B.49 and chapter 256S
during the eligible facility's closure period.

(d) "Eligible facility" means a licensed assisted living facility that has an approved
closure plan, as determined by the commissioner of health under section 144G.57, that is
acting to close the facility and no longer serve residents in that setting. A facility where a
provider is relinquishing an assisted living facility license to transition to a different license
type is not an eligible facility.

Subd. 3.

Application.

(a) An eligible facility may apply to the commissioner of human
services for assisted living closure transition payments in the manner prescribed by the
commissioner.

(b) The commissioner shall notify the facility within 14 calendars days of the facility's
application about the result of the application, including whether the facility meets the
definition of an eligible facility.

Subd. 4.

Issuing closure payments.

(a) The commissioner must increase the payment
for eligible claims by 50 percent during the eligible facility's closure period.

(b) The commissioner must direct managed care organizations to increase the payment
for eligible claims by 50 percent during the eligible facility's closure period for eligible
claims submitted to managed care organizations.

Subd. 5.

Interagency coordination.

The commissioner of human services must
coordinate the activities under this section with any impacted state agencies and lead agencies.

EFFECTIVE DATE.

This section is effective July 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. 25.

Minnesota Statutes 2022, section 256S.21, is amended to read:

256S.21 RATE SETTING; APPLICATION; EVALUATION.

Subdivision 1.

Application of rate setting.

The payment rate methodologies in sections
256S.2101 to 256S.215 apply to:

(1) elderly waiver, elderly waiver customized living, and elderly waiver foster care under
this chapter;

(2) alternative care under section 256B.0913;

(3) essential community supports under section 256B.0922; and

(4) community access for disability inclusion customized living and brain injury
customized living under section 256B.49.

Subd. 2.

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. 3.

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 are 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 is 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 section
256S.2101, subdivision 3, through the reports directed by subdivision 2.

EFFECTIVE DATE.

Subdivisions 1 and 2 are effective January 1, 2024. Subdivision
3 is effective January 1, 2025.

Sec. 26.

Minnesota Statutes 2022, section 256S.2101, subdivision 2, is amended to read:

Subd. 2.

Phase-in for elderly waiver rates.

Except for home-delivered meals as
described in section 256S.215, subdivision 15 and the services in subdivision 2a, 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:

(1) beginning January 1, 2024, the sum of 18.8 27.8 percent of the rates calculated under
sections 256S.211 to 256S.215, and 81.2 72.2 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; and

(2) beginning January 1, 2026, the sum of 25 percent of the rates calculated under sections
256S.211 to 256S.215, and 75 percent of the rates calculated using the rate methodology
in effect as of June 30, 2017.

Sec. 27.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:

Subd. 2a.

Service rates exempt from phase-in.

Subdivision 2 does not apply to rates
for homemaker services described in section 256S.215, subdivisions 9 to 11.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 28.

Minnesota Statutes 2022, section 256S.2101, is amended by adding a subdivision
to read:

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
adjustments to the phase-in in subdivision 2, or any updates to services rates directed under
section 256S.211, subdivision 3, 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 the adjusted phase-in in
subdivision 2, 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 direct support professionals 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.

Sec. 29.

Minnesota Statutes 2022, section 256S.211, is amended by adding a subdivision
to read:

Subd. 3.

Updating services rates.

On January 1, 2024, and every two years thereafter,
the commissioner shall recalculate rates for services as directed in section 256S.215. Prior
to recalculating the rates, the commissioner shall:

(1) update the base wage index for services in section 256S.212 based on the most
recently available Bureau of Labor Statistics Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA data;

(2) update the payroll taxes and benefits factor in section 256S.213, subdivision 1, based
on the most recently available nursing facility cost report data;

(3) update the supervision wage components in section 256S.213, subdivisions 4 and 5,
based on the most recently available Bureau of Labor Statistics Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA data; and

(4) update the adjusted base wage for services as directed in section 256S.214.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 30.

Minnesota Statutes 2022, section 256S.211, is amended by adding a subdivision
to read:

Subd. 4.

Updating home-delivered meals rate.

On January 1 of each year, the
commissioner shall update the home-delivered meals rate in section 256S.215, subdivision
15, by the percent increase in the nursing facility dietary per diem using the two most recently
available nursing facility cost reports.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 31.

Minnesota Statutes 2022, section 256S.212, is amended to read:

256S.212 RATE SETTING; BASE WAGE INDEX.

Subdivision 1.

Updating SOC codes.

If any of the SOC codes and positions used in
this section are no longer available, the commissioner shall, in consultation with stakeholders,
select a new SOC code and position that is the closest match to the previously used SOC
position.

Subd. 2.

Home management and support services base wage.

For customized living,
and foster care, and residential care component services, the home management and support
services base wage equals 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for home health and personal and home care aide (SOC code 39-9021
31-1120); 33.33 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
wage for food preparation workers (SOC code 35-2021); and 33.34 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for maids and
housekeeping cleaners (SOC code 37-2012).

Subd. 3.

Home care aide base wage.

For customized living, and foster care, and
residential care component services, the home care aide base wage equals 50 75 percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health
and personal care aides (SOC code 31-1011 31-1120); and 50 25 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code 31-1014 31-1131).

Subd. 4.

Home health aide base wage.

For customized living, and foster care, and
residential care component services, the home health aide base wage equals 20 33.33 percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed
practical and licensed vocational nurses (SOC code 29-2061); and 80 33.33 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code 31-1014 31-1131); and 33.34 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for home health and personal care aides (SOC code
31-1120).

Subd. 5.

Medication setups by licensed nurse base wage.

For customized living, and
foster care, and residential care component services, the medication setups by licensed nurse
base wage equals ten 25 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for licensed practical and licensed vocational nurses (SOC code 29-2061);
and 90 75 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average
wage for registered nurses (SOC code 29-1141).

Subd. 6.

Chore services base wage.

The chore services base wage equals 100 50 percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for landscaping
and groundskeeping workers (SOC code 37-3011); and 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for maids and housekeeping cleaners
(SOC code 37-2012).

Subd. 7.

Companion services base wage.

The companion services base wage equals
50 80 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage
for home health and personal and home care aides (SOC code 39-9021 31-1120); and 50
20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
maids and housekeeping cleaners (SOC code 37-2012).

Subd. 8.

Homemaker services and assistance with personal care base wage.

The
homemaker services and assistance with personal care base wage equals 60 50 percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home health
and personal and home care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code 31-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).

Subd. 9.

Homemaker services and cleaning base wage.

The homemaker services and
cleaning base wage equals 60 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for personal and home care aide (SOC code 39-9021); 20 percent
of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing
assistants (SOC code 31-1014); and 20 100 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).

Subd. 10.

Homemaker services and home management base wage.

The homemaker
services and home management base wage equals 60 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for home health and personal and home
care aide aides (SOC code 39-9021 31-1120); 20 and 50 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1014 31-1131); and 20 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for maids and housekeeping cleaners (SOC code 37-2012).

Subd. 11.

In-home respite care services base wage.

The in-home respite care services
base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA
average wage for registered nurses (SOC code 29-1141); 75 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants home health and
personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for licensed practical and licensed
vocational nurses (SOC code 29-2061).

Subd. 12.

Out-of-home respite care services base wage.

The out-of-home respite care
services base wage equals five 15 percent of the Minneapolis-St. Paul-Bloomington, MN-WI
MetroSA average wage for registered nurses (SOC code 29-1141); 75 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
home health and personal care aides (SOC code 31-1014 31-1120); and 20 ten percent of
the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for licensed practical
and licensed vocational nurses (SOC code 29-2061).

Subd. 13.

Individual community living support base wage.

The individual community
living support base wage equals 20 60 percent of the Minneapolis-St. Paul-Bloomington,
MN-WI MetroSA average wage for licensed practical and licensed vocational nurses social
and human services assistants (SOC code 29-2061 21-1093); and 80 40 percent of the
Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants
(SOC code 31-1014 31-1131).

Subd. 14.

Registered nurse base wage.

The registered nurse base wage equals 100
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for
registered nurses (SOC code 29-1141).

Subd. 15.

Social worker Unlicensed supervisor base wage.

The social worker
unlicensed supervisor base wage equals 100 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for medical and public health social
first-line supervisors of personal service workers (SOC code 21-1022 39-1022).

Subd. 16.

Adult day services base wage.

The adult day services base wage equals 75
percent of the Minneapolis-St. Paul-Bloomington, MN-WI MetroSA average wage for home
health and personal care aides (SOC code 31-1120); and 25 percent of the Minneapolis-St.
Paul-Bloomington, MN-WI MetroSA average wage for nursing assistants (SOC code
31-1131).

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 32.

Minnesota Statutes 2022, section 256S.213, is amended to read:

256S.213 RATE SETTING; FACTORS.

Subdivision 1.

Payroll taxes and benefits factor.

The payroll taxes and benefits factor
is the sum of net payroll taxes and benefits, divided by the sum of all salaries for all nursing
facilities on the most recent and available cost report.

Subd. 2.

General and administrative factor.

The general and administrative factor is
the difference of net general and administrative expenses and administrative salaries, divided
by total operating expenses for all nursing facilities on the most recent and available cost
report 14.4 percent.

Subd. 3.

Program plan support factor.

(a) The program plan support factor is 12.8 ten
percent for the following services to cover the cost of direct service staff needed to provide
support for home and community-based the service when not engaged in direct contact with
participants.:

(1) adult day services;

(2) customized living; and

(3) foster care.

(b) The program plan support factor is 15.5 percent for the following services to cover
the cost of direct service staff needed to provide support for the service when not engaged
in direct contact with participants:

(1) chore services;

(2) companion services;

(3) homemaker assistance with personal care;

(4) homemaker cleaning;

(5) homemaker home management;

(6) in-home respite care;

(7) individual community living support; and

(8) out-of-home respite care.

Subd. 4.

Registered nurse management and supervision factor wage component.

The
registered nurse management and supervision factor wage component equals 15 percent of
the registered nurse adjusted base wage as defined in section 256S.214.

Subd. 5.

Social worker Unlicensed supervisor supervision factor wage
component.

The social worker unlicensed supervisor supervision factor wage component
equals 15 percent of the social worker unlicensed supervisor adjusted base wage as defined
in section 256S.214.

Subd. 6.

Facility and equipment factor.

The facility and equipment factor for adult
day services is 16.2 percent.

Subd. 7.

Food, supplies, and transportation factor.

The food, supplies, and
transportation factor for adult day services is 24 percent.

Subd. 8.

Supplies and transportation factor.

The supplies and transportation factor
for the following services is 1.56 percent:

(1) chore services;

(2) companion services;

(3) homemaker assistance with personal care;

(4) homemaker cleaning;

(5) homemaker home management;

(6) in-home respite care;

(7) individual community support services; and

(8) out-of-home respite care.

Subd. 9.

Absence factor.

The absence factor for the following services is 4.5 percent:

(1) adult day services;

(2) chore services;

(3) companion services;

(4) homemaker assistance with personal care;

(5) homemaker cleaning;

(6) homemaker home management;

(7) in-home respite care;

(8) individual community living support; and

(9) out-of-home respite care.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 33.

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

256S.214 RATE SETTING; ADJUSTED BASE WAGE.

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

(3) the position's base wage multiplied by the absence factor under section 256S.213,
subdivision 9, if applicable.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 34.

Minnesota Statutes 2022, section 256S.215, subdivision 2, is amended to read:

Subd. 2.

Home management and support services component rate.

The component
rate for home management and support services is calculated as follows:

(1) sum the home management and support services adjusted base wage plus and the
registered nurse management and supervision factor. wage component;

(2) multiply the result of clause (1) by the general and administrative factor; and

(3) sum the results of clauses (1) and (2).

Sec. 35.

Minnesota Statutes 2022, section 256S.215, subdivision 3, is amended to read:

Subd. 3.

Home care aide services component rate.

The component rate for home care
aide services is calculated as follows:

(1) sum the home health aide services adjusted base wage plus and the registered nurse
management and supervision factor. wage component;

(2) multiply the result of clause (1) by the general and administrative factor; and

(3) sum the results of clauses (1) and (2).

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 36.

Minnesota Statutes 2022, section 256S.215, subdivision 4, is amended to read:

Subd. 4.

Home health aide services component rate.

