2001 Minnesota Statutes

CHAPTER 145A. Local public health boards

     145A.01 Citation. 

    This chapter may be cited as the "Local Public Health Act." 

    HIST: 1987 c 309 s 1 

     145A.02 Definitions. 

    Subdivision 1.    Applicability.  Definitions in this 
 section apply to this chapter. 

    Subd. 2.    Board of health.  "Board of health" or 
 "board" means an administrative authority established under 
 section 145A.03 or 145A.07. 

    Subd. 3.    City.  "City" means a statutory city or home 
 rule charter city as defined in section 410.015. 

    Subd. 4.    Commissioner.  "Commissioner" means the 
 Minnesota commissioner of health. 

    Subd. 5.    Community health board.  "Community health 
 board" means a board of health established, operating, and 
 eligible for a subsidy under sections 145A.09 to 145A.13. 

    Subd. 6.    Community health services.  "Community 
 health services" means activities designed to protect and 
 promote the health of the general population within a community 
 health service area by emphasizing the prevention of disease, 
 injury, disability, and preventable death through the promotion 
 of effective coordination and use of community resources, and by 
 extending health services into the community.  Program 
 categories of community health services include disease 
 prevention and control, emergency medical care, environmental 
 health, family health, health promotion, and home health care. 

    Subd. 7.    Community health service area.  "Community 
 health service area" means a city, county, or multicounty area 
 that is organized as a community health board under section 
 145A.09 and for which a subsidy is received under sections 
 145A.09 to 145A.13. 

    Subd. 8.    County board.  "County board" or "county" 
 means a county board of commissioners as defined in chapter 375. 

    Subd. 9.    Disease prevention and control.  "Disease 
 prevention and control" means activities intended to prevent or 
 control communicable diseases.  These activities include the 
 coordination or provision of disease surveillance, 
 investigation, reporting, and related counseling, education, 
 screening, immunization, case management and clinical services. 

    Subd. 10.    Emergency medical care.  "Emergency medical 
 care" means activities intended to protect the health of persons 
 suffering a medical emergency and to ensure rapid and effective 
 emergency medical treatment.  These activities include the 
 coordination or provision of training, cooperation with public 
 safety agencies, communications, life-support transportation 
 under sections 144E.06 to 144E.19, public information and 
 involvement, and system management. 

    Subd. 11.    Environmental health.  "Environmental 
 health" means activities intended to achieve an environment 
 conducive to human health, comfort, safety, and well-being.  
 These activities include the coordination or provision of 
 education, regulation, and consultation related to food 
 protection, hazardous substances and product safety, water 
 supply sanitation, waste disposal, environmental pollution 
 control, occupational health and safety, public health nuisance 
 control, institutional sanitation, recreational sanitation 
 including swimming pool sanitation and safety, and housing code 
 enforcement for health and safety purposes. 

    Subd. 12.    Family health.  "Family health" means 
 activities intended to promote optimum health outcomes as 
 related to human reproduction and child growth and development.  
 These activities include the coordination or provision of 
 education, counseling, screening, clinical services, school 
 health services, nutrition services, family planning services as 
 defined in section 145.925, and other interventions directed at 
 improving family health.  Family health services must not 
 include arrangements, referrals, or counseling for, or provision 
 of, voluntary termination of pregnancy. 

    Subd. 13.    Health promotion.  "Health promotion" means 
 activities intended to reduce the prevalence of risk conditions 
 or behaviors of individuals or communities for the purpose of 
 preventing chronic disease and effecting other definable 
 advances in health status.  These activities include the 
 coordination or provision of community organization, regulation, 
 targeted screening and education, as well as informational and 
 other scientifically supported interventions to foster health by 
 affecting related conditions and behaviors. 

    Subd. 14.    Home health care.  "Home health care" means 
 activities intended to reduce the ill effects and complications 
 of existing disease and to provide suitable alternatives to 
 inpatient care in a health facility.  These activities include 
 the coordination or provision of health assessment, nursing 
 care, education, counseling, nutrition services, delegated 
 medical and ancillary services, case management, referral and 
 follow-up. 

    Subd. 15.    Medical consultant.  "Medical consultant" 
 means a physician licensed to practice medicine in Minnesota who 
 is working under a written agreement with, employed by, or on 
 contract with a board of health to provide advice and 
 information, to authorize medical procedures through standing 
 orders, and to assist a board of health and its staff in 
 coordinating their activities with local medical practitioners 
 and health care institutions. 

    Subd. 16.    Population.  "Population" means the total 
 number of residents of the state or any city or county as 
 established by the last federal census, by a special census 
 taken by the United States Bureau of the Census, by the state 
 demographer under section 4A.02, or by an estimate of city 
 population prepared by the metropolitan council, whichever is 
 the most recent as to the stated date of count or estimate. 

    Subd. 17.    Public health nuisance.  "Public health 
 nuisance" means any activity or failure to act that adversely 
 affects the public health. 

    Subd. 18.    Public health nurse.  "Public health nurse" 
 means a person who is licensed as a registered nurse by the 
 Minnesota board of nursing under sections 148.171 to 148.285 and 
 who meets the voluntary registration requirements established by 
 the board of nursing. 

    HIST: 1987 c 309 s 2; 1989 c 194 s 2; 1991 c 345 art 2 s 43; 
 1997 c 199 s 14; 1999 c 245 art 9 s 47 

     145A.03 Establishment and organization. 

    Subdivision 1.    Establishment; assignment of 
 responsibilities.  (a) The governing body of a city or county 
 must undertake the responsibilities of a board of health or 
 establish a board of health and assign to it the powers and 
 duties of a board of health. 

    (b) A city council may ask a county or joint powers board 
 of health to undertake the responsibilities of a board of health 
 for the city's jurisdiction. 

    (c) A county board or city council within the jurisdiction 
 of a community health board operating under sections 145A.09 to 
 145A.13 is preempted from forming a board of health except as 
 specified in section 145A.10, subdivision 2. 

    Subd. 2.    Joint powers board of health.  Except as 
 preempted under section 145A.10, subdivision 2, a county may 
 establish a joint board of health by agreement with one or more 
 contiguous counties, or a city may establish a joint board of 
 health with one or more contiguous cities in the same county, or 
 a city may establish a joint board of health with the county or 
 counties within which it is located.  The agreements must be 
 established according to section 471.59. 

    Subd. 3.    Withdrawal from joint powers board of health. 
  A county or city may withdraw from a joint powers board of 
 health by resolution of its governing body not less than one 
 year after the effective date of the initial joint powers 
 agreement.  The withdrawing county or city must notify the 
 commissioner and the other parties to the agreement at least one 
 year before the beginning of the calendar year in which 
 withdrawal takes effect. 

    Subd. 4.    Membership; duties of chair.  A board of 
 health must have at least five members, one of whom must be 
 elected by the members as chair and one as vice-chair.  The 
 chair, or in the chair's absence, the vice-chair, must preside 
 at meetings of the board of health and sign or authorize an 
 agent to sign contracts and other documents requiring signature 
 on behalf of the board of health. 

    Subd. 5.    Meetings.  A board of health must hold 
 meetings at least twice a year and as determined by its rules of 
 procedure.  The board must adopt written procedures for 
 transacting business and must keep a public record of its 
 transactions, findings, and determinations.  Members may receive 
 a per diem plus travel and other eligible expenses while engaged 
 in official duties. 

    Subd. 6.    Duplicate licensing.  A local board of 
 health must work with the commissioner of agriculture to 
 eliminate duplicate licensing and inspection of grocery and 
 convenience stores by no later than March 1, 1992. 