The component rate for home
health aide services is calculated as follows:

(1) sum the home health aide services adjusted base wage plus and the registered nurse
management and supervision factor. wage component;

(2) multiply the result of clause (1) by the general and administrative factor; and

(3) sum the results of clauses (1) and (2).

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 37.

Minnesota Statutes 2022, section 256S.215, subdivision 7, is amended to read:

Subd. 7.

Chore services rate.

The 15-minute unit rate for chore services is calculated
as follows:

(1) sum the chore services adjusted base wage and the social worker unlicensed supervisor
supervision factor wage component; and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 38.

Minnesota Statutes 2022, section 256S.215, subdivision 8, is amended to read:

Subd. 8.

Companion services rate.

The 15-minute unit rate for companion services is
calculated as follows:

(1) sum the companion services adjusted base wage and the social worker unlicensed
supervisor supervision factor wage component; and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 39.

Minnesota Statutes 2022, section 256S.215, subdivision 9, is amended to read:

Subd. 9.

Homemaker services and assistance with personal care rate.

The 15-minute
unit rate for homemaker services and assistance with personal care is calculated as follows:

(1) sum the homemaker services and assistance with personal care adjusted base wage
and the registered nurse management and unlicensed supervisor supervision factor wage
component; and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 40.

Minnesota Statutes 2022, section 256S.215, subdivision 10, is amended to read:

Subd. 10.

Homemaker services and cleaning rate.

The 15-minute unit rate for
homemaker services and cleaning is calculated as follows:

(1) sum the homemaker services and cleaning adjusted base wage and the registered
nurse management and unlicensed supervisor supervision factor wage component; and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 41.

Minnesota Statutes 2022, section 256S.215, subdivision 11, is amended to read:

Subd. 11.

Homemaker services and home management rate.

The 15-minute unit rate
for homemaker services and home management is calculated as follows:

(1) sum the homemaker services and home management adjusted base wage and the
registered nurse management and unlicensed supervisor supervision factor wage component;
and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 42.

Minnesota Statutes 2022, section 256S.215, subdivision 12, is amended to read:

Subd. 12.

In-home respite care services rates.

(a) The 15-minute unit rate for in-home
respite care services is calculated as follows:

(1) sum the in-home respite care services adjusted base wage and the registered nurse
management and supervision factor wage component; and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

(b) The in-home respite care services daily rate equals the in-home respite care services
15-minute unit rate multiplied by 18.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 43.

Minnesota Statutes 2022, section 256S.215, subdivision 13, is amended to read:

Subd. 13.

Out-of-home respite care services rates.

(a) The 15-minute unit rate for
out-of-home respite care is calculated as follows:

(1) sum the out-of-home respite care services adjusted base wage and the registered
nurse management and supervision factor wage component; and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

(b) The out-of-home respite care services daily rate equals the 15-minute unit rate for
out-of-home respite care services multiplied by 18.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 44.

Minnesota Statutes 2022, section 256S.215, subdivision 14, is amended to read:

Subd. 14.

Individual community living support rate.

The individual community living
support rate is calculated as follows:

(1) sum the home care aide individual community living support adjusted base wage
and the social worker registered nurse management and supervision factor wage component;
and

(2) multiply the result of clause (1) by the general and administrative factor;

(3) multiply the result of clause (1) by the supplies and transportation factor; and

(4) sum the results of clauses (1) to (3) and divide the result of clause (1) by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 45.

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

Subd. 15.

Home-delivered meals rate.

Effective January 1, 2024, the home-delivered
meals rate equals $9.30 is $8.17, updated as directed in section 256S.211, subdivision 4.
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 July 1, 2023.

Sec. 46.

Minnesota Statutes 2022, section 256S.215, subdivision 16, is amended to read:

Subd. 16.

Adult day services rate.

The 15-minute unit rate for adult day services, with
an assumed staffing ratio of one staff person to four participants, is the sum of is calculated
as follows:

(1) one-sixteenth of the home care aide divide the adult day services adjusted base wage,
except that the general and administrative factor used to determine the home care aide
services adjusted base wage is 20 percent by five to reflect an assumed staffing ratio of one
to five;

(2) one-fourth of the registered nurse management and supervision factor sum the result
of clause (1) and the registered nurse management and supervision wage component; and

(3) $0.63 to cover the cost of meals. multiply the result of clause (2) by the general and
administrative factor;

(4) multiply the result of clause (2) by the facility and equipment factor;

(5) multiply the result of clause (2) by the food, supplies, and transportation factor; and

(6) sum the results of clauses (2) to (5) and divide the result by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 47.

Minnesota Statutes 2022, section 256S.215, subdivision 17, is amended to read:

Subd. 17.

Adult day services bath rate.

The 15-minute unit rate for adult day services
bath is the sum of calculated as follows:

(1) one-fourth of the home care aide sum the adult day services adjusted base wage,
except that the general and administrative factor used to determine the home care aide
services adjusted base wage is 20 percent and the nurse management and supervision wage
component;

(2) one-fourth of the registered nurse management and supervision multiply the result
of clause (1) by the general and administrative factor; and

(3) $0.63 to cover the cost of meals. multiply the result of clause (1) by the facility and
equipment factor;

(4) multiply the result of clause (1) by the food, supplies, and transportation factor; and

(5) sum the results of clauses (1) to (4) and divide the result by four.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 48. DIRECTION TO COMMISSIONER; FUTURE PACE IMPLEMENTATION
FUNDING.

The commissioner of human services must work collaboratively with stakeholders to
undertake an actuarial analysis of medical assistance costs for nursing home eligible
beneficiaries for the purposes of establishing a monthly medical assistance capitation rate
for the program of all-inclusive care for the elderly (PACE). The analysis must account for
all sources of state medical assistance 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, title 42, section
447, and long-term care costs. The commissioner must also estimate the administrative
costs associated with implementing and monitoring PACE. The commissioner must provide
a report to the chairs and ranking minority members of the legislative committees with
jurisdiction over health care funding of 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 March 1, 2024. By September 1,
2024, the commissioner shall inform the chairs and ranking minority members of the
legislative committees with jurisdiction over health care funding 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. 49. DIRECTION TO COMMISSIONER; 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. 50. NURSING FACILITY FUNDING.

(a) Effective July 1, 2023, through June 30, 2025, the total payment rate for all facilities
reimbursed under Minnesota Statutes, chapter 256R, must be increased by an amount per
resident day equal to a net state general fund expenditure of $37,045,000 in fiscal year 2024
and $37,045,000 in fiscal year 2025. Effective July 1, 2025, the total payment rate for all
facilities reimbursed under Minnesota Statutes, chapter 256R, must be increased by an
amount per resident day equal to a net state expenditure of $23,698,000 per fiscal year. The
rate increases under this paragraph are add-ons to the facilities' rates calculated under
Minnesota Statutes, chapter 256R.

(b) To be eligible to receive a payment under this section, a nursing facility must attest
to the commissioner of human services that the additional revenue will be used exclusively
to increase compensation-related costs for employees directly employed by the facility on
or after July 1, 2023, excluding:

(1) owners of the building and operation;

(2) persons employed in the central office of an entity that has any ownership interest
in the nursing facility or exercises control over the nursing facility;

(3) persons paid by the nursing facility under a management contract; and

(4) persons providing separately billable services.

(c) Contracted housekeeping, dietary, and laundry employees providing services on site
at the nursing facility are eligible for compensation-related cost increases under this section,
provided the agency that employs them submits to the nursing facility proof of the costs of
the increases provided to those employees.

(d) For purposes of this section, compensation-related costs include:

(1) permanent new increases to wages and salaries implemented on or after July 1, 2023,
and before September 1, 2023, for nursing facility employees;

(2) permanent new increases to wages and salaries implemented on or after July 1, 2023,
and before September 1, 2023, for employees in the organization's shared services
departments of hospital-attached nursing facilities for the nursing facility allocated share
of wages; and

(3) the employer's share of FICA taxes, Medicare taxes, state and federal unemployment
taxes, PERA, workers' compensation, and pension and employee retirement accounts directly
associated with the wage and salary increases in clauses (1) and (2) incurred no later than
December 31, 2025, and paid for no later than June 30, 2026.

(e) A facility that receives a rate increase under this section must complete a distribution
plan in the form and manner determined by the commissioner. This plan must specify the
total amount of money the facility is estimated to receive from this rate increase and how
that money will be distributed to increase the allowable compensation-related costs described
in paragraph (d) for employees described in paragraphs (b) and (c). This estimate must be
computed by multiplying $28.65 by the sum of the medical assistance and private pay
resident days as defined in Minnesota Statutes, section 256R.02, subdivision 45, for the
period beginning October 1, 2021, through September 30, 2022, dividing this sum by 365
and multiplying the result by 915. A facility must submit its distribution plan to the
commissioner by October 1, 2023. The commissioner may review the distribution plan to
ensure that the payment rate adjustment per resident day is used in accordance with this
section. The commissioner may allow for a distribution plan amendment under exceptional
circumstances to be determined at the sole discretion of the commissioner.

(f) By September 1, 2023, a facility must post the distribution plan summary and leave
it posted for a period of at least six months in an area of the facility to which all employees
have access. The posted distribution plan summary must be in the form and manner
determined by the commissioner. The distribution plan summary must include instructions
regarding how to contact the commissioner, or the commissioner's representative, if an
employee believes the employee is covered by paragraph (b) or (c) and has not received the
compensation-related increases described in paragraph (d). The instruction to such employees
must include the e-mail address and telephone number that may be used by the employee
to contact the commissioner's representative. The posted distribution plan summary must
demonstrate how the increase in paragraph (a) received by the nursing facility from July 1,
2023, through December 1, 2025, will be used in full to pay the compensation-related costs
in paragraph (d) for employees described in paragraphs (b) and (c).

(g) If the nursing facility expends less on new compensation-related costs than the amount
that was made available by the rate increase in this section for that purpose, the amount of
this rate adjustment must be reduced to equal the amount utilized by the facility for purposes
authorized under this section. If the facility fails to post the distribution plan summary in
its facility as required, fails to submit its distribution plan to the commissioner by the due
date, or uses the money for unauthorized purposes, these rate increases must be treated as
an overpayment and subsequently recovered.

(h) The commissioner shall not treat payments received under this section as an applicable
credit for purposes of setting total payment rates under Minnesota Statutes, chapter 256R.

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. 51. DIRECTION TO COMMISSIONERS OF HUMAN SERVICES AND
HEALTH; SMALL PROVIDER REGULATORY RELIEF.

The commissioners of human services and health must consult with assisted living
facility license holders who provide customized living and whose facilities are smaller than
11 beds to compile a list of regulatory requirements, compliance with which is particularly
difficult for small providers. The commissioners must provide the chairs and ranking minority
members of the legislative committees with jurisdiction over assisted living licensure and
customized living with recommendations, including draft legislation, to reduce the regulatory
burden on small providers.

Sec. 52. 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. 53. REPEALER.

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

(b) Minnesota Statutes 2022, section 256S.19, subdivision 4, is repealed.

EFFECTIVE DATE.

Paragraph (a) is effective July 1, 2023. Paragraph (b) is effective
January 1, 2024.

ARTICLE 3

HEALTH CARE

Section 1.

Minnesota Statutes 2022, section 252.27, subdivision 2a, is amended to read:

Subd. 2a.

Contribution amount.

(a) The natural or adoptive parents of a minor child,
not including a child determined eligible for medical assistance without consideration of
parental income under the Tax Equity and Fiscal Responsibility Act (TEFRA) option or a
child accessing home and community-based waiver services, must contribute to the cost of
services used by making monthly payments on a sliding scale based on income, unless the
child is married or has been married, parental rights have been terminated, or the child's
adoption is subsidized according to chapter 259A or through title IV-E of the Social Security
Act. The parental contribution is a partial or full payment for medical services provided for
diagnostic, therapeutic, curing, treating, mitigating, rehabilitation, maintenance, and personal
care services as defined in United States Code, title 26, section 213, needed by the child
with a chronic illness or disability.

(b) For households with adjusted gross income equal to or greater than 275 percent of
federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:

(1) if the adjusted gross income is equal to or greater than 275 percent of federal poverty
guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 1.65 percent of adjusted gross income at 275 percent of
federal poverty guidelines and increases to 4.5 percent of adjusted gross income for those
with adjusted gross income up to 545 percent of federal poverty guidelines;

(2) if the adjusted gross income is greater than 545 percent of federal poverty guidelines
and less than 675 percent of federal poverty guidelines, the parental contribution shall be
4.5 percent of adjusted gross income;

(3) if the adjusted gross income is equal to or greater than 675 percent of federal poverty
guidelines and less than 975 percent of federal poverty guidelines, the parental contribution
shall be determined using a sliding fee scale established by the commissioner of human
services which begins at 4.5 percent of adjusted gross income at 675 percent of federal
poverty guidelines and increases to 5.99 percent of adjusted gross income for those with
adjusted gross income up to 975 percent of federal poverty guidelines; and

(4) if the adjusted gross income is equal to or greater than 975 percent of federal poverty
guidelines, the parental contribution shall be 7.49 percent of adjusted gross income.

If the child lives with the parent, the annual adjusted gross income is reduced by $2,400
prior to calculating the parental contribution. If the child resides in an institution specified
in section 256B.35, the parent is responsible for the personal needs allowance specified
under that section in addition to the parental contribution determined under this section.
The parental contribution is reduced by any amount required to be paid directly to the child
pursuant to a court order, but only if actually paid.

(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes in
the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.

(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.

(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis effective
with the first month in which the child receives services. Annually upon redetermination
or at termination of eligibility, if the contribution exceeded the cost of services provided,
the local agency or the state shall reimburse that excess amount to the parents, either by
direct reimbursement if the parent is no longer required to pay a contribution, or by a
reduction in or waiver of parental fees until the excess amount is exhausted. All
reimbursements must include a notice that the amount reimbursed may be taxable income
if the parent paid for the parent's fees through an employer's health care flexible spending
account under the Internal Revenue Code, section 125, and that the parent is responsible
for paying the taxes owed on the amount reimbursed.

(f) The monthly contribution amount must be reviewed at least every 12 months; when
there is a change in household size; and when there is a loss of or gain in income from one
month to another in excess of ten percent. The local agency shall mail a written notice 30
days in advance of the effective date of a change in the contribution amount. A decrease in
the contribution amount is effective in the month that the parent verifies a reduction in
income or change in household size.

(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be deducted
from the adjusted gross income of the parent making the payment prior to calculating the
parental contribution under paragraph (b).

(h) The contribution under paragraph (b) shall be increased by an additional five percent
if the local agency determines that insurance coverage is available but not obtained for the
child. For purposes of this section, "available" means the insurance is a benefit of employment
for a family member at an annual cost of no more than five percent of the family's annual
income. For purposes of this section, "insurance" means health and accident insurance
coverage, enrollment in a nonprofit health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.

Parents who have more than one child receiving services shall not be required to pay
more than the amount for the child with the highest expenditures. There shall be no resource
contribution from the parents. The parent shall not be required to pay a contribution in
excess of the cost of the services provided to the child, not counting payments made to
school districts for education-related services. Notice of an increase in fee payment must
be given at least 30 days before the increased fee is due.

(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in
the 12 months prior to July 1:

(1) the parent applied for insurance for the child;

(2) the insurer denied insurance;

(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a
complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and

(4) as a result of the dispute, the insurer reversed its decision and granted insurance.

For purposes of this section, "insurance" has the meaning given in paragraph (h).

A parent who has requested a reduction in the contribution amount under this paragraph
shall submit proof in the form and manner prescribed by the commissioner or county agency,
including, but not limited to, the insurer's denial of insurance, the written letter or complaint
of the parents, court documents, and the written response of the insurer approving insurance.
The determinations of the commissioner or county agency under this paragraph are not rules
subject to chapter 14.

Sec. 2.

Minnesota Statutes 2022, section 256B.04, is amended by adding a subdivision to
read:

Subd. 26.

Notice of employed persons with disabilities program.

At the time of initial
enrollment and at least annually thereafter, the commissioner shall provide information on
the medical assistance program for employed persons with disabilities under section
256B.057, subdivision 9, to all medical assistance enrollees who indicate they have a
disability.

Sec. 3.

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 sections 256B.055,
subdivision 15, and 256B.057, subdivision 9.

EFFECTIVE DATE.

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

Sec. 4.

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) (d) 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) (e) 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.
(f) 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) (g) 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.

(h) For enrollees whose income does not exceed 200 percent of the federal poverty
guidelines who are: (1) eligible under this subdivision and who are also enrolled in Medicare,;
and (2) not eligible for medical assistance reimbursement of Medicare premiums under
subdivisions 3, 3a, 3b, or 4, the commissioner shall reimburse the enrollee for Medicare
part A and Medicare part B premiums under section 256B.0625, subdivision 15, paragraph
(a). and part A and part B coinsurance and deductibles. Reimbursement of the Medicare
coinsurance and deductibles, when added to the amount paid by Medicare, must not exceed
the total rate the provider would have received for the same service or services if the person
was receiving benefits as a qualified Medicare beneficiary.

(i) The commissioner must permit any individual who was disenrolled for nonpayment
of premiums previously required under this subdivision to reapply for medical assistance
under this subdivision and be reenrolled if eligible without paying past due premiums.

EFFECTIVE DATE.

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

Sec. 5.

Minnesota Statutes 2022, section 256B.0625, subdivision 17, is amended to read:

Subd. 17.

Transportation costs.

(a) "Nonemergency medical transportation service"
means motor vehicle transportation provided by a public or private person that serves
Minnesota health care program beneficiaries who do not require emergency ambulance
service, as defined in section 144E.001, subdivision 3, to obtain covered medical services.

(b) Medical assistance covers medical transportation costs incurred solely for obtaining
emergency medical care or transportation costs incurred by eligible persons in obtaining
emergency or nonemergency medical care when paid directly to an ambulance company,
nonemergency medical transportation company, or other recognized providers of
transportation services. Medical transportation must be provided by:

(1) nonemergency medical transportation providers who meet the requirements of this
subdivision;

(2) ambulances, as defined in section 144E.001, subdivision 2;

(3) taxicabs that meet the requirements of this subdivision;

(4) public transit, as defined in section 174.22, subdivision 7; or

(5) not-for-hire vehicles, including volunteer drivers, as defined in section 65B.472,
subdivision 1, paragraph (h).

(c) Medical assistance covers nonemergency medical transportation provided by
nonemergency medical transportation providers enrolled in the Minnesota health care
programs. All nonemergency medical transportation providers must comply with the
operating standards for special transportation service as defined in sections 174.29 to 174.30
and Minnesota Rules, chapter 8840, and all drivers must be individually enrolled with the
commissioner and reported on the claim as the individual who provided the service. All
nonemergency medical transportation providers shall bill for nonemergency medical
transportation services in accordance with Minnesota health care programs criteria. Publicly
operated transit systems, volunteers, and not-for-hire vehicles are exempt from the
requirements outlined in this paragraph.

(d) An organization may be terminated, denied, or suspended from enrollment if:

(1) the provider has not initiated background studies on the individuals specified in
section 174.30, subdivision 10, paragraph (a), clauses (1) to (3); or

(2) the provider has initiated background studies on the individuals specified in section
174.30, subdivision 10, paragraph (a), clauses (1) to (3), and:

(i) the commissioner has sent the provider a notice that the individual has been
disqualified under section 245C.14; and

(ii) the individual has not received a disqualification set-aside specific to the special
transportation services provider under sections 245C.22 and 245C.23.

(e) The administrative agency of nonemergency medical transportation must:

(1) adhere to the policies defined by the commissioner;

(2) pay nonemergency medical transportation providers for services provided to
Minnesota health care programs beneficiaries to obtain covered medical services;

(3) provide data monthly to the commissioner on appeals, complaints, no-shows, canceled
trips, and number of trips by mode; and

(4) by July 1, 2016, in accordance with subdivision 18e, utilize a web-based single
administrative structure assessment tool that meets the technical requirements established
by the commissioner, reconciles trip information with claims being submitted by providers,
and ensures prompt payment for nonemergency medical transportation services.

(f) Until the commissioner implements the single administrative structure and delivery
system under subdivision 18e, clients shall obtain their level-of-service certificate from the
commissioner or an entity approved by the commissioner that does not dispatch rides for
clients using modes of transportation under paragraph (i), clauses (4), (5), (6), and (7).

(g) The commissioner may use an order by the recipient's attending physician, advanced
practice registered nurse, physician assistant, or a medical or mental health professional to
certify that the recipient requires nonemergency medical transportation services.
Nonemergency medical transportation providers shall perform driver-assisted services for
eligible individuals, when appropriate. Driver-assisted service includes passenger pickup
at and return to the individual's residence or place of business, assistance with admittance
of the individual to the medical facility, and assistance in passenger securement or in securing
of wheelchairs, child seats, or stretchers in the vehicle.

Nonemergency medical transportation providers must take clients to the health care
provider using the most direct route, and must not exceed 30 miles for a trip to a primary
care provider or 60 miles for a trip to a specialty care provider, unless the client receives
authorization from the local agency.

Nonemergency medical transportation providers may not bill for separate base rates for
the continuation of a trip beyond the original destination. Nonemergency medical
transportation providers must maintain trip logs, which include pickup and drop-off times,
signed by the medical provider or client, whichever is deemed most appropriate, attesting
to mileage traveled to obtain covered medical services. Clients requesting client mileage
reimbursement must sign the trip log attesting mileage traveled to obtain covered medical
services.

(h) The administrative agency shall use the level of service process established by the
commissioner to determine the client's most appropriate mode of transportation. If public
transit or a certified transportation provider is not available to provide the appropriate service
mode for the client, the client may receive a onetime service upgrade.

(i) The covered modes of transportation are:

(1) client reimbursement, which includes client mileage reimbursement provided to
clients who have their own transportation, or to family or an acquaintance who provides
transportation to the client;

(2) volunteer transport, which includes transportation by volunteers using their own
vehicle;

(3) unassisted transport, which includes transportation provided to a client by a taxicab
or public transit. If a taxicab or public transit is not available, the client can receive
transportation from another nonemergency medical transportation provider;

(4) assisted transport, which includes transport provided to clients who require assistance
by a nonemergency medical transportation provider;

(5) lift-equipped/ramp transport, which includes transport provided to a client who is
dependent on a device and requires a nonemergency medical transportation provider with
a vehicle containing a lift or ramp;

(6) protected transport, which includes transport provided to a client who has received
a prescreening that has deemed other forms of transportation inappropriate and who requires
a provider: (i) with a protected vehicle that is not an ambulance or police car and has safety
locks, a video recorder, and a transparent thermoplastic partition between the passenger and
the vehicle driver; and (ii) who is certified as a protected transport provider; and

(7) stretcher transport, which includes transport for a client in a prone or supine position
and requires a nonemergency medical transportation provider with a vehicle that can transport
a client in a prone or supine position.

(j) The local agency shall be the single administrative agency and shall administer and
reimburse for modes defined in paragraph (i) according to paragraphs (m) and (n) when the
commissioner has developed, made available, and funded the web-based single administrative
structure, assessment tool, and level of need assessment under subdivision 18e. The local
agency's financial obligation is limited to funds provided by the state or federal government.

(k) The commissioner shall:

(1) verify that the mode and use of nonemergency medical transportation is appropriate;

(2) verify that the client is going to an approved medical appointment; and

(3) investigate all complaints and appeals.

(l) The administrative agency shall pay for the services provided in this subdivision and
seek reimbursement from the commissioner, if appropriate. As vendors of medical care,
local agencies are subject to the provisions in section 256B.041, the sanctions and monetary
recovery actions in section 256B.064, and Minnesota Rules, parts 9505.2160 to 9505.2245.

(m) Payments for nonemergency medical transportation must be paid based on the client's
assessed mode under paragraph (h), not the type of vehicle used to provide the service. The
medical assistance reimbursement rates for nonemergency medical transportation services
that are payable by or on behalf of the commissioner for nonemergency medical
transportation services are:

(1) $0.22 per mile for client reimbursement;

(2) up to 100 percent of the Internal Revenue Service business deduction rate for volunteer
transport;

(3) equivalent to the standard fare for unassisted transport when provided by public
transit, and $11 $12.93 for the base rate and $1.30 $1.53 per mile when provided by a
nonemergency medical transportation provider;

(4) $13 $15.28 for the base rate and $1.30 $1.53 per mile for assisted transport;

(5) $18 $21.15 for the base rate and $1.55 $1.82 per mile for lift-equipped/ramp transport;

(6) $75 for the base rate and $2.40 per mile for protected transport; and

(7) $60 for the base rate and $2.40 per mile for stretcher transport, and $9 per trip for
an additional attendant if deemed medically necessary.