    HIST: 1987 c 309 s 3; 1991 c 52 s 3 

     145A.04 Powers and duties of board of health. 

    Subdivision 1.    Jurisdiction; enforcement.  A county 
 or multicounty board of health has the powers and duties of a 
 board of health for all territory within its jurisdiction not 
 under the jurisdiction of a city board of health.  Under the 
 general supervision of the commissioner, the board shall enforce 
 laws, regulations, and ordinances pertaining to the powers and 
 duties of a board of health within its jurisdictional area. 

    Subd. 2.    Appointment of agent.  A board of health 
 must appoint, employ, or contract with a person or persons to 
 act on its behalf.  The board shall notify the commissioner of 
 the agent's name, address, and phone number where the agent may 
 be reached between board meetings and submit a copy of the 
 resolution authorizing the agent to act on the board's behalf.  

    Subd. 3.    Employment; medical consultant.  (a) A board 
 of health may establish a health department or other 
 administrative agency and may employ persons as necessary to 
 carry out its duties. 

    (b) Except where prohibited by law, employees of the board 
 of health may act as its agents. 

    (c) Employees of the board of health are subject to any 
 personnel administration rules adopted by a city council or 
 county board forming the board of health unless the employees of 
 the board are within the scope of a statewide personnel 
 administration system. 

    (d) The board of health may appoint, employ, or contract 
 with a medical consultant to receive appropriate medical advice 
 and direction. 

    Subd. 4.    Acquisition of property; request for and 
 acceptance of funds; collection of fees.  (a) A board of 
 health may acquire and hold in the name of the county or city 
 the lands, buildings, and equipment necessary for the purposes 
 of sections 145A.03 to 145A.13.  It may do so by any lawful 
 means, including gifts, purchase, lease, or transfer of 
 custodial control. 

    (b) A board of health may accept gifts, grants, and 
 subsidies from any lawful source, apply for and accept state and 
 federal funds, and request and accept local tax funds. 

    (c) A board of health may establish and collect reasonable 
 fees for performing its duties and providing community health 
 services. 

    (d) With the exception of licensing and inspection 
 activities, access to community health services provided by or 
 on contract with the board of health must not be denied to an 
 individual or family because of inability to pay. 

    Subd. 5.    Contracts.  To improve efficiency, quality, 
 and effectiveness, avoid unnecessary duplication, and gain cost 
 advantages, a board of health may contract to provide, receive, 
 or ensure provision of services. 

    Subd. 6.    Investigation; reporting and control of 
 communicable diseases.  A board of health shall make 
 investigations and reports and obey instructions on the control 
 of communicable diseases as the commissioner may direct under 
 section 144.12, 145A.06, subdivision 2, or 145A.07.  Boards of 
 health must cooperate so far as practicable to act together to 
 prevent and control epidemic diseases. 

    Subd. 7.    Entry for inspection.  To enforce public 
 health laws, ordinances or rules, a member or agent of a board 
 of health may enter a building, conveyance, or place where 
 contagion, infection, filth, or other source or cause of 
 preventable disease exists or is reasonably suspected. 

    Subd. 8.    Removal and abatement of public health 
 nuisances.  (a) If a threat to the public health such as a 
 public health nuisance, source of filth, or cause of sickness is 
 found on any property, the board of health or its agent shall 
 order the owner or occupant of the property to remove or abate 
 the threat within a time specified in the notice but not longer 
 than ten days.  Action to recover costs of enforcement under 
 this subdivision must be taken as prescribed in section 145A.08. 

    (b) Notice for abatement or removal must be served on the 
 owner, occupant, or agent of the property in one of the 
 following ways: 

    (1) by registered or certified mail; 

    (2) by an officer authorized to serve a warrant; or 

    (3) by a person aged 18 years or older who is not 
 reasonably believed to be a party to any action arising from the 
 notice. 

    (c) If the owner of the property is unknown or absent and 
 has no known representative upon whom notice can be served, the 
 board of health or its agent shall post a written or printed 
 notice on the property stating that, unless the threat to the 
 public health is abated or removed within a period not longer 
 than ten days, the board will have the threat abated or removed 
 at the expense of the owner under section 145A.08 or other 
 applicable state or local law. 

    (d) If the owner, occupant, or agent fails or neglects to 
 comply with the requirement of the notice provided under 
 paragraphs (b) and (c), then the board of health or its agent 
 shall remove or abate the nuisance, source of filth, or cause of 
 sickness described in the notice from the property. 

    Subd. 9.    Injunctive relief.  In addition to any other 
 remedy provided by law, the board of health may bring an action 
 in the court of appropriate jurisdiction to enjoin a violation 
 of statute, rule, or ordinance that the board has power to 
 enforce, or to enjoin as a public health nuisance any activity 
 or failure to act that adversely affects the public health. 

    Subd. 10.    Hindrance of enforcement prohibited; penalty. 
  It is a misdemeanor deliberately to hinder a member of a 
 board of health or its agent from entering a building, 
 conveyance, or place where contagion, infection, filth, or other 
 source or cause of preventable disease exists or is reasonably 
 suspected, or otherwise to interfere with the performance of the 
 duties of the board of health. 

    Subd. 11.    Neglect of enforcement prohibited; penalty. 
  It is a misdemeanor for a member or agent of a board of 
 health to refuse or neglect to perform a duty imposed on a board 
 of health by statute or ordinance. 

    Subd. 12.    Other powers and duties established by law. 
  This section does not limit powers and duties of a board of 
 health prescribed in other sections. 

    HIST: 1987 c 309 s 4 

     145A.05 Local ordinances. 

    Subdivision 1.    Generally.  A county board may adopt 
 ordinances for all or a part of its jurisdiction to regulate 
 actual or potential threats to the public health under this 
 section and section 375.51, unless the ordinances are preempted 
 by, in conflict with, or less restrictive than standards in 
 state law or rule. 

    Subd. 2.    Animal control.  In addition to powers under 
 sections 35.67 to 35.69, a county board may adopt ordinances to 
 issue licenses or otherwise regulate the keeping of animals, to 
 restrain animals from running at large, to authorize the 
 impounding and sale or summary destruction of animals, and to 
 establish pounds. 

    Subd. 3.    Control of unwholesome substances.  Unless 
 preempted by or in conflict with sections 394.21 to 394.37, a 
 county board may adopt ordinances to prevent bringing, 
 depositing, or leaving within the county any unwholesome 
 substance and to require the owners or occupants of lands to 
 remove unwholesome substances or to provide for removal at the 
 expense of the owner or occupant. 

    Subd. 4.    Regulation of waste.  A county board may 
 adopt ordinances to provide for or regulate the disposal of 
 sewage, garbage, and other refuse. 

    Subd. 5.    Regulation of water.  A county board may 
 adopt ordinances to provide for cleaning and removal of 
 obstructions from waters in the county and to prevent their 
 obstruction or pollution. 

    Subd. 6.    Regulation of offensive trades.  A county 
 board may adopt ordinances to regulate offensive trades, unless 
 the ordinances are preempted by, in conflict with, or less 
 restrictive than standards under sections 394.21 to 394.37.  In 
 this subdivision, "offensive trade" means a trade or employment 
 that is hurtful to inhabitants within any county, city, or town, 
 dangerous to the public health, injurious to neighboring 
 property, or from which offensive odors arise. 

    Subd. 7.    Control of public health nuisances.  A 
 county board may adopt ordinances to define public health 
 nuisances and to provide for their prevention or abatement. 

    Subd. 7a.    Curfew.  A county board may adopt an 
 ordinance establishing a countywide curfew for unmarried persons 
 under 18 years of age.  If the county board of a county located 
 in the seven-county metropolitan area adopts a curfew ordinance 
 under this subdivision, the ordinance shall contain an earlier 
 curfew for children under the age of 12 than for older children. 

    Subd. 8.    Enforcement of delegated powers.  A county 
 board may adopt ordinances consistent with this section to 
 administer and enforce the powers and duties delegated by 
 agreement with the commissioner under section 145A.07. 

    Subd. 9.    Relation to cities and towns.  The governing 
 body of a city or town may adopt ordinances relating to the 
 public health authorized by law or agreement with the 
 commissioner under section 145A.07.  The ordinances must not 
 conflict with or be less restrictive than ordinances adopted by 
 the county board within whose jurisdiction the city or town is 
 located. 

    HIST: 1987 c 309 s 5; 1994 c 636 art 9 s 10; 1995 c 226 art 2 
 s 1 

     145A.06 Commissioner; powers and duties relative to 
  boards of health. 

    Subdivision 1.    Generally.  In addition to other 
 powers and duties provided by law, the commissioner has the 
 powers listed in subdivisions 2 to 4. 

    Subd. 2.    Supervision of local enforcement.  (a) In 
 the absence of provision for a board of health, the commissioner 
 may appoint three or more persons to act as a board until one is 
 established.  The commissioner may fix their compensation, which 
 the county or city must pay. 

    (b) The commissioner by written order may require any two 
 or more boards of health to act together to prevent or control 
 epidemic diseases. 

    (c) If a board fails to comply with section 145A.04, 
 subdivision 6, the commissioner may employ medical and other 
 help necessary to control communicable disease at the expense of 
 the board of health involved. 

    (d) If the commissioner has reason to believe that the 
 provisions of this chapter have been violated, the commissioner 
 shall inform the attorney general and submit information to 
 support the belief.  The attorney general shall institute 
 proceedings to enforce the provisions of this chapter or shall 
 direct the county attorney to institute proceedings.  

    Subd. 3. Repealed, 1989 c 194 s 22 

    Subd. 4.    Assistance to boards of health.  The 
 commissioner shall help and advise boards of health that ask for 
 help in developing, administering, and carrying out public 
 health services and programs.  

    Subd. 5.    Deadly infectious diseases.  The 
 commissioner shall promote measures aimed at preventing 
 businesses from facilitating sexual practices that transmit 
 deadly infectious diseases by providing technical advice to 
 boards of health to assist them in regulating these practices or 
 closing establishments that constitute a public health nuisance. 

    HIST: 1987 c 309 s 6; 1988 c 689 art 2 s 47 

     145A.07 Delegation of powers and duties. 

    Subdivision 1.    Agreements to perform duties of 
 commissioner.  (a) The commissioner of health may enter into 
 an agreement with any board of health to delegate all or part of 
 the licensing, inspection, reporting, and enforcement duties 
 authorized under sections 144.12; 144.381 to 144.387; 144.411 to 
 144.417; 144.71 to 144.74; 145A.04, subdivision 6; provisions of 
 chapter 103I pertaining to construction, repair, and abandonment 
 of water wells; chapter 157; and sections 327.14 to 327.28. 

    (b) Agreements are subject to subdivision 3. 

    (c) This subdivision does not affect agreements entered 
 into under Minnesota Statutes 1986, section 145.031, 145.55, or 
 145.918, subdivision 2. 

    Subd. 2.    Agreements to perform duties of board of 
 health.  A board of health may authorize a township board, 
 city council, or county board within its jurisdiction to 
 establish a board of health under section 145A.03 and delegate 
 to the board of health by agreement any powers or duties under 
 sections 145A.04, 145A.07, subdivision 2, and 145A.08.  An 
 agreement to delegate powers and duties of a board of health 
 must be approved by the commissioner and is subject to 
 subdivision 3. 

    Subd. 3.    Terms of agreements.  (a) Agreements 
 authorized under this section must be in writing and signed by 
 the delegating authority and the designated agent. 

    (b) The agreement must list criteria the delegating 
 authority will use to determine if the designated agent's 
 performance meets appropriate standards and is sufficient to 
 replace performance by the delegating authority.  

    (c) The agreement may specify minimum staff requirements 
 and qualifications, set procedures for the assessment of costs, 
 and provide for termination procedures if the delegating 
 authority finds that the designated agent fails to comply with 
 the agreement. 

    (d) A designated agent must not perform licensing, 
 inspection, or enforcement duties under the agreement in 
 territory outside its jurisdiction unless approved by the 
 governing body for that territory through a separate agreement. 

    (e) The scope of agreements established under this section 
 is limited to duties and responsibilities agreed upon by the 
 parties.  The agreement may provide for automatic renewal and 
 for notice of intent to terminate by either party.  

    (f) During the life of the agreement, the delegating 
 authority shall not perform duties that the designated agent is 
 required to perform under the agreement, except inspections 
 necessary to determine compliance with the agreement and this 
 section or as agreed to by the parties. 

    (g) The delegating authority shall consult with, advise, 
 and assist a designated agent in the performance of its duties 
 under the agreement. 

    (h) This section does not alter the responsibility of the 
 delegating authority for the performance of duties specified in 
 law. 

    HIST: 1987 c 309 s 7; 1989 c 209 art 2 s 18; 1990 c 426 art 2 
 s 1; 1993 c 206 s 12; 1995 c 186 s 43 

     145A.08 Assessment of costs; tax levy authorized. 

    Subdivision 1.    Cost of care.  A person who has or 
 whose dependent or spouse has a communicable disease that is 
 subject to control by the board of health is financially liable 
 to the unit or agency of government that paid for the reasonable 
 cost of care provided to control the disease under section 
 145A.04, subdivision 6. 

    Subd. 2.    Assessment of costs of enforcement.  (a) If 
 costs are assessed for enforcement of section 145A.04, 
 subdivision 8, and no procedure for the assessment of costs has 
 been specified in an agreement established under section 
 145A.07, the enforcement costs must be assessed as prescribed in 
 this subdivision. 

    (b) A debt or claim against an individual owner or single 
 piece of real property resulting from an enforcement action 
 authorized by section 145A.04, subdivision 8, must not exceed 
 the cost of abatement or removal.  

    (c) The cost of an enforcement action under section 
 145A.04, subdivision 8, may be assessed and charged against the 
 real property on which the public health nuisance, source of 
 filth, or cause of sickness was located.  The auditor of the 
 county in which the action is taken shall extend the cost so 
 assessed and charged on the tax roll of the county against the 
 real property on which the enforcement action was taken. 

    (d) The cost of an enforcement action taken by a town or 
 city board of health under section 145A.04, subdivision 8, may 
 be recovered from the county in which the town or city is 
 located if the city clerk or other officer certifies the costs 
 of the enforcement action to the county auditor as prescribed in 
 this section.  Taxes equal to the full amount of the enforcement 
 action but not exceeding the limit in paragraph (b) must be 
 collected by the county treasurer and paid to the city or town 
 as other taxes are collected and paid. 

    Subd. 3.    Tax levy authorized.  A city council or 
 county board that has formed or is a member of a board of health 
 may levy taxes on all taxable property in its jurisdiction to 
 pay the cost of performing its duties under this chapter. 

    HIST: 1987 c 309 s 8; 1Sp1989 c 1 art 5 s 6 

     145A.09 Purpose; formation; eligibility; withdrawal. 