(n) The base rate for nonemergency medical transportation services in areas defined
under RUCA to be super rural is equal to 111.3 percent of the respective base rate in
paragraph (m), clauses (1) to (7). The mileage rate for nonemergency medical transportation
services in areas defined under RUCA to be rural or super rural areas is:

(1) for a trip equal to 17 miles or less, equal to 125 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7); and

(2) for a trip between 18 and 50 miles, equal to 112.5 percent of the respective mileage
rate in paragraph (m), clauses (1) to (7).

(o) For purposes of reimbursement rates for nonemergency medical transportation
services under paragraphs (m) and (n), the zip code of the recipient's place of residence
shall determine whether the urban, rural, or super rural reimbursement rate applies.

(p) For purposes of this subdivision, "rural urban commuting area" or "RUCA" means
a census-tract based classification system under which a geographical area is determined
to be urban, rural, or super rural.

(q) The commissioner, when determining reimbursement rates for nonemergency medical
transportation under paragraphs (m) and (n), shall exempt all modes of transportation listed
under paragraph (i) from Minnesota Rules, part 9505.0445, item R, subitem (2).

(r) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraph (m) by one percent
up or down for every increase or decrease of ten cents for the price of gasoline. The increase
or decrease must be calculated using a base gasoline price of $3.00. The percentage increase
or decrease must be calculated using the average of the most recently available price of all
grades of gasoline for Minnesota as posted publicly by the United States Energy Information
Administration.

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. 6.

Minnesota Statutes 2022, section 256B.0625, subdivision 17a, is amended to read:

Subd. 17a.

Payment for ambulance services.

(a) Medical assistance covers ambulance
services. Providers shall bill ambulance services according to Medicare criteria.
Nonemergency ambulance services shall not be paid as emergencies. Effective for services
rendered on or after July 1, 2001, medical assistance payments for ambulance services shall
be paid at the Medicare reimbursement rate or at the medical assistance payment rate in
effect on July 1, 2000, whichever is greater.

(b) Effective for services provided on or after July 1, 2016, medical assistance payment
rates for ambulance services identified in this paragraph are increased by five percent.
Capitation payments made to managed care plans and county-based purchasing plans for
ambulance services provided on or after January 1, 2017, shall be increased to reflect this
rate increase. The increased rate described in this paragraph applies to ambulance service
providers whose base of operations as defined in section 144E.10 is located:

(1) outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
the cities of Duluth, Mankato, Moorhead, St. Cloud, and Rochester; or

(2) within a municipality with a population of less than 1,000.

(c) Effective for the first day of each calendar quarter in which the price of gasoline as
posted publicly by the United States Energy Information Administration exceeds $3.00 per
gallon, the commissioner shall adjust the rate paid per mile in paragraphs (a) and (b) by one
percent up or down for every increase or decrease of ten cents for the price of gasoline. The
increase or decrease must be calculated using a base gasoline price of $3.00. The percentage
increase or decrease must be calculated using the average of the most recently available
price of all grades of gasoline for Minnesota as posted publicly by the United States Energy
Information Administration.

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. 7.

Minnesota Statutes 2022, section 256B.0625, subdivision 18h, is amended to read:

Subd. 18h.

Nonemergency medical transportation provisions related to managed
care.

(a) The following nonemergency medical transportation (NEMT) subdivisions apply
to managed care plans and county-based purchasing plans:

(1) subdivision 17, paragraphs (a), (b), (i), and (n);

(2) subdivision 18; and

(3) subdivision 18a.

(b) A nonemergency medical transportation provider must comply with the operating
standards for special transportation service specified in sections 174.29 to 174.30 and
Minnesota Rules, chapter 8840. Publicly operated transit systems, volunteers, and not-for-hire
vehicles are exempt from the requirements in this paragraph.

(c) Managed care plans and county-based purchasing plans must provide a fuel adjustment
for NEMT rates when fuel exceeds $3 per gallon. If, for any contract year, federal approval
is not received for this paragraph, the commissioner must adjust the capitation rates paid to
managed care plans and county-based purchasing plans for that contract year to reflect the
removal of this provision. Contracts between managed care plans and county-based
purchasing plans and providers to whom this paragraph applies must allow recovery of
payments from those providers if capitation rates are adjusted in accordance with this
paragraph. Payment recoveries must not exceed the amount equal to any increase in rates
that results from this paragraph. This paragraph expires if federal approval is not received
for this paragraph at any time.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 8.

Minnesota Statutes 2022, section 256B.0625, subdivision 22, is amended to read:

Subd. 22.

Hospice care.

Medical assistance covers hospice care services under Public
Law 99-272, section 9505, to the extent authorized by rule, except that a recipient age 21
or under who elects to receive hospice services does not waive coverage for services that
are related to the treatment of the condition for which a diagnosis of terminal illness has
been made. Hospice respite and end-of-life care under subdivision 22a are not hospice care
services under this subdivision.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 9.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:

Subd. 22a.

Residential hospice facility; hospice respite and end-of-life care for
children.

(a) Medical assistance covers hospice respite and end-of-life care if the care is
for recipients age 21 or under who elect to receive hospice care delivered in a facility that
is licensed under sections 144A.75 to 144A.755 and that is a residential hospice facility
under section 144A.75, subdivision 13, paragraph (a). Hospice care services under
subdivision 22 are not hospice respite or end-of-life care under this subdivision.

(b) The payment rates for coverage under this subdivision must be 100 percent of the
Medicare rate for continuous home care hospice services as published in the Centers for
Medicare and Medicaid Services annual final rule updating payments and policies for hospice
care. Payment for hospice respite and end-of-life care under this subdivision must be made
from state money, though the commissioner must seek to obtain federal financial participation
for the payments. Payment for hospice respite and end-of-life care must be paid to the
residential hospice facility and are not included in any limit or cap amount applicable to
hospice services payments to the elected hospice services provider.

(c) Certification of the residential hospice facility by the federal Medicare program must
not be a requirement of medical assistance payment for hospice respite and end-of-life care
under this subdivision.

EFFECTIVE DATE.

This section is effective January 1, 2024.

Sec. 10.

Minnesota Statutes 2022, section 256B.073, subdivision 3, is amended to read:

Subd. 3.

Requirements.

(a) In developing implementation requirements for electronic
visit verification, the commissioner shall ensure that the requirements:

(1) are minimally administratively and financially burdensome to a provider;

(2) are minimally burdensome to the service recipient and the least disruptive to the
service recipient in receiving and maintaining allowed services;

(3) consider existing best practices and use of electronic visit verification;

(4) are conducted according to all state and federal laws;

(5) are effective methods for preventing fraud when balanced against the requirements
of clauses (1) and (2); and

(6) are consistent with the Department of Human Services' policies related to covered
services, flexibility of service use, and quality assurance.

(b) The commissioner shall make training available to providers on the electronic visit
verification system requirements.

(c) The commissioner shall establish baseline measurements related to preventing fraud
and establish measures to determine the effect of electronic visit verification requirements
on program integrity.

(d) The commissioner shall make a state-selected electronic visit verification system
available to providers of services.

(e) The commissioner shall make available and publish on the agency website the name
and contact information for the vendor of the state-selected electronic visit verification
system and the other vendors that offer alternative electronic visit verification systems. The
information provided must state that the state-selected electronic visit verification system
is offered at no cost to the provider of services and that the provider may choose an alternative
system that may be at a cost to the provider.

Sec. 11.

Minnesota Statutes 2022, section 256B.073, is amended by adding a subdivision
to read:

Subd. 5.

Vendor requirements.

(a) The vendor of the electronic visit verification system
selected by the commissioner and the vendor's affiliate must comply with the requirements
of this subdivision.

(b) The vendor of the state-selected electronic visit verification system and the vendor's
affiliate must:

(1) notify the provider of services that the provider may choose the state-selected
electronic visit verification system at no cost to the provider;

(2) offer the state-selected electronic visit verification system to the provider of services
prior to offering any fee-based electronic visit verification system;

(3) notify the provider of services that the provider may choose any fee-based electronic
visit verification system prior to offering the vendor's or its affiliate's fee-based electronic
visit verification system;

(4) when offering the state-selected electronic visit verification system, clearly
differentiate between the state-selected electronic visit verification system and the vendor's
or its affiliate's alternative fee-based system; and

(5) allow the provider of services, at no cost to the provider, to terminate the agreement
after 12 months of the provider executing the agreement.

(c) The vendor of the state-selected electronic visit verification system and the vendor's
affiliate must not use state data that is not available to other vendors of electronic visit
verification systems to develop, promote, or sell the vendor's or its affiliate's alternative
electronic visit verification system.

(d) Upon request from the provider, the vendor of the state-selected electronic visit
verification system must provide proof of compliance with the requirements of this
subdivision.

(e) An agreement between the vendor of the state-selected electronic visit verification
system or its affiliate and a provider of services for an electronic visit verification system
that is not the state-selected system entered into on or after July 1, 2023, is subject to
immediate termination by the provider if the vendor violates any of the requirements of this
subdivision.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 12.

Minnesota Statutes 2022, section 256B.14, subdivision 2, is amended to read:

Subd. 2.

Actions to obtain payment.

The state agency shall promulgate rules to
determine the ability of responsible relatives to contribute partial or complete payment or
repayment of medical assistance furnished to recipients for whom they are responsible. All
medical assistance exclusions shall be allowed, and a resource limit of $10,000 for
nonexcluded resources shall be implemented. Above these limits, a contribution of one-third
of the excess resources shall be required. These rules shall not require payment or repayment
when payment would cause undue hardship to the responsible relative or that relative's
immediate family. These rules shall be consistent with the requirements of section 252.27
for do not apply to parents of children whose eligibility for medical assistance was determined
without deeming of the parents' resources and income under the Tax Equity and Fiscal
Responsibility Act (TEFRA) option or to parents of children accessing home and
community-based waiver services. The county agency shall give the responsible relative
notice of the amount of the payment or repayment. If the state agency or county agency
finds that notice of the payment obligation was given to the responsible relative, but that
the relative failed or refused to pay, a cause of action exists against the responsible relative
for that portion of medical assistance granted after notice was given to the responsible
relative, which the relative was determined to be able to pay.

The action may be brought by the state agency or the county agency in the county where
assistance was granted, for the assistance, together with the costs of disbursements incurred
due to the action.

In addition to granting the county or state agency a money judgment, the court may,
upon a motion or order to show cause, order continuing contributions by a responsible
relative found able to repay the county or state agency. The order shall be effective only
for the period of time during which the recipient receives medical assistance from the county
or state agency.

Sec. 13.

Minnesota Statutes 2022, section 256B.766, is amended to read:

256B.766 REIMBURSEMENT FOR BASIC CARE SERVICES.

(a) Effective for services provided on or after July 1, 2009, total payments for basic care
services, shall be reduced by three percent, except that for the period July 1, 2009, through
June 30, 2011, total payments shall be reduced by 4.5 percent for the medical assistance
and general assistance medical care programs, prior to third-party liability and spenddown
calculation. Effective July 1, 2010, the commissioner shall classify physical therapy services,
occupational therapy services, and speech-language pathology and related services as basic
care services. The reduction in this paragraph shall apply to physical therapy services,
occupational therapy services, and speech-language pathology and related services provided
on or after July 1, 2010.

(b) Payments made to managed care plans and county-based purchasing plans shall be
reduced for services provided on or after October 1, 2009, to reflect the reduction effective
July 1, 2009, and payments made to the plans shall be reduced effective October 1, 2010,
to reflect the reduction effective July 1, 2010.

(c) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for outpatient hospital facility fees shall be reduced by five percent from the
rates in effect on August 31, 2011.

(d) Effective for services provided on or after September 1, 2011, through June 30, 2013,
total payments for ambulatory surgery centers facility fees, medical supplies and durable
medical equipment not subject to a volume purchase contract, prosthetics and orthotics,
renal dialysis services, laboratory services, public health nursing services, physical therapy
services, occupational therapy services, speech therapy services, eyeglasses not subject to
a volume purchase contract, hearing aids not subject to a volume purchase contract, and
anesthesia services shall be reduced by three percent from the rates in effect on August 31,
2011.