    Subdivision 1.    General purpose.  The purpose of 
 sections 145A.09 to 145A.14 is to develop and maintain an 
 integrated system of community health services under local 
 administration and within a system of state guidelines and 
 standards. 

    Subd. 2.    Community health board; eligibility.  A 
 board of health that meets the requirements of sections 145A.09 
 to 145A.13 is a community health board and is eligible for a 
 community health subsidy under section 145A.13. 

    Subd. 3.    Population requirement.  A board of health 
 must include within its jurisdiction a population of 30,000 or 
 more persons or be composed of three or more contiguous counties 
 to be eligible to form a community health board. 

    Subd. 4.    Cities.  A city that received a subsidy 
 under section 145A.13 and that meets the requirements of 
 sections 145A.09 to 145A.13 is eligible for a community health 
 subsidy under section 145A.13. 

    Subd. 5.    Human services board.  A county board or a 
 joint powers board of health that establishes a community health 
 board and has or establishes an operational human services board 
 under chapter 402 must assign the powers and duties of a 
 community health board to the human services board. 

    Subd. 6.    Boundaries of community health service areas. 
  The community health service area of a multicounty or 
 multicity community health board must be within a region 
 designated under sections 462.381 to 462.398, unless this 
 condition is waived by the commissioner with the approval of the 
 regional development commission directly involved or the 
 metropolitan council, if appropriate.  In a region without a 
 regional development commission, the commissioner of trade and 
 economic development shall act in place of the regional 
 development commission. 

    Subd. 7.    Withdrawal.  (a) A county or city that has 
 established or joined a community health board may withdraw from 
 the subsidy program authorized by sections 145A.09 to 145A.13 by 
 resolution of its governing body in accordance with section 
 145A.03, subdivision 3, and this subdivision. 

    (b) A county or city may not withdraw from a joint powers 
 community health board during the first two calendar years 
 following that county's or city's initial adoption of the joint 
 powers agreement.  

    (c) The withdrawal of a county or city from a community 
 health board does not affect the eligibility for the community 
 health subsidy of any remaining county or city for one calendar 
 year following the effective date of withdrawal. 

    (d) The amount of additional annual payment for calendar 
 year 1985 made pursuant to Minnesota Statutes 1984, section 
 145.921, subdivision 4, must be subtracted from the subsidy for 
 a county that, due to withdrawal from a community health board, 
 ceases to meet the terms and conditions under which that 
 additional annual payment was made. 

    HIST: 1987 c 186 s 15; 1987 c 309 s 9,25; 1991 c 345 art 2 s 
 44 

     145A.10 Powers and duties of community health boards. 

    Subdivision 1.    General.  A community health board has 
 the powers and duties of a board of health prescribed in 
 sections 145A.03, 145A.04, 145A.07, and 145A.08, as well as the 
 general responsibility for development and maintenance of an 
 integrated system of community health services as prescribed in 
 sections 145A.09 to 145A.13. 

    Subd. 2.    Preemption.  (a) Not later than 365 days 
 after the approval of a community health plan by the 
 commissioner, any other board of health within the community 
 health service area for which the plan has been prepared must 
 cease operation, except as authorized in a joint powers 
 agreement under section 145A.03, subdivision 2, or delegation 
 agreement under section 145A.07, subdivision 2, or as otherwise 
 allowed by this subdivision. 

    (b) This subdivision does not preempt or otherwise change 
 the powers and duties of any city or county eligible for subsidy 
 under section 145A.09. 

    (c) This subdivision does not preempt the authority to 
 operate a community health services program of any city of the 
 first or second class operating an existing program of community 
 health services located within a county with a population of 
 300,000 or more persons until the city council takes action to 
 allow the county to preempt the city's powers and duties. 

    Subd. 3.    Medical consultant.  The community health 
 board must appoint, employ, or contract with a medical 
 consultant to ensure appropriate medical advice and direction 
 for the board of health and assist the board and its staff in 
 the coordination of community health services with local medical 
 care and other health services. 

    Subd. 4.    Employees.  Persons employed by a county, 
 city, or the state whose functions and duties are assumed by a 
 community health board shall become employees of the board 
 without loss in benefits, salaries, or rights.  Failure to 
 comply with this subdivision does not affect eligibility under 
 section 145A.09. 

    Subd. 5.    Community health plan.  The community health 
 board must prepare and submit to the commissioner a written plan 
 at times prescribed by the commissioner under section 145A.12, 
 subdivision 3, but no more often than every two years.  The 
 community health plan must provide for the assessment of 
 community health status and the integration, development, and 
 provision of community health services that meet the priority 
 needs of the community health service area.  The plan must be 
 consistent with the standards and procedures established under 
 section 145A.12, subdivision 3, and must at least include 
 documentation of the following: 

    (1) a review and assessment of the implementation of the 
 preceding community health plan; 

    (2) the process used to assess community health status and 
 encourage full community participation in the development of the 
 proposed community health plan; 

    (3) an identification of personal health services, 
 institutional health services, health-related environmental 
 programs and services, and related human services in the 
 community; 

    (4) an assessment of community health status, a statement 
 of goals and objectives according to priority, and the reasons 
 for the priority order; 

    (5) a description of and rationale for the method the 
 community health board plans to use to address each identified 
 community health goal and objective and how each program 
 category defined in section 145A.02 and any agreements entered 
 into under section 145A.07 will be implemented to achieve these 
 goals and objectives; 

    (6) a description of the ways in which planned community 
 health services defined in section 145A.02 will be coordinated 
 with services and resources identified in clause (2); 

    (7) the projected annual budgets for expenditure of the 
 subsidy and local match provided for in section 145A.13 and for 
 other sources of funding for the program categories defined in 
 section 145A.02 including a description of the ways this funding 
 is coordinated with funding from other local, state, and federal 
 sources; and 

    (8) assurances that community health services will comply 
 with applicable state and federal laws. 

    Subd. 6.    Budget; plan revision.  The community health 
 board must prepare and submit to the commissioner an annual 
 budget for the expenditure of local match and subsidy funds 
 under section 145A.13 and for other sources of funding for 
 community health services.  Revisions to the community health 
 plan or annual budgets must be submitted to the commissioner in 
 the same manner as prescribed in section 145A.12, subdivisions 3 
 and 4. 

    Subd. 7.    Equal access to services.  The community 
 health board must ensure that community health services are 
 accessible to all persons on the basis of need.  No one shall be 
 denied services because of race, color, sex, age, language, 
 religion, nationality, inability to pay, political persuasion, 
 or place of residence. 

    Subd. 8.    Reports.  The community health board must 
 compile and submit reports to the commissioner on its 
 expenditures and activities as required under section 145A.12, 
 subdivision 5. 

    Subd. 9.    Recommended legislation.  The community 
 health board may recommend local ordinances pertaining to 
 community health services to any county board or city council 
 within its jurisdiction and advise the commissioner on matters 
 relating to public health that require assistance from the 
 state, or that may be of more than local interest. 

    Subd. 10.    State and local advisory committees.  (a) A 
 state community health advisory committee is established to 
 advise, consult with, and make recommendations to the 
 commissioner on the development, maintenance, funding, and 
 evaluation of community health services.  Each community health 
 board may appoint a member to serve on the committee.  The 
 committee must meet at least quarterly, and special meetings may 
 be called by the committee chair or a majority of the members.  
 Members or their alternates may receive a per diem and must be 
 reimbursed for travel and other necessary expenses while engaged 
 in their official duties.  

    (b) The city councils or county boards that have 
 established or are members of a community health board must 
 appoint a community health advisory committee to advise, consult 
 with, and make recommendations to the community health board on 
 matters relating to the development, maintenance, funding, and 
 evaluation of community health services.  The committee must 
 consist of at least five members and must be generally 
 representative of the population and health care providers of 
 the community health service area.  The committee must meet at 
 least three times a year and at the call of the chair or a 
 majority of the members.  Members may receive a per diem and 
 reimbursement for travel and other necessary expenses while 
 engaged in their official duties. 

    (c) State and local advisory committees must adopt bylaws 
 or operating procedures that specify the length of terms of 
 membership, procedures for assuring that no more than half of 
 these terms expire during the same year, and other matters 
 relating to the conduct of committee business.  Bylaws or 
 operating procedures may allow one alternate to be appointed for 
 each member of a state or local advisory committee.  Alternates 
 may be given full or partial powers and duties of members.  

    HIST: 1987 c 309 s 10; 2001 c 161 s 25 

     145A.11 Powers and duties of city and county relative to 
  subsidy. 

    Subdivision 1.    Generally.  In addition to the powers 
 and duties prescribed elsewhere in law and in section 145A.05, a 
 city council or county board that has formed or is a member of a 
 community health board has the powers and duties prescribed in 
 this section. 

    Subd. 2.    Consideration of community health plan in tax 
 levy.  In levying taxes authorized under section 145A.08, 
 subdivision 3, a city council or county board that has formed or 
 is a member of a community health board must consider the income 
 and expenditures required to meet the objectives of the 
 community health plan for its area. 

    Subd. 3.    Approval of plan and budget.  (a) The county 
 board must review and approve the community health plan and 
 budget or any revision prepared according to section 145A.10, 
 subdivision 6, within 30 days of its receipt and before the 
 submission of the plan, budget, or revision to the commissioner. 

    (b) The community health plan, budget, or revision 
 submitted to the county board must incorporate the community 
 health plan, budget, or revision developed by any city within 
 its community health service area that has a community health 
 board. 

    (c) The county board may approve the community health plan, 
 budget, or revision as written or refer it back to the community 
 health board with comments and instructions for further 
 consideration. 

    (d) A city council or county board that is a member of a 
 community health board may appeal to the commissioner for 
 resolution of differences regarding the community health plan, 
 budget, or revision. 

    (e) Failure to act within the specified time constitutes 
 approval. 

    Subd. 4.    Ordinances relating to community health 
 services.  A city council or county board that has established 
 or is a member of a community health board may by ordinance 
 adopt and enforce minimum standards for services provided 
 according to sections 145A.02 and 145A.10, subdivision 5.  An 
 ordinance must not conflict with state law or with more 
 stringent standards established either by rule of an agency of 
 state government or by the provisions of the charter or 
 ordinances of any city organized under section 145A.09, 
 subdivision 4. 

    HIST: 1987 c 309 s 11 

     145A.12 Powers and duties of commissioner relative to 
  subsidy. 

    Subdivision 1.    Administrative and program support.  
 The commissioner must assist community health boards in the 
 development, administration, and implementation of community 
 health services.  This assistance may consist of but is not 
 limited to: 

    (1) informational resources, consultation, and training to 
 help community health boards plan, develop, integrate, provide 
 and evaluate community health services; and 

    (2) administrative and program guidelines, developed with 
 the advice of the state community health advisory committee.  
 Adoption of these guidelines by a community health board is not 
 a prerequisite for plan approval as prescribed in subdivision 4. 

    Subd. 2.    Personnel standards.  In accordance with 
 chapter 14, and in consultation with the state community health 
 advisory committee, the commissioner may adopt rules to set 
 standards for administrative and program personnel to ensure 
 competence in administration and planning and in each program 
 area defined in section 145A.02. 

    Subd. 3.    Planning standards; budgets; revisions.  The 
 commissioner may, in accordance with chapter 14 and in 
 consultation with the state community health advisory committee, 
 adopt rules to set submission dates, procedures, and standards 
 for community health plans, budgets, and revisions prepared 
 according to section 145A.10, subdivisions 5 and 6. 

    Subd. 4.    Review and approval of plan, budget or 
 revision.  The commissioner must review and act on the 
 community health plan, budget, or any proposed revision within 
 60 days after receiving the plan, budget, or revision.  The 
 commissioner may approve the plan, budget, or revision as 
 written or refer it back to the community health board with 
 comments and instructions for further consideration.  Failure to 
 act within the specified time constitutes approval. 

    Subd. 5.    Reporting standards.  The commissioner may, 
 in accordance with chapter 14 and in consultation with the state 
 community health advisory committee, adopt rules establishing 
 standards and procedures for a uniform reporting system that 
 will permit the evaluation of the efficiency and effectiveness 
 of community health services. 

    Subd. 6. Repealed, 1997 c 7 art 2 s 67 

    HIST: 1987 c 309 s 12 

     145A.13 Community health services subsidy. 

    Subdivision 1.    Subsidy formula.  The commissioner of 
 health shall distribute a subsidy for the operations of 
 community health boards organized and operating under sections 
 145A.09 to 145A.13. 

    (a) Each city or county eligible for a subsidy under 
 section 145A.09, subdivision 2, shall receive no less for any 
 calendar year than the total community health services subsidy 
 that was allocated for that city or county by the commissioner 
 of health under this section for calendar year 1985. 

    (b) Additional money appropriated for the operations of 
 community health boards organized and operating under sections 
 145A.09 to 145A.13 shall be distributed in proportion to 
 population. 

    Subd. 2.    Local match.  Each community health board 
 that receives a subsidy shall provide local matching money equal 
 to that subsidy during the year for which the subsidy is made, 
 subject to the following provisions: 

    (a) the local matching funds may include local tax levies, 
 gifts, fees for services, and revenues from contracts; 

    (b) when the amount of local matching funds for a community 
 health board is less than the amount specified, the subsidy 
 provided for that community health board under this section 
 shall be reduced proportionally; 

    (c) when a community health board fails to expend the full 
 amount of the subsidy to which it would be entitled in any one 
 year under the provisions of sections 145A.09 to 145A.13, the 
 state commissioner of health may retain the surplus, subject to 
 disbursement to the community health board in the following 
 calendar year if the community health board can demonstrate a 
 need for and ability to expend the surplus for the purposes 
 provided in section 145A.10; and 

    (d) a city organized under the provisions of sections 
 145A.09 to 145A.13 that levies a tax for provision of community 
 health services shall be exempted from any county levy for the 
 same services to the extent of the levy imposed by the city. 

    Subd. 3.    Payment.  When a community health board 
 meets the requirements prescribed in section 145A.09, 
 subdivision 2, the state commissioner of health shall pay the 
 amount of subsidy to the community health board or its designee 
 according to applicable rules from the money appropriated for 
 the purpose and according to the following: 

    (a) the commissioner of health shall make payments for 
 community health services to each community health board or its 
 designee in 12 installments a year; 

    (b) the commissioner shall ensure that the pertinent 
 payment of the allotment for each month is made on the first 
 working day after the end of each month of the calendar year, 
 except for the last month of the calendar year; 

    (c) the commissioner shall ensure that each community 
 health board or its designee receives its payment of the 
 allotment for that month no later than the last working day of 
 that month.  The payment described in this subdivision for 
 services rendered during June, 1985, shall be made on the first 
 working day of July, 1985; and 

    (d) the commissioner shall make payment to a human services 
 board organized and operating under section 145A.09, subdivision 
 5, or to its designee, as prescribed in section 402.02, 
 subdivision 4. 