(e) Effective for services provided on or after September 1, 2014, payments for
ambulatory surgery centers facility fees, hospice services, renal dialysis services, laboratory
services, public health nursing services, eyeglasses not subject to a volume purchase contract,
and hearing aids not subject to a volume purchase contract shall be increased by three percent
and payments for outpatient hospital facility fees shall be increased by three percent.
Payments made to managed care plans and county-based purchasing plans shall not be
adjusted to reflect payments under this paragraph.

(f) Payments for medical supplies and durable medical equipment not subject to a volume
purchase contract, and prosthetics and orthotics, provided on or after July 1, 2014, through
June 30, 2015, shall be decreased by .33 percent. Payments for medical supplies and durable
medical equipment not subject to a volume purchase contract, and prosthetics and orthotics,
provided on or after July 1, 2015, shall be increased by three percent from the rates as
determined under paragraphs (i) and (j).

(g) Effective for services provided on or after July 1, 2015, payments for outpatient
hospital facility fees, medical supplies and durable medical equipment not subject to a
volume purchase contract, prosthetics, and orthotics to a hospital meeting the criteria specified
in section 62Q.19, subdivision 1, paragraph (a), clause (4), shall be increased by 90 percent
from the rates in effect on June 30, 2015. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.

(h) This section does not apply to physician and professional services, inpatient hospital
services, family planning services, mental health services, dental services, prescription
drugs, medical transportation, federally qualified health centers, rural health centers, Indian
health services, and Medicare cost-sharing.

(i) Effective for services provided on or after July 1, 2015, the following categories of
medical supplies and durable medical equipment shall be individually priced items: enteral
nutrition and supplies, customized and other specialized tracheostomy tubes and supplies,
electric patient lifts, and durable medical equipment repair and service. This paragraph does
not apply to medical supplies and durable medical equipment subject to a volume purchase
contract, products subject to the preferred diabetic testing supply program, and items provided
to dually eligible recipients when Medicare is the primary payer for the item. The
commissioner shall not apply any medical assistance rate reductions to durable medical
equipment as a result of Medicare competitive bidding.

(j) Effective for services provided on or after July 1, 2015, medical assistance payment
rates for durable medical equipment, prosthetics, orthotics, or supplies shall be increased
as follows:

(1) payment rates for durable medical equipment, prosthetics, orthotics, or supplies that
were subject to the Medicare competitive bid that took effect in January of 2009 shall be
increased by 9.5 percent; and

(2) payment rates for durable medical equipment, prosthetics, orthotics, or supplies on
the medical assistance fee schedule, whether or not subject to the Medicare competitive bid
that took effect in January of 2009, shall be increased by 2.94 percent, with this increase
being applied after calculation of any increased payment rate under clause (1).

This paragraph does not apply to medical supplies and durable medical equipment subject
to a volume purchase contract, products subject to the preferred diabetic testing supply
program, items provided to dually eligible recipients when Medicare is the primary payer
for the item, and individually priced items identified in paragraph (i). Payments made to
managed care plans and county-based purchasing plans shall not be adjusted to reflect the
rate increases in this paragraph.

(k) Effective for nonpressure support ventilators provided on or after January 1, 2016,
the rate shall be the lower of the submitted charge or the Medicare fee schedule rate. Effective
for pressure support ventilators provided on or after January 1, 2016, the rate shall be the
lower of the submitted charge or 47 percent above the Medicare fee schedule rate. For
payments made in accordance with this paragraph, if, and to the extent that, the commissioner
identifies that the state has received federal financial participation for ventilators in excess
of the amount allowed effective January 1, 2018, under United States Code, title 42, section
1396b(i)(27), the state shall repay the excess amount to the Centers for Medicare and
Medicaid Services with state funds and maintain the full payment rate under this paragraph.

(l) Payment rates for durable medical equipment, prosthetics, orthotics or supplies, that
are subject to the upper payment limit in accordance with section 1903(i)(27) of the Social
Security Act, shall be paid the Medicare rate. Rate increases provided in this chapter shall
not be applied to the items listed in this paragraph.

(m) For dates of service on or after July 1, 2023, through June 30, 2024, enteral nutrition
and supplies must be paid according to this paragraph. If sufficient data exists for a product
or supply, payment must be based upon the 50th percentile of the usual and customary
charges per product code submitted to the department, using only charges submitted per
unit. Increases in rates resulting from the 50th percentile payment method must not exceed
150 percent of the previous fiscal year's rate per code and product combination. Data are
sufficient if: (1) the department has at least 100 paid claim lines by at least ten different
providers for a given product or supply; or (2) in the absence of the data in clause (1), the
department has at least 20 claim lines by at least five different providers for a product or
supply that does not meet the requirements of clause (1). If sufficient data are not available
to calculate the 50th percentile for enteral products or supplies, the payment rate shall be
the payment rate in effect on June 30, 2023.

(n) For dates of service on or after July 1, 2024, enteral nutrition and supplies must be
paid according to this paragraph and updated annually each January 1. If sufficient data
exists for a product or supply, payment must be based upon the 50th percentile of the usual
and customary charges per product code submitted to the department for the previous
calendar year, using only charges submitted per unit. Increases in rates resulting from the
50th percentile payment method must not exceed 150 percent of the previous year's rate per
code and product combination. Data are sufficient if: (1) the department has at least 100
paid claim lines by at least ten different providers for a given product or supply; or (2) in
the absence of the data in clause (1), the department has at least 20 claim lines by at least
five different providers for a product or supply that does not meet the requirements of clause
(1). If sufficient data is not available to calculate the 50th percentile for enteral products or
supplies, the payment shall be the manufacturer's suggested retail price of that product or
supply minus 20 percent. If the manufacturer's suggested retail price is not available, payment
shall be the actual acquisition cost of that product or supply plus 20 percent.

Sec. 14. INCREASED MEDICAL ASSISTANCE INCOME LIMIT FOR OLDER
ADULTS AND PERSONS WITH DISABILITIES.

Effective July 1, 2023, the commissioner of human services must increase the income
limit under Minnesota Statutes, section 256B.056, subdivision 4, paragraph (a), to a level
that is projected to result in a net cost to the state of $5,000,000 for the 2026-2027 biennium.

ARTICLE 4

BEHAVIORAL HEALTH

Section 1.

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

Subd. 6.

Addiction and recovery Office of Addiction and Recovery; director.

An
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;

(2) assist in leading the subcabinet and the advisory council toward progress on
measurable goals that track the state's efforts in combatting addiction; 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 addiction and recovery director, the
subcabinet, and the advisory council, and the Office of Addiction and Recovery established
in this section.

Sec. 3.

Minnesota Statutes 2022, section 4.046, is amended by adding a subdivision to
read:

Subd. 8.

Division of Youth Substance Use and Addiction Recovery.

(a) A Division
of Youth Substance Use and Addiction Recovery is created in the Office of Addiction and
Recovery to focus on preventing adolescent substance use and addiction. The addiction and
recovery director shall employ a director to lead the Division of Youth Substance Use and
Addiction Recovery and staff necessary to fulfill its purpose.

(b) The director of the division shall:

(1) make efforts to bridge mental health and substance abuse treatment silos and work
across agencies to focus the state's role and resources in preventing youth substance use
and addiction;

(2) develop and share resources on evidence-based strategies and programs for addressing
youth substance use and prevention;

(3) establish and manage external partnerships and build relationships with communities,
community leaders, and persons and organizations with direct experience with youth
substance use and addiction; and

(4) work to achieve progress on established measurable goals that track the state's efforts
in preventing substance use and addiction among the state's youth population.

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.

EFFECTIVE DATE.

This section is effective January 1, 2024.

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 good diet, exercise, attending counseling or 12-step groups,
and taking medications.

EFFECTIVE DATE.

This section is effective January 1, 2024.

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).
A comprehensive assessment 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, except when the comprehensive assessment is being completed as part of a
diagnostic assessment; and

(3) 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 of recognizing opioid overdose; and

(4) the use, availability, and administration of naloxone to respond to opioid overdose.

If the client is identified as having opioid use disorder at a later point, the education 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, that the client is receiving services under;

(5) identify the participants involved in the client's treatment planning. The client must
be a participant 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 are to 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 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 natural supports;

(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.

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) 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
1a;

(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.

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 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, specifically withdrawal, 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 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 the 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. 18.

Minnesota Statutes 2022, section 254B.01, subdivision 8, is amended to read:

Subd. 8.

Recovery community organization.

"Recovery community organization"
means an independent organization led and governed by representatives of local communities
of recovery. A recovery community organization mobilizes resources within and outside
of the recovery community to increase the prevalence and quality of long-term recovery
from alcohol and other drug addiction substance use disorder. Recovery community
organizations provide peer-based recovery support activities such as training of recovery
peers. Recovery community organizations provide mentorship and ongoing support to
individuals dealing with a substance use disorder and connect them with the resources that
can support each person's recovery. A recovery community organization also promotes a
recovery-focused orientation in community education and outreach programming, and
organize recovery-focused policy advocacy activities to foster healthy communities and
reduce the stigma of substance use disorder.

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.

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. 21.

Minnesota Statutes 2022, section 254B.04, is amended by adding a subdivision
to read:

Subd. 4.

Assessment criteria and risk descriptions.

(a) A level of care determination
must use the following criteria to assess risk:

(b) Dimension 1: Acute intoxication and withdrawal potential. A vendor must use the
following scoring and 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 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 scoring and 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 scoring and 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 scoring and
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 is cooperative, motivated, ready to change, admits problems, 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) 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 scoring and 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 scoring
and 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 system
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 system 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. 22.

Minnesota Statutes 2022, section 254B.05, subdivision 1, is amended to read:

Subdivision 1.

Licensure required Eligible vendors.

(a) Programs licensed by the
commissioner are eligible vendors. Hospitals may apply for and receive licenses to be
eligible vendors, notwithstanding the provisions of section 245A.03. American Indian
programs that provide substance use disorder treatment, extended care, transitional residence,
or outpatient treatment services, and are licensed by tribal government are eligible vendors.

(b) A licensed professional in private practice as defined in section 245G.01, subdivision
17, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible
vendor of a comprehensive assessment and assessment summary provided according to
section 245G.05, and treatment services provided according to sections 245G.06 and
245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses
(1) to (6).

(c) A county is an eligible vendor for a comprehensive assessment and assessment
summary when provided by an individual who meets the staffing credentials of section
245G.11, subdivisions 1 and 5, and completed according to the requirements of section
245G.05. A county is an eligible vendor of care coordination services when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 7, and
provided according to the requirements of section 245G.07, subdivision 1, paragraph (a),
clause (5). A county is an eligible vendor of peer recovery services when the services are
provided by an individual who meets the requirements of section 245G.11, subdivision 8.

(d) A recovery community organization that meets certification requirements identified
by the commissioner certified by the Board of Recovery Services under sections 254B.20
to 254B.24 is an eligible vendor of peer support services.

(e) Recovery community organizations directly approved by the commissioner of human
services before June 30, 2023, will retain their designation as a recovery community
organization.

(e) (f) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.

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 by 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.

EFFECTIVE DATE.

The amendments to paragraph (b), clause (1), items (i) to (iv),
are effective January 1, 2025, or upon federal approval, whichever is later. The amendments
to paragraph (b), clause (1), items (v) to (vii), are effective January 1, 2024, or upon federal
approval, whichever is later. The amendments to paragraph (b), clauses (2) to (10), are
effective January 1, 2024.

Sec. 24.

[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 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-a-day 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-a-day 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
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.

Sec. 25.

[254B.191] EVIDENCE-BASED TRAINING.

The commissioner must establish ongoing training opportunities for substance use
disorder treatment providers under chapter 245F 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 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. 26.

[254B.20] DEFINITIONS.

Subdivision 1.

Applicability.

For the purposes of sections 254B.20 to 254B.24, the
following terms have the meanings given.

Subd. 2.

Board.

"Board" means the Board of Recovery Services established by section
254B.21.

Subd. 3.

Credential or credentialing.

"Credential" or "credentialing" means the
standardized process of formally reviewing and designating a recovery organization as
qualified to employ peer recovery specialists based on criteria established by the board.

Subd. 4.

Minnesota Certification Board.

"Minnesota Certification Board" means the
nonprofit agency member board of the International Certification and Reciprocity Consortium
that sets the policies and procedures for alcohol and other drug professional certifications
in Minnesota, including peer recovery specialists.

Subd. 5.

Peer recovery specialist.