    HIST: 1976 c 9 s 11; 1977 c 305 s 45; 1983 c 312 art 1 s 19; 
 1985 c 248 s 70; 1Sp1985 c 9 art 2 s 20; 1987 c 309 s 24,25; 
 1989 c 209 art 2 s 19 

     145A.14 Special grants. 

    Subdivision 1.    Migrant health grants.  (a) The 
 commissioner may make special grants to cities, counties, groups 
 of cities or counties, or nonprofit corporations to establish, 
 operate, or subsidize clinic facilities and services, including 
 mobile clinics, to furnish health services for migrant 
 agricultural workers and their families in areas of the state 
 where significant numbers of migrant workers are located.  
 "Migrant agricultural worker" means any individual whose 
 principal employment is in agriculture on a seasonal basis, who 
 has been so employed within the past 24 months, and who has 
 established a temporary residence for the purpose of such 
 employment. 

    (b) Applicants must submit for approval a plan and budget 
 for the use of the funds in the form and detail specified by the 
 commissioner. 

    (c) Applicants must keep records, including records of 
 expenditures to be audited, as the commissioner specifies. 

    Subd. 2.    Indian health grants.  (a) The commissioner 
 may make special grants to community health boards to establish, 
 operate, or subsidize clinic facilities and services to furnish 
 health services for American Indians who reside off reservations.

    (b) To qualify for a grant under this subdivision the 
 community health plan submitted by the community health board 
 must contain a proposal for the delivery of the services and 
 documentation that representatives of the Indian community 
 affected by the plan were involved in its development. 

    (c) Applicants must submit for approval a plan and budget 
 for the use of the funds in the form and detail specified by the 
 commissioner. 

    (d) Applicants must keep records, including records of 
 expenditures to be audited, as the commissioner specifies. 

    Subd. 3.    Grants to prevent tobacco use.  The 
 commissioner of health may award special grants to community 
 boards of health to conduct communitywide programs or to 
 community health boards or nonprofit corporations to conduct 
 statewide programs to prevent tobacco use.  

    Subd. 4.    Health promotion team.  (a) The community 
 health board may establish a community-based health promotion 
 team made up of representatives of business and industry, public 
 health, labor, voluntary agencies, hospitals, medical clinics, 
 churches, media, schools, civic groups, local government and 
 elected officials, nursing homes, consumers, and others as 
 appropriate. 

    (b) A community-based health promotion team shall: 

    (1) collect and summarize community health data relating to 
 behavioral risk factors such as smoking, consumption of 
 alcoholic beverages, and poor nutrition habits; 

    (2) identify, rank, and prioritize lifestyle-based health 
 problems; 

    (3) develop strategies to address health promotion 
 concerns; 

    (4) implement a five-year health promotion plan that 
 includes an annual evaluation component and establish a 
 mechanism for program maintenance following completion of the 
 plan; 

    (5) design and implement a "healthy messages" media plan; 
 and 

    (6) seek grants and other funding from foundations, 
 educational institutions, and other nonprofit entities. 

    (c) Within the limit of available appropriations, the 
 commissioner may grant money to a community health board to 
 enable the board to establish a community-based health promotion 
 team.  The commissioner shall monitor the activities of teams 
 under this section and report to the legislature by January 1, 
 1991, on the teams' operation and progress. 

    HIST: 1Sp1985 c 14 art 19 s 24; 1987 c 309 s 13,19,25; 1989 c 
 120 s 1 

     145A.15 Home visiting program. 

    Subdivision 1.    Establishment.  (a) The commissioner 
 of health shall expand the current grant program to fund 
 additional projects designed to prevent child abuse and neglect 
 and reduce juvenile delinquency by promoting positive parenting, 
 resiliency in children, and a healthy beginning for children by 
 providing early intervention services for families in need.  
 Grant dollars shall be available to train paraprofessionals to 
 provide in-home intervention services and to allow public health 
 nurses to do case management of services.  The grant program 
 shall provide early intervention services for families in need 
 and will include: 

    (1) expansion of current public health nurse and family 
 aide home visiting programs and public health home visiting 
 projects which prevent child abuse and neglect, prevent juvenile 
 delinquency, and build resiliency in children; 

    (2) early intervention to promote a healthy and nurturing 
 beginning; 

    (3) distribution of educational and public information 
 programs and materials in hospital maternity divisions, 
 well-baby clinics, obstetrical clinics, and community clinics; 
 and 

    (4) training of home visitors in skills necessary for 
 comprehensive home visiting which promotes a healthy and 
 nurturing beginning for the child. 

    (b) No new grants shall be awarded under this section after 
 June 30, 2001.  Grant contracts awarded and in effect under this 
 section as of July 1, 2001, shall continue until their 
 expiration date. 

    Subd. 2.    Grant recipients.  (a) The commissioner is 
 authorized to award grants to programs that meet the 
 requirements of subdivision 3 and include a strong child abuse 
 and neglect prevention focus for families in need of services.  
 Priority will be given to families considered to be in need of 
 additional services.  These families include, but are not 
 limited to, families with: 

    (1) adolescent parents; 

    (2) a history of alcohol and other drug abuse; 

    (3) a history of child abuse, domestic abuse, or other 
 types of violence in the family of origin; 

    (4) a history of domestic abuse, rape, or other forms of 
 victimization; 

    (5) reduced cognitive functioning; 

    (6) a lack of knowledge of child growth and development 
 stages; 

    (7) low resiliency to adversities and environmental 
 stresses; or 

    (8) lack of sufficient financial resources to meet their 
 needs. 

    (b) Grants made under this section shall be used to fund 
 existing and new home visiting programs.  In awarding grants 
 under this section, the commissioner shall give priority to new 
 home visiting programs with local matching funds. 

    Subd. 3.    Program requirements.  (a) The commissioner 
 shall award grants, using a request for proposal system, to 
 programs designed to: 

    (1) contact families at the birth of the child through a 
 public health nurse or trained program representative who will 
 meet the family, provide information, describe the benefits of 
 the program, and offer a home visit to the family to occur 
 during the first weeks of the newborn's life in the home 
 setting; 

    (2) visit the family and newborn in the home setting at 
 which time the public health nurse or trained individual will 
 answer parents' questions, give information, including 
 information on breast feeding, and make referrals to any other 
 appropriate services; 

    (3) conduct a screening process to determine if families 
 need additional support or are at risk for child abuse and 
 neglect and provide additional home visiting services needed by 
 the families including, but not limited to, education on:  
 parenting skills, child development and stages of growth, 
 communication skills, stress management, problem-solving skills, 
 positive child discipline practices, methods to improve 
 parent-child interactions and enhance self-esteem, community 
 support services and other resources, and how to enjoy and have 
 fun with your children; 

    (4) establish clear objectives and protocols for the home 
 visits; 

    (5) determine the frequency and duration of home visits 
 based on a risk-need assessment of the client; except that home 
 visits may begin as early as the first trimester of pregnancy 
 and continue based on the need of the client until the child 
 reaches age six; 

    (6) refer and actively assist the family in accessing new 
 parent and family education, self-help and support services 
 available in the community; 

    (7) develop and distribute educational resource materials 
 and offer presentations on the prevention of child abuse and 
 neglect for use in hospital maternity divisions, well-baby 
 clinics, obstetrical clinics, and community clinics; and 

    (8) coordinate with other local home visitation programs, 
 particularly those offered by school boards under section 
 124D.13, subdivision 4, so as to avoid duplication. 