"Peer recovery specialist" has the meaning given to
"recovery peer" in section 245F.02, subdivision 21. A peer recovery specialist must meet
the qualifications of a recovery peer in section 245G.11, subdivision 8.

Subd. 6.

Peer recovery services.

"Peer recovery services" has the meaning given to
"peer recovery support services" in section 245F.02, subdivision 17.

Sec. 27.

[254B.21] MINNESOTA BOARD OF RECOVERY SERVICES.

Subdivision 1.

Creation.

(a) The Minnesota Board of Recovery Services is established
and consists of 13 members appointed by the governor as follows:

(1) five of the members must be certified peer recovery specialists certified under the
Minnesota Certification Board with an active credential;

(2) two of the members must be certified peer recovery specialist supervisors certified
under the Minnesota Certification Board with an active credential;

(3) four of the members must be currently employed by a Minnesota-based recovery
community organization recognized by the commissioner of human services; and

(4) two of the members must be public members as defined in section 214.02, and be
either a family member of a person currently using substances or a person in recovery from
a substance use disorder.

(b) At the time of their appointments, at least three members must reside outside of the
seven-county metropolitan area.

(c) At the time of their appointments, at least three members must be members of:

(1) a community of color; or

(2) an underrepresented community, defined as a group that is not represented in the
majority with respect to race, ethnicity, national origin, sexual orientation, gender identity,
or physical ability.

Subd. 2.

Officers.

The board must annually elect a chair and vice-chair from among its
members and may elect other officers as necessary. The board must meet at least twice a
year but may meet more frequently at the call of the chair.

Subd. 3.

Membership terms; compensation.

Membership terms, compensation of
members, removal of members, the filling of membership vacancies, and fiscal year and
reporting requirements are as provided in section 15.058.

Subd. 4.

Expiration.

The board does not expire.

Sec. 28.

[254B.22] DUTIES OF THE BOARD.

The Minnesota Board of Recovery Services shall:

(1) develop and define by rule criteria for credentialing recovery organizations using
nationally recognized best practices and standards;

(2) determine the renewal cycle and renewal period for eligible vendors of peer recovery
services;

(3) receive, review, approve, or disapprove initial applications, renewals, and
reinstatement requests for credentialing from recovery organizations;

(4) establish administrative procedures for processing applications submitted under
clause (3) and hire or appoint such agents as are appropriate for processing applications;

(5) retain records of board actions and proceedings in accordance with public records
laws; and

(6) establish, maintain, and publish annually a register of current credentialed recovery
organizations.

Sec. 29.

[254B.23] REQUIREMENTS FOR CREDENTIALING.

Subdivision 1.

Application requirements.

An application submitted to the board for
credentialing must include:

(1) evidence that the applicant is a nonprofit organization based in Minnesota or meets
the eligibility criteria defined by the board;

(2) a description of the applicant's activities and services that support recovery from
substance use disorder; and

(3) any other requirements as specified by the board.

Subd. 2.

Fee.

Each applicant must pay a nonrefundable application fee as established
by the board. The revenue from the fee must be deposited in the state government special
revenue fund.

Sec. 30.

[254B.24] APPEAL AND HEARING.

A recovery organization aggrieved by the board's failure to issue, renew, or reinstate
credentialing under sections 254B.20 to 254B.24 may appeal by requesting a hearing under
the procedures of chapter 14.

Sec. 31.

[254B.30] PROJECT ECHO GRANTS.

Subdivision 1.

Establishment.

The commissioner must establish a grant program to
support new or existing Project ECHO programs in the state.

Subd. 2.

Project ECHO at Hennepin Healthcare.

The commissioner must use
appropriations under this subdivision to award grants to Hennepin Healthcare to establish
at least four substance use disorder-focused Project ECHO programs, 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 subdivision 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.

Sec. 32.

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. 33.

Minnesota Statutes 2022, section 256I.05, is amended by adding a subdivision
to read:

Subd. 1s.

Supplemental rate; Douglas County.

Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2023, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per
month, including any legislatively authorized inflationary adjustments, for a housing support
provider located in Douglas County that operates a long-term residential facility with a total
of 74 beds that serve chemically dependent men and provide 24-hour-a-day supervision
and other support services.

Sec. 34.

Minnesota Statutes 2022, section 256I.05, is amended by adding a subdivision
to read:

Subd. 1t.

Supplemental rate; Crow Wing County.

Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2023, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per
month, including any legislatively authorized inflationary adjustments, for a housing support
provider located in Crow Wing County that operates a long-term residential facility with a
total of 90 beds that serves chemically dependent men and women and provides
24-hour-a-day supervision and other support services.

Sec. 35.

Minnesota Statutes 2022, section 256I.05, is amended by adding a subdivision
to read:

Subd. 1u.

Supplemental rate; Douglas County.

Notwithstanding the provisions in this
section, beginning July 1, 2023, a county agency shall negotiate a supplemental rate for up
to 20 beds in addition to the rate specified in subdivision 1, not to exceed the maximum rate
allowed under subdivision 1a, including any legislatively authorized inflationary adjustments,
for a housing support provider located in Douglas County that operates two facilities and
provides room and board and supplementary services to adult males recovering from
substance use disorder, mental illness, or housing instability.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 36.

[325F.725] SOBER HOME TITLE PROTECTION.

No person or entity may use the phrase "sober home," whether alone or in combination
with other words and whether orally or in writing, to advertise, market, or otherwise describe,
offer, or promote itself, or any housing, service, service package, or program that it provides
within this state, unless the person or entity is a cooperative living residence, a room and
board residence, an apartment, or any other living accommodation that provides temporary
housing to persons with a substance use disorder, does not provide counseling or treatment
services to residents, promotes sustained recovery from substance use disorders, and follows
the sober living guidelines published by the federal Substance Abuse and Mental Health
Services Administration.

Sec. 37. CULTURALLY RESPONSIVE RECOVERY COMMUNITY GRANTS.

The commissioner must establish start-up and capacity-building grants for prospective
or new recovery community organizations serving or intending to serve culturally specific
or population-specific recovery communities. 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 and retaining staff;

(2) staff training, purchasing office equipment and supplies;

(3) purchasing software and website services;

(4) costs associated with establishing nonprofit status;

(5) rental and lease costs and community outreach; and

(6) education and recovery events.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 38. 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 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. 39. FAMILY TREATMENT START-UP AND CAPACITY-BUILDING
GRANTS.

The commissioner 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.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 40. MEDICAL ASSISTANCE BEHAVIORAL HEALTH SYSTEM
TRANSFORMATION STUDY.

The commissioner, 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. 41. 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 necessary
changes to cross-references.

Sec. 42. REPEALER.

(a) Minnesota Statutes 2022, sections 245G.05, 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 5

SUBSTANCE USE DISORDER

Section 1.

[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 two doses of nasal naloxone available on site.

(c) The commissioner of health must develop and disseminate to schools a short training
video about how and when to administer nasal naloxone. The person having control of the
school building must ensure that at least one staff member trained on how and when to
administer nasal naloxone is on site when the school building is open to students, staff, or
the public, including before school, after school, or weekend activities.

EFFECTIVE DATE.

This section is effective July 1, 2023.

Sec. 2.

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. 3.

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 naloxone on site.
Staff must be trained on how and when to administer opiate antagonists.

Sec. 4.

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. 5.

[245.89] SUBSTANCE USE DISORDERS PUBLIC AWARENESS
CAMPAIGN.

(a) The commissioner must establish an ongoing, 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 centers lived experience and equity. The
commissioner may also consult with 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. 6.

[245.891] OVERDOSE SURGE ALERT SYSTEM.

The commissioner must establish a statewide overdose surge text message alert system.
The system may include other forms of electronic alerts. The purpose of the system is 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 the surrounding area. The
commissioner may collaborate with local agencies, other state agencies, and harm-reduction
organizations to promote and improve the voluntary text service.

Sec. 7.

[245.892] HARM-REDUCTION AND CULTURALLY SPECIFIC GRANTS.

(a) The commissioner 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 fentanyl-testing supplies,
disinfectants, naloxone rescue kits, sharps disposal, wound-care supplies, medication lock
boxes, FDA-approved home testing kits for viral hepatitis and HIV, and written educational
and resource materials.

(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, develop a sense of
community, and develop a connection to ancestral roots.

(e) Naloxone training grant funds may be used to provide information and training on
safe storage and use of opiate antagonists. Training may be conducted via multiple modalities,
including but not limited to in-person, virtual, written, and video recordings.

Sec. 8.

[245.893] OPIATE ANTAGONIST TRAINING GRANTS.

The commissioner must establish grants to support training on how to safely store opiate
antagonists, opioid overdose symptoms and identification, and how and when to administer
opiate antagonists. Eligible grantees include correctional facilities or programs, housing
programs, and substance use disorder programs.

Sec. 9.

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 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. 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
overdose antagonist distribution. Grantees may utilize funds for opioid overdose prevention,
community asset mapping, education, and overdose 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) $400,000 is appropriated 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.

(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 $309,000 is 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.

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) (i), 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) (j), 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) (j), 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) are
available for three years.

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 naloxone 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 2024.

(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 2024.

(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 2024.

(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 2024.

(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.

ARTICLE 6

OPIOID PRESCRIBING IMPROVEMENT PROGRAM

Section 1.

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 standards" means parameters of opioid prescribing practices
that fall outside community standard thresholds for prescribing to such a degree that a
provider must be disenrolled as a medical assistance provider.

(g) "Opioid prescriber" means a licensed health care provider who prescribes opioids to
medical assistance and MinnesotaCare Minnesota health care program 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. 2.

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
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. 3.

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 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.

(c) If, after a year from the commissioner's notice under paragraph (b), the opioid
prescriber's prescribing practices do not improve so that they are consistent with community
standards, the commissioner shall may take one or more of the following steps:

(1) 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) The commissioner shall terminate from Minnesota health care programs all opioid
prescribers and provider groups whose prescribing practices fall within the applicable opioid
disenrollment standards.

(e) 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. 4. REPEALER.

Minnesota Statutes 2022, section 256B.0638, subdivisions 1, 2, 3, 4, 5, and 6, are
repealed.

EFFECTIVE DATE.

This section is effective June 30, 2024.

ARTICLE 7

DEPARTMENT OF DIRECT CARE AND TREATMENT

Section 1.

Minnesota Statutes 2022, section 246.54, subdivision 1a, is amended to read:

Subd. 1a.

Anoka-Metro Regional Treatment Center.

(a) A county's payment of the
cost of care provided at Anoka-Metro Regional Treatment Center shall be according to the
following schedule:

(1) zero percent for the first 30 days;

(2) 20 percent for days 31 and over if the stay is determined to be clinically appropriate
for the client; and

(3) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged. The county
is responsible for 50 percent of the cost of care under this clause for a person committed as
a person who has a mental illness and is dangerous to the public under section 253B.18 and
who is awaiting transfer to another state-operated facility or program.

Notwithstanding any law to the contrary, the client is not responsible for payment of the
cost of care under this subdivision.

(b) If payments received by the state under sections 246.50 to 246.53 exceed 80 percent
of the cost of care for days over 31 for clients who meet the criteria in paragraph (a), clause
(2), the county shall be responsible for paying the state only the remaining amount. The
county shall not be entitled to reimbursement from the client, the client's estate, or from the
client's relatives, except as provided in section 246.53.

Sec. 2.

Minnesota Statutes 2022, section 246.54, subdivision 1b, is amended to read:

Subd. 1b.

Community behavioral health hospitals.

(a) A county's payment of the cost
of care provided at state-operated community-based behavioral health hospitals for adults
and children shall be according to the following schedule:

(1) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged except as
provided under paragraph (b); and

(2) the county shall not be entitled to reimbursement from the client, the client's estate,
or from the client's relatives, except as provided in section 246.53.

(b) The county is responsible for 50 percent of the cost of care under paragraph (a),
clause (1), for a person committed as a person who has a mental illness and is dangerous
to the public under section 253B.18 and who is awaiting transfer to another state-operated
facility or program.

(c) Notwithstanding any law to the contrary, the client is not responsible for payment
of the cost of care under this subdivision.

ARTICLE 8

MISCELLANEOUS

Section 1. FINANCIAL REVIEW OF GRANT AND BUSINESS SUBSIDY
RECIPIENTS.

Subdivision 1.

Definitions.

(a) As used in this section, the following terms have the
meanings given.

(b) "Grant" means a grant or business subsidy funded by an appropriation in this act.