    (b) Programs must provide at least 40 hours of training for 
 public health nurses, family aides, and other home visitors.  
 Training must include information on the following: 

    (1) the dynamics of child abuse and neglect, domestic and 
 nondomestic violence, and victimization within family systems; 

    (2) signs of abuse or other indications that a child may be 
 at risk of abuse or neglect; 

    (3) what is child abuse and neglect; 

    (4) how to properly report cases of child abuse and 
 neglect; 

    (5) sensitivity and respect for diverse cultural practices 
 in child rearing and family systems, including but not limited 
 to complex family relationships, safety, appropriate services, 
 family preservation, family finances for self-sufficiency, and 
 other special needs or circumstances; 

    (6) community resources, social service agencies, and 
 family support activities or programs; 

    (7) healthy child development and growth; 

    (8) parenting skills; 

    (9) positive child discipline practices; 

    (10) identification of stress factors and stress reduction 
 techniques; 

    (11) home visiting techniques; 

    (12) needs assessment measures; and 

    (13) caring for the special needs of newborns and mothers 
 before and after the birth of the infant. 

    Program services must be community-based, accessible, and 
 culturally relevant and must be designed to foster collaboration 
 among existing agencies and community-based organizations. 

    Subd. 4.    Evaluation.  Each program that receives a 
 grant under this section must include a plan for program 
 evaluation designed to measure the effectiveness of the program 
 in preventing child abuse and neglect.  On January 1, 1994, and 
 annually thereafter, the commissioner of health shall submit a 
 report to the legislature on all activities initiated in the 
 prior biennium under this section.  The report shall include 
 information on the outcomes reported by all programs that 
 received grant funds under this section in that biennium. 

    Subd. 5.    Expiration.  This section expires June 30, 
 2003. 

    HIST: 1992 c 571 art 10 s 9; 1995 c 207 art 9 s 37; 1998 c 397 
 art 11 s 3; 1998 c 407 art 2 s 86; 1Sp2001 c 9 art 1 s 49,50 

     145A.16 Universally offered home visiting programs for 
  infant care. 

    Subdivision 1.    Establishment.  The commissioner shall 
 establish a grant program to fund universally offered home 
 visiting programs designed to serve all live births in 
 designated geographic areas.  The commissioner shall designate 
 the geographic area to be served by each program.  At least one 
 program must provide home visiting services to families within 
 the seven-county metropolitan area, and at least one program 
 must provide home visiting services to families outside the 
 metropolitan area.  The purpose of the program is to strengthen 
 families and to promote positive parenting and healthy child 
 development.  No new grants shall be awarded under this section 
 after June 30, 2001.  Competitive grant contracts awarded and in 
 effect under this section as of July 1, 2001, shall expire 
 December 31, 2003. 

    Subd. 2.    Steering committee.  The commissioner shall 
 establish an ad hoc steering committee to develop and implement 
 a comprehensive plan for the universally offered home visiting 
 programs.  The members of the ad hoc steering committee shall 
 include, at a minimum, representatives of local public health 
 departments, public health nurses, other health care providers, 
 paraprofessionals, community-based family workers, 
 representatives of the state councils of color, representatives 
 of health insurance plans, and other individuals with expertise 
 in the field of home visiting, early childhood health and 
 development, and child abuse prevention.  

    Subd. 3.    Program requirements.  The commissioner 
 shall award grants using a request for proposal system.  
 Existing home visiting programs or a family services 
 collaborative established under section 256F.13 may apply for 
 the grants.  Health information and assessment, counseling, 
 social support, educational services, and referral to community 
 resources must be offered to all families, regardless of need or 
 risk, beginning prenatally or as soon after birth as possible, 
 and continuing as needed.  Each program applying for a grant 
 must have access to adequate community resources to complement 
 the home visiting services and must be designed to: 

    (1) identify all newborn infants within the geographic area 
 served by the program.  Identification may be made prenatally or 
 at the time of birth; 

    (2) offer a home visit by a trained home visitor.  The 
 offer of a home visit must be made in a way that guarantees that 
 the existence of the pregnancy is not revealed to any other 
 individual without the written consent of the pregnant female.  
 If home visiting is accepted, the first visit must occur 
 prenatally or as soon after birth as possible and must include a 
 public health nursing assessment by a public health nurse; 

    (3) offer, at a minimum, information on infant care, child 
 growth and development, positive parenting, the prevention of 
 disease and exposure to environmental hazards, and support 
 services available in the community; 

    (4) provide information on and referral to health care 
 services, if needed, including information on health care 
 coverage for which the individual or family may be eligible and 
 information on family planning, pediatric preventive services, 
 immunizations, and developmental assessments, and information on 
 the availability of public assistance programs as appropriate; 

    (5) recruit home visit workers who will represent, to the 
 extent possible, all the races, cultures, and languages spoken 
 by eligible families in the designated geographic areas; and 

    (6) train and supervise home visitors in accordance with 
 the requirements established under subdivision 5.  

    Subd. 4.    Coordination.  To minimize duplication, a 
 program receiving a grant must establish a coalition that 
 includes parents, health care providers who provide services to 
 families with young children in the service area, and 
 representatives of local schools, governmental and nonprofit 
 agencies, community-based organizations, health insurance plans, 
 and local hospitals.  A program may use a family services 
 collaborative as the coalition if a collaborative is established 
 in the area served by the program.  The coalition must designate 
 the roles of all provider agencies, family identification 
 methods, referral mechanisms, and payment responsibilities 
 appropriate for the existing systems in the program's service 
 area.  The coalition must also coordinate with other programs 
 offered by school boards under section 124D.13, subdivision 4, 
 and programs offered under section 145A.15.  

    Subd. 5.    Training.  The commissioner shall establish 
 training requirements for home visitors and minimum requirements 
 for supervision by a public health nurse.  The requirements for 
 nurses must be consistent with chapter 148.  Training must 
 include child development, positive parenting techniques, and 
 diverse cultural practices in child rearing and family systems.  
 A program may use grant money to train home visitors. 

    Subd. 6.    Evaluation.  (a) The commissioner shall 
 evaluate the effectiveness of the home visiting programs, taking 
 into consideration the following goals:  

    (1) appropriate child growth, development, and access to 
 health care; 

    (2) appropriate utilization of preventive health care and 
 medical care for acute illnesses; 

    (3) lower rates of substantiated child abuse and neglect; 

    (4) up-to-date immunizations; 

    (5) a reduction in unintended pregnancies; 

    (6) increasing families' understanding of lead poisoning 
 prevention; 

    (7) lower rates of unintentional injuries; and 

    (8) fewer hospitalizations and emergency room visits.  

    (b) The commissioner shall compare overall outcomes of 
 universally offered home visiting programs with targeted home 
 visiting programs and report the findings to the legislature.  
 The report must also include information on how home visiting 
 programs will coordinate activities and preventive services 
 provided by health plans and other organizations. 

    (c) The commissioner shall report to the legislature by 
 February 15, 1998, on the comprehensive plan for the universally 
 offered home visiting programs and recommend any draft 
 legislation needed to implement the plan.  The commissioner 
 shall report to the legislature biennially beginning December 
 15, 2001, on the effectiveness of the universally offered home 
 visiting programs.  In the report due December 15, 2001, the 
 commissioner shall include recommendations on the feasibility 
 and cost of expanding the program statewide.  

    Subd. 7.    Technical assistance.  The commissioner 
 shall provide administrative and technical assistance to each 
 program, including assistance conducting short- and long-term 
 evaluations of the home visiting program required under 
 subdivision 6.  The commissioner may request research and 
 evaluation support from the University of Minnesota.  

    Subd. 8.    Matching funds.  The commissioner and the 
 grant programs shall seek to supplement any state funding with 
 private and other nonstate funding sources, including other 
 grants and insurance coverage for services provided.  Program 
 funding may be used only to supplement, not to replace, existing 
 funds being used for home visiting.  

    Subd. 9.    Payment for home visiting services.  Any 
 health plan that provides services to families or individuals 
 enrolled in medical assistance, general assistance medical care, 
 or the MinnesotaCare program must contract with the programs 
 receiving grants under this section and the programs established 
 under section 145A.15 that are providing home visiting services 
 in the area served by the health plan to provide home visiting 
 services covered under medical assistance, general assistance 
 medical care, or the MinnesotaCare program to their enrollees.  
 A health plan may require a home visiting program to comply with 
 the health plan's requirements on the same basis as the health 
 plan's other participating providers. 

    Subd. 10.    Expiration.  This section expires December 
 31, 2003. 

    HIST: 1997 c 203 art 2 s 16; 1998 c 397 art 11 s 3; 1Sp2001 c 
 9 art 1 s 51,52 

     145A.17 Family home visiting programs. 

    Subdivision 1.    Establishment; goals.  The 
 commissioner shall establish a program to fund family home 
 visiting programs designed to foster a healthy beginning for 
 children in families at or below 200 percent of the federal 
 poverty guidelines, prevent child abuse and neglect, reduce 
 juvenile delinquency, promote positive parenting and resiliency 
 in children, and promote family health and economic 
 self-sufficiency.  A program funded under this section must 
 serve families at or below 200 percent of the federal poverty 
 guidelines, and other families determined to be at risk, 
 including but not limited to being at risk for child abuse, 
 child neglect, or juvenile delinquency.  Programs must give 
 priority for services to families considered to be in need of 
 services, including but not limited to families with: 

    (1) adolescent parents; 

    (2) a history of alcohol or other drug abuse; 

    (3) a history of child abuse, domestic abuse, or other 
 types of violence; 

    (4) a history of domestic abuse, rape, or other forms of 
 victimization; 

    (5) reduced cognitive functioning; 

    (6) a lack of knowledge of child growth and development 
 stages; 

    (7) low resiliency to adversities and environmental 
 stresses; or 

    (8) insufficient financial resources to meet family needs. 

    Subd. 2.    Allocation of funds.  The commissioner shall 
 distribute funds available under this section to community 
 health boards, as defined in section 145A.02, and to tribal 
 governments.  Funds shall be distributed to community health 
 boards as follows:  (1) each community health board shall 
 receive an allocation of $25,000 per year; and (2) remaining 
 funds available to community health boards shall be distributed 
 according to the formula in section 256J.625, subdivision 3.  
 The commissioner, in consultation with tribal governments, shall 
 establish a formula for distributing funds to tribal governments.

    Subd. 3.    Requirements for programs; process.  (a) 
 Before a community health board or tribal government may receive 
 an allocation under subdivision 2, a community health board or 
 tribal government must submit a proposal to the commissioner 
 that includes identification, based on a community assessment, 
 of the populations at or below 200 percent of the federal 
 poverty guidelines that will be served and the other populations 
 that will be served.  Each program that receives funds must: 

    (1) use either a broad community-based or selective 
 community-based strategy to provide preventive and early 
 intervention home visiting services; 

    (2) offer a home visit by a trained home visitor.  If a 
 home visit is accepted, the first home visit must occur 
 prenatally or as soon after birth as possible and must include a 
 public health nursing assessment by a public health nurse; 

    (3) offer, at a minimum, information on infant care, child 
 growth and development, positive parenting, preventing diseases, 
 preventing exposure to environmental hazards, and support 
 services available in the community; 

    (4) provide information on and referrals to health care 
 services, if needed, including information on health care 
 coverage for which the child or family may be eligible; and 
 provide information on preventive services, developmental 
 assessments, and the availability of public assistance programs 
 as appropriate; 

    (5) provide youth development programs; 

    (6) recruit home visitors who will represent, to the extent 
 possible, the races, cultures, and languages spoken by families 
 that may be served; 

    (7) train and supervise home visitors in accordance with 
 the requirements established under subdivision 4; 

    (8) maximize resources and minimize duplication by 
 coordinating activities with local social and human services 
 organizations, education organizations, and other appropriate 
 governmental entities and community-based organizations and 
 agencies; and 

    (9) utilize appropriate racial and ethnic approaches to 
 providing home visiting services. 

    (b) Funds available under this section shall not be used 
 for medical services.  The commissioner shall establish an 
 administrative cost limit for recipients of funds.  The outcome 
 measures established under subdivision 6 must be specified to 
 recipients of funds at the time the funds are distributed. 

    (c) Data collected on individuals served by the home 
 visiting programs must remain confidential and must not be 
 disclosed by providers of home visiting services without a 
 specific informed written consent that identifies disclosures to 
 be made.  Upon request, agencies providing home visiting 
 services must provide recipients with information on 
 disclosures, including the names of entities and individuals 
 receiving the information and the general purpose of the 
 disclosure.  Prospective and current recipients of home visiting 
 services must be told and informed in writing that written 
 consent for disclosure of data is not required for access to 
 home visiting services. 

    Subd. 4.    Training.  The commissioner shall establish 
 training requirements for home visitors and minimum requirements 
 for supervision by a public health nurse.  The requirements for 
 nurses must be consistent with chapter 148.  Training must 
 include child development, positive parenting techniques, 
 screening and referrals for child abuse and neglect, and diverse 
 cultural practices in child rearing and family systems. 

    Subd. 5.    Technical assistance.  The commissioner 
 shall provide administrative and technical assistance to each 
 program, including assistance in data collection and other 
 activities related to conducting short- and long-term 
 evaluations of the programs as required under subdivision 7.  
 The commissioner may request research and evaluation support 
 from the University of Minnesota. 

    Subd. 6.    Outcome measures.  The commissioner shall 
 establish outcomes to determine the impact of family home 
 visiting programs funded under this section on the following 
 areas: 

    (1) appropriate utilization of preventive health care; 

    (2) rates of substantiated child abuse and neglect; 

    (3) rates of unintentional child injuries; 

    (4) rates of children who are screened and who pass early 
 childhood screening; and 

    (5) any additional qualitative goals and quantitative 
 measures established by the commissioner. 

    Subd. 7.    Evaluation.  Using the qualitative goals and 
 quantitative outcome measures established under subdivisions 1 
 and 6, the commissioner shall conduct ongoing evaluations of the 
 programs funded under this section.  Community health boards and 
 tribal governments shall cooperate with the commissioner in the 
 evaluations and shall provide the commissioner with the 
 information necessary to conduct the evaluations.  As part of 
 the ongoing evaluations, the commissioner shall rate the impact 
 of the programs on the outcome measures listed in subdivision 6, 
 and shall periodically determine whether home visiting programs 
 are the best way to achieve the qualitative goals established 
 under subdivisions 1 and 6.  If the commissioner determines that 
 home visiting programs are not the best way to achieve these 
 goals, the commissioner shall provide the legislature with 
 alternative methods for achieving them. 

    Subd. 8.    Report.  By January 15, 2002, and January 15 
 of each even-numbered year thereafter, the commissioner shall 
 submit a report to the legislature on the family home visiting 
 programs funded under this section and on the results of the 
 evaluations conducted under subdivision 7. 

    Subd. 9.    No supplanting of existing funds.  Funding 
 available under this section may be used only to supplement, not 
 to replace, nonstate funds being used for home visiting services 
 as of July 1, 2001. 

    HIST: 1Sp2001 c 9 art 1 s 53