(c) "Grantee" means a business entity as defined in Minnesota Statutes, section 5.001.

Subd. 2.

Financial information required; determination of ability to perform.

Before
an agency awards a competitive, legislatively-named, single source, or sole source grant,
the agency must assess the risk that a grantee cannot or would not perform the required
duties. In making this assessment, the agency must review the following information:

(1) the grantee's history of performing duties similar to those required by the grant,
whether the size of the grant requires the grantee to perform services at a significantly
increased scale, and whether the size of the grant will require significant changes to the
operation of the grantee's organization;

(2) for a grantee that is a nonprofit organization, the grantee's Form 990 or Form 990-EZ
filed with the Internal Revenue Service in each of the prior three years. If the grantee has
not been in existence long enough or is not required to file Form 990 or Form 990-EZ, the
grantee must demonstrate to the grantor's satisfaction that the grantee is exempt and must
instead submit the grantee's most recent board-reviewed financial statements and
documentation of internal controls;

(3) for a for-profit business, three years of federal and state tax returns, current financial
statements, certification that the business is not under bankruptcy proceedings, and disclosure
of any liens on its assets. If a business has not been in business long enough to have three
years of tax returns, the grantee must demonstrate to the grantor's satisfaction that the grantee
has appropriate internal financial controls;

(4) evidence of registration and good standing with the secretary of state under Minnesota
Statutes, chapter 317A, or other applicable law;

(5) if the grantee's total annual revenue exceeds $750,000, the grantee's most recent
financial audit performed by an independent third party in accordance with generally accepted
accounting principles; and

(6) certification, provided by the grantee, that none of its principals have been convicted
of a financial crime.

Subd. 3.

Additional measures for some grantees.

The agency may require additional
information and must provide enhanced oversight for grants that have not previously received
state or federal grants for similar amounts or similar duties and so have not yet demonstrated
the ability to perform the duties required under the grant on the scale required.

Subd. 4.

Assistance from administration.

An agency without adequate resources or
experience to perform obligations under this section may contract with the commissioner
of administration to perform the agency's duties under this section.

Subd. 5.

Agency authority to not award grant.

If an agency determines that there is
an appreciable risk that a grantee receiving a competitive, single source, or sole source grant
cannot or would not perform the required duties under the grant agreement, the agency must
notify the grantee and the commissioner of administration and give the grantee an opportunity
to respond to the agency's concerns. If the grantee does not satisfy the agency's concerns
within 45 days, the agency must not award the grant.

Subd. 6.

Legislatively-named grantees.

If an agency determines that there is an
appreciable risk that a grantee receiving a legislatively-named grant cannot or would not
perform the required duties under the grant agreement, the agency must notify the grantee,
the commissioner of administration, and the chair and ranking minority members of Ways
and Means Committee in the house of representatives, the chairs and ranking minority
members of the Finance Committee in the senate, and the chairs and ranking minority
members of the committees in the house of representatives and the senate with primary
jurisdiction over the bill in which the money for the grant was appropriated. The agency
must give the grantee an opportunity to respond to the agency's concerns. If the grantee
does not satisfy the agency's concerns within 45 days, the agency must delay award of the
grant until adjournment of the next regular or special legislative session.

Subd. 7.

Subgrants.

If a grantee will disburse the money received from the grant to
other organizations to perform duties required under the grant agreement, the agency must
be a party to agreements between the grantee and a subgrantee. Before entering agreements
for subgrants, the agency must perform the financial review required under this section with
respect to the subgrantees.

Subd. 8.

Effect.

The requirements of this section are in addition to other requirements
imposed by law, the commissioner of administration under Minnesota Statutes, sections
16B.97 to 16B.98, or agency grant policy.

ARTICLE 9

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

$

6,735,763,000

$

7,317,034,000

Appropriations by Fund
	2024	2025
General	6,733,999,000	7,315,232,000
Health Care Access	31,000	69,000
Lottery Prize	1,733,000	1,733,000

The amounts that may be spent for each
purpose are specified in the following
subdivisions.

Subd. 2. Central Office; Operations

15,739,000

11,260,000

(a) Vulnerable Adult Act redesign phase
two. Notwithstanding Minnesota Statutes,
section 16A.28, any amount appropriated in
this act for administration for the Vulnerable
Adult Act redesign phase two is available until
June 30, 2027.

(b) Caregiver respite services grants.
Notwithstanding Minnesota Statutes, section
16A.28, any amount appropriated in this act
for administration for caregiver respite
services grants is available until June 30, 2027.

(c) Base level adjustment. The general fund
base is $5,168,000 in fiscal year 2026 and
$5,018,000 in fiscal year 2027.

Subd. 3. Central Office; Health Care

3,313,000

3,953,000

Base level adjustment. The general fund base
is $3,683,000 in fiscal year 2026 and
$3,683,000 in fiscal year 2027.

Subd. 4. Central Office; Aging and Disabilities Services

18,136,000

21,810,000

(a) Research on access to long-term care
services and financing. $700,000 in fiscal
year 2024 is from the general fund for
additional funding for the actuarial research
study of public and private financing options
for long-term services and supports reform
under Laws 2021, First Special Session
chapter 7, article 17, section 16. This is a
onetime appropriation.

(b) Case management training curriculum.
$377,000 in fiscal year 2024 and $377,000 in
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. This is a onetime
appropriation.

(c) Office of Ombudsperson for Long-Term
Care. $1,744,000 in fiscal year 2024 and
$2,049,000 in fiscal year 2025 are for
additional staff and associated direct costs in
the Office of Ombudsperson for Long-Term
Care. The additional staff must include ten
full-time regional ombudsmen, two full-time
supervisors, and five additional full-time
support staff.

(d) Direct care services corps pilot project.
$500,000 in fiscal year 2024 is from the
general fund for a grant to the Metropolitan
Center for Independent Living for the direct
care services corps pilot project. Up to $25,000
may be used by the Metropolitan Center for
Independent Living for administrative costs.
This is a onetime appropriation.

(e) Research on access to long-term care
services and financing. Any unexpended
amount of the fiscal year 2023 appropriation
referenced in Laws 2021, First Special Session
chapter 7, article 17, section 16, estimated to
be ....., is canceled. The amount canceled is
appropriated in fiscal year 2024 for the same
purpose.

(f) Provider capacity grant for rural and
underserved communities. Notwithstanding
Minnesota Statutes, section 16A.28, any
amount appropriated in this act for
administration for provider capacity grants for
rural and underserved communities is available
until June 30, 2027.

(g) Long-term care workforce grants for
new Americans. Notwithstanding Minnesota
Statutes, section 16A.28, any amount
appropriated in this act for administration for
long-term care workforce grants for new
Americans is available until June 30, 2027.

(h) Vulnerable Adult Act redesign phase
two. Notwithstanding Minnesota Statutes,
section 16A.28, any amount appropriated in
this act for administration for the Vulnerable
Adult Act redesign phase two is available until
June 30, 2027.

(i) Caregiver respite services grants.
Notwithstanding Minnesota Statutes, section
16A.28, any amount appropriated in this act
for administration for caregiver respite
services grants is available until June 30, 2027.

(j) Senior nutrition program.
Notwithstanding Minnesota Statutes, section
16A.28, any amount appropriated in this act
for administration for the senior nutrition
program is available until June 30, 2027.

(k) Base level adjustment. The general fund
base is $7,468,000 in fiscal year 2026 and
$7,465,000 in fiscal year 2027.

Subd. 5. Central Office; Behavioral Health, Housing, and Deaf and Hard of Hearing Services

4,857,000

6,539,000

(a) Competency-based training for
substance use disorder provider
community. $150,000 in fiscal year 2024 and
$150,000 in fiscal year 2025 are for provider
participation in clinical training for the
transition to American Society of Addiction
Medicine standards.

(b) Substance use disorders public
awareness campaign. $300,000 in fiscal year
2024 and $300,000 in fiscal year 2025 are
from the general fund for a public awareness
campaign under Minnesota Statutes, section
245.89.

(c) Overdose surge alert system. $250,000
in fiscal year 2024 and $250,000 in fiscal year
2025 are for an overdose surge alert system
under Minnesota Statutes, section 245.891.

(d) Culturally specific recovery community
organization start-up grants.
Notwithstanding Minnesota Statutes, section
16A.28, any amount appropriated in this act
for administration for culturally specific
recovery community organization start-up
grants is available until June 30, 2027.

(e) Culturally specific services grants.
Notwithstanding Minnesota Statutes, section
16A.28, any amount appropriated in this act
for administration for culturally specific
services grants is available until June 30, 2027.

(f) Base level adjustment. The general fund
base is $4,029,000 in fiscal year 2026 and
$4,029,000 in fiscal year 2027.

Subd. 6. Forecasted Programs; Housing Support

783,000

1,592,000

Subd. 7. Forecasted Programs; MinnesotaCare

31,000

69,000

This appropriation is from the Health Care
Access Fund.

Subd. 8. Forecasted Programs; Medical Assistance

5,715,267,000

6,360,981,000

Subd. 9. Forecasted Programs; Alternative Care

47,189,000

51,022,000

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. 10. Forecasted Programs; Behavioral Health Fund

96,387,000

98,417,000

Subd. 11. Grant Programs; Other Long-Term Care Grants

31,248,000

27,176,000

(a) Provider capacity grant for rural and
underserved communities. $13,016,000 in
fiscal year 2025 is for provider capacity grants
for rural and underserved communities under
Minnesota Statutes, section 256.4761.
Notwithstanding Minnesota Statutes, section
16A.28, this appropriation is available until
June 30, 2027.

(b) Long-term care workforce grants for
new Americans. $10,060,000 in fiscal year
2024 and $10,060,000 in fiscal year 2025 are
for long-term care workforce grants for new
Americans under Minnesota Statutes, section
256.4762. Notwithstanding Minnesota
Statutes, section 16A.28, this appropriation is
available until June 30, 2027.

(c) Supported decision making programs.
$2,000,000 in fiscal year 2024 and $2,000,000
in fiscal year 2025 are for supported decision
making grants under Minnesota Statutes,
section 256.4771. This is a onetime
appropriation.

(d) HCBS workforce development grants.
Any unexpended amount of the 2023
appropriation referenced in Laws 2021, First
Special Session chapter 7, article 17, section
20, estimated to be ....., is canceled. The
amount canceled is appropriated in fiscal year
2024 for the same purpose.

(e) Base level adjustment. The general fund
base is $1,925,000 in fiscal year 2026 and
$1,925,000 in fiscal year 2027.

Subd. 12. Grant Programs; Aging and Adult Services Grants

100,277,000

105,417,000

(a) Vulnerable Adult Act redesign phase
two. $19,791,000 in fiscal year 2024 and
$20,652,000 in fiscal year 2025 are for grants
to counties for the Vulnerable Adult Act
redesign phase two. Notwithstanding
Minnesota Statutes, section 16A.28, this
appropriation is available until June 30, 2027.

(b) Caregiver respite services grants.
$6,009,000 in fiscal year 2025 is for caregiver
respite services grants under Minnesota
Statutes, section 256.9756. Notwithstanding
Minnesota Statutes, section 16A.28, this
appropriation is available until June 30, 2027.
This is a onetime appropriation.

(c) Live well at home grants. $30,000,000 in
fiscal year 2024 and $30,000,000 in fiscal year
2025 are for live well at home grants under
Minnesota Statutes, section 256.9754,
subdivision 3f. This is a onetime appropriation
and is available until June 30, 2027.

(d) Senior nutrition program. $15,791,000
in fiscal year 2024 and $15,761,000 in fiscal
year 2025 are for the senior nutrition program.
Notwithstanding Minnesota Statutes, section
16A.28, this appropriation is available until
June 30, 2027. This is a onetime appropriation.

(e) Boundary Waters Care Center nursing
facility grant. $250,000 in fiscal year 2024
is for a sole source grant to Boundary Waters
Care Center in Ely, Minnesota.

(f) Assisted living rent increase relief grants.
$500,000 in fiscal year 2024 is for grants to
residents of assisted living facilities who
experienced rate increases of over ten percent
in calendar year 2022.

(g) Base level adjustment. The general fund
base is $32,995,000 in fiscal year 2026 and
$32,995,000 in fiscal year 2027.

Subd. 13. Deaf and Hard of Hearing Grants

2,886,000

2,886,000

Subd. 14. Grant Programs; Disabilities Grants

151,405,000

42,691,000

(a) Direct Support Connect. The base is
increased by $250,000 in fiscal year 2026 for
Direct Support Connect. This is a onetime base
adjustment.

(b) Home and community-based services
innovation pool. $2,000,000 in fiscal year
2024 and $2,000,000 in fiscal year 2025 are
for the home and community-based services
innovation pool under Minnesota Statutes,
section 256B.0921.

(c) Emergency grant program for autism
spectrum disorder treatment agencies.
$10,000,000 in fiscal year 2024 and
$10,000,000 in fiscal year 2025 are for the
emergency grant program for autism spectrum
disorder treatment providers. This is a onetime
appropriation and is available until June 30,
2025.

(d) Temporary grants for small customized
living providers. $650,000 in fiscal year 2024
and $650,000 in fiscal year 2025 are for grants
to assist small customized living providers to
transition to community residential services
licensure or integrated community supports
licensure. This is a onetime appropriation.

(e) Self-directed bargaining agreement;
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. Of this
amount, $5,600,000 is for stipends and
$495,000 is for administration. 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. Of
this amount, $1,400,000 of the appropriation
is for stipends and $200,000 is for
administration. 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. Of this amount,
$50,000,000 is for retention bonuses and
$750,000 is for administration of the bonuses.
This is a onetime appropriation and is
available until June 30, 2025.

(h) Self-directed bargaining agreement;
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. Of this amount,
$2,000,000 in fiscal year 2024 is for stipends,
and $100,000 in fiscal year 2024 and $100,000
in fiscal year 2025 are for administration. This
is a onetime appropriation.

(i) Self-directed bargaining agreement;
orientation program. $2,000,000 in fiscal
year 2024 and $2,000,000 in fiscal year 2025
are for onetime $100 payments to collective
bargaining unit members who complete
voluntary orientation requirements. Of this
amount, $1,500,000 in fiscal year 2024 and
$1,500,000 in fiscal year 2025 are for the
onetime $100 payments, and $500,000 in
fiscal year 2024 and $500,000 in fiscal year
2025 are for orientation-related costs. This is
a onetime appropriation.

(j) Self-directed bargaining agreement;
Home Care Orientation Trust. $1,000,000
in fiscal year 2024 is for the Home Care
Orientation Trust under Minnesota Statutes,
section 179A.54, subdivision 11. The
commissioner shall disburse the appropriation
to the board of trustees of the Home Care
Orientation Trust for deposit into an account
designated by the board of trustees outside the
state treasury and state's accounting system.
This is a onetime appropriation.

(k) HIV/AIDS support services. $10,100,000
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 256.935. This is a onetime
appropriation and is available until June 30,
2025.

(l) Motion analysis advancements clinical
study and patient care. $400,000 is fiscal
year 2024 is for a grant to the Mayo Clinic
Motion Analysis Laboratory and Limb Lab
for continued research in motion analysis
advancements and patient care. This is a
onetime appropriation and is available through
June 30, 2025.

(m) Grant to Family Voices in Minnesota.
$75,000 in fiscal year 2024 and $75,000 in
fiscal year 2025 are for a grant to Family
Voices in Minnesota under Minnesota
Statutes, section 256.4776.

(n) Self-advocacy grants for persons with
intellectual and developmental disabilities.
$323,000 in fiscal year 2024 and $323,000 in
fiscal year 2025 are for self-advocacy grants
under Minnesota Statutes, section 256.477.
Of these amounts, $218,000 in fiscal year
2024 and $218,000 in fiscal year 2025 are for
the activities under Minnesota Statutes, section
256.477, subdivision 1, paragraph (a), clauses
(5) to (7), and for administrative costs, and
$105,000 in fiscal year 2024 and $105,000 in
fiscal year 2025 are for the activities under
Minnesota Statutes, section 256.477,
subdivision 2.

(o) Home and community-based workforce
incentive fund grants. $34,742,000 in fiscal
year 2024 and $4,983,000 in fiscal year 2025
are for the home and community-based
workforce incentive fund grants under
Minnesota Statutes, section 256.4764. The
base for this appropriation is $2,986,000 in
fiscal year 2026 and $2,986,000 in fiscal year
2027.

(p) Technology for home grants. $300,000
in fiscal year 2024 and $300,000 in fiscal year
2025 are for technology for home grants under
Minnesota Statutes, section 256.4773.

(q) Direct Support Professionals
Employee-Owned Cooperative program.
$175,000 in fiscal year 2024 and $175,000 in
fiscal year 2025 are for a grant to the
Metropolitan Consortium of Community
Developers for the Direct Support
Professionals Employee-Owned Cooperative
program. The grantee must use the grant
amount for outreach and engagement,
managing a screening and selection process,
providing one-on-one technical assistance,
developing and providing training curricula
related to cooperative development and home
and community-based waiver services,
administration, reporting, and program
evaluation. This is a onetime appropriation.

(r) Transfer. $10,000 in fiscal year 2024 is
for a transfer to Anoka County for
administrative costs related to fielding and
responding to complaints related to unfair rent
increases.

(s) Base level adjustment. The general fund
base is $28,194,000 in fiscal year 2026 and
$27,944,000 in fiscal year 2027.

Subd. 15. Grant Programs; Adult Mental Health Grants

1,200,000

3,200,000

(a) Training for peer workforce. $1,000,000
in fiscal year 2024 and $3,000,000 in fiscal
year 2025 from the general fund are for peer
workforce training grants. This is a onetime
appropriation and is available until June 30,
2027.

(b) Family enhancement center grant.
$200,000 in fiscal year 2024 and $200,000 in
fiscal year 2025 are for a grant to the Family
Enhancement Center to develop, maintain,
and expand community-based social
engagement and connection programs to help
families dealing with trauma and mental health
issues develop connections with each other
and their communities, including the NEST
parent monitoring program, the cook to
connect program, and the call to movement
initiative. This paragraph does not expire.

(c) Base level adjustment. The general fund
base is $200,000 in fiscal year 2026 and
$200,000 in fiscal year 2027.

Subd. 16. Grant Programs; Chemical Dependency Treatment Support Grants

Appropriations by Fund
General	24,275,000	21,047,000
Lottery Prize	1,733,000	1,733,000

(a) Culturally specific recovery community
organization start-up grants. $1,000,000 in
fiscal year 2024 and $3,000,000 in fiscal year
2025 are for culturally specific recovery
community organization start-up grants.
Notwithstanding Minnesota Statutes, section
16A.28, this appropriation is available until
June 30, 2027. This is a onetime appropriation.

(b) Technical assistance for culturally
specific organizations; culturally specific
services grants. $1,000,000 in fiscal year
2024 and $3,000,000 in fiscal year 2025 are
for grants to culturally specific providers for
technical assistance navigating culturally
specific and responsive substance use and
recovery programs. Notwithstanding
Minnesota Statutes, section 16A.28, this
appropriation is available until June 30, 2027.

(c) Technical assistance for culturally
specific organizations; culturally specific
grant development training. $200,000 in
fiscal year 2024 and $200,000 in fiscal year
2025 are for grants for up to four trainings for
community members and culturally specific
providers for grant writing training for
substance use and recovery-related grants.
This is a onetime appropriation.

(d) Harm reduction and culturally specific
grants. $500,000 in fiscal year 2024 and
$500,000 in fiscal year 2025 are to provide
sole source grants to culturally specific
communities to purchase testing supplies and
naloxone.

(e) Family treatment start-up and
capacity-building grants. $10,000,000 in
fiscal year 2024 is for family treatment and
capacity-building grants. This is a onetime
appropriation and is available until June 30,
2027.

(f) Start-up and capacity building grants
for withdrawal management. $500,000 in
fiscal year 2024 and $3,000,000 in fiscal year
2025 are for start-up and capacity building
grants for withdrawal management.
Notwithstanding Minnesota Statutes, section
16A.28, this appropriation is available until
June 30, 2027. This is a onetime appropriation.

(g) Recovery community organization
grants. $6,000,000 in fiscal year 2025 is for
grants to recovery community organizations,
as defined in Minnesota Statutes, section
254B.01, subdivision 8, to provide for costs
and community-based peer recovery support
services that are not otherwise eligible for
reimbursement under Minnesota Statutes,
section 254B.05, as part of the continuum of
care for substance use disorders.
Notwithstanding Minnesota Statutes, section
16A.28, this appropriation is available until
June 30, 2027. This is a onetime appropriation.

(h) Opiate antagonist training grants.
$1,500,000 in fiscal year 2024 and $1,500,000
in fiscal year 2025 are for opiate antagonist
training grants under Minnesota Statutes,
section 245.893.

(i) 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.

(j) Project ECHO at Hennepin Health Care.
$1,228,000 in fiscal year 2024 and $1,500,000
in fiscal year 2025 are for Project ECHO
grants under Minnesota Statutes, section
254B.30, subdivision 2.

(k) White Earth Nation substance use
disorder digital therapy tool. $4,000,000 in
fiscal year 2024 is from the general fund for
a grant to the White Earth Nation to develop
an individualized Native American centric
digital therapy tool with Pathfinder Solutions.
This is a onetime appropriation. The grant
must be used to:

(1) develop a mobile application that is
culturally tailored to connecting substance use
disorder resources with White Earth Nation
members;

(2) convene a planning circle with White Earth
Nation members to design the tool;

(3) provide and expand White Earth
Nation-specific substance use disorder
services; and

(4) partner with an academic research
institution to evaluate the efficacy of the
program.

(l) Wellness in the Woods. $100,000 in fiscal
year 2024 and $100,000 in fiscal year 2025
are for a grant to Wellness in the Woods to
provide daily peer support for individuals who
are in recovery, are transitioning out of
incarceration, or have experienced trauma.
This paragraph does not expire.

(m) Base level adjustment. The general fund
base is $5,847,000 in fiscal year 2026 and
$5,847,000 in fiscal year 2027.

Subd. 17. Direct Care and Treatment - Transfer Authority

Money appropriated under subdivisions 18 to
22 may be transferred between budget
activities and between years of the biennium
with the approval of the commissioner of
management and budget.

Subd. 18. Direct Care and Treatment - Mental Health and Substance Abuse

169,962,000

177,152,000

Subd. 19. Direct Care and Treatment - Community-Based Services

21,223,000

22,280,000

Subd. 20. Direct Care and Treatment - Forensic Services

141,020,000

148,513,000

Subd. 21. Direct Care and Treatment - Sex Offender Program

115,920,000

121,726,000

Subd. 22. Direct Care and Treatment - Operations

72,912,000

87,570,000

The general fund base is $80,222,000 in fiscal
year 2026 and $81,142,000 in fiscal year 2027.

Sec. 3. COUNCIL ON DISABILITY

$

1,818,000

$

2,285,000

Sec. 4. OFFICE OF THE OMBUDSMAN FOR MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES

$

3,700,000

$

4,017,000

(a) Department of Psychiatry monitoring.
$100,000 in fiscal year 2024 and $100,000 in
fiscal year 2025 are for monitoring the
Department of Psychiatry at the University of
Minnesota.

(b) Base level adjustment. The general fund
base is $3,917,000 in fiscal year 2026 and
$3,917,000 in fiscal year 2027.

Sec. 5. COMMISSIONER OF EMPLOYMENT AND ECONOMIC DEVELOPMENT

$

3,924,000

$

76,000

$3,800,000 in fiscal year 2024 is for
development and implementation of an
awareness-building campaign for the
recruitment of direct care professionals, and
$124,000 in fiscal year 2024 and $76,000 in
fiscal year 2025 are for administration. This
is a onetime appropriation and is available
until June 30, 2025.

Sec. 6. COMMISSIONER OF MANAGEMENT AND BUDGET

$

900,000

$

900,000

Sec. 7.

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. 8.

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. 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.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 9. DIRECT CARE AND TREATMENT FISCAL YEAR 2023
APPROPRIATION.

$4,829,000 is appropriated in fiscal year 2023 to the commissioner of human services
for direct care and treatment programs. This is a onetime appropriation.

EFFECTIVE DATE.

This section is effective the day following final enactment.

Sec. 10. APPROPRIATION ENACTED MORE THAN ONCE.

If an appropriation is enacted more than once in the 2023 legislative session, the
appropriation must be given effect only once.

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.

Sec. 12. EFFECTIVE DATE.

This article is effective July 1, 2023, unless a different effective date is specified.