1.1    .................... moves to amend H. F. No. 297 as follows:
1.2Delete everything after the enacting clause and insert:

1.3"ARTICLE 1
1.4CHILDREN AND FAMILY

1.5    Section 1. Minnesota Statutes 2006, section 119B.05, subdivision 1, is amended to read:
1.6    Subdivision 1. Eligible participants. Families eligible for child care assistance
1.7under the MFIP child care program are:
1.8    (1) MFIP participants who are employed or in job search and meet the requirements
1.9of section 119B.10;
1.10    (2) persons who are members of transition year families under section 119B.011,
1.11subdivision 20
, and meet the requirements of section 119B.10;
1.12    (3) families who are participating in employment orientation or job search, or
1.13other employment or training activities that are included in an approved employability
1.14development plan under section sections 256J.09 and 256J.95;
1.15    (4) MFIP families who are participating in work job search, job support,
1.16employment, or training activities as required in their employment plan, or in appeals,
1.17hearings, assessments, or orientations according to chapter 256J;
1.18    (5) MFIP families who are participating in social services activities under chapter
1.19256J as required in their employment plan approved according to chapter 256J;
1.20    (6) families who are participating in programs as required in tribal contracts under
1.21section 119B.02, subdivision 2, or 256.01, subdivision 2; and
1.22    (7) families who are participating in the transition year extension under section
1.23119B.011, subdivision 20a .

1.24    Sec. 2. Minnesota Statutes 2006, section 256.01, subdivision 4, is amended to read:
1.25    Subd. 4. Duties as state agency. (a) The state agency shall:
2.1    (1) supervise the administration of assistance to dependent children under Laws
2.21937, chapter 438, by the county agencies in an integrated program with other service for
2.3dependent children maintained under the direction of the state agency;
2.4    (2) may subpoena witnesses and administer oaths, make rules, and take such action
2.5as may be necessary, or desirable for carrying out the provisions of Laws 1937, chapter
2.6438. All rules made by the state agency shall be binding on the counties and shall be
2.7complied with by the respective county agencies;
2.8    (3) (2) establish adequate standards for personnel employed by the counties and the
2.9state agency in the administration of Laws 1937, chapter 438, and make the necessary
2.10rules to maintain such standards;
2.11    (4) (3) prescribe the form of and print and supply to the county agencies blanks
2.12for applications, reports, affidavits, and such other forms as it may deem necessary and
2.13advisable;
2.14    (5) (4) cooperate with the federal government and its public welfare agencies
2.15in any reasonable manner as may be necessary to qualify for federal aid for temporary
2.16assistance for needy families and in conformity with title I of Public Law 104-193, the
2.17Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and successor
2.18amendments, including the making of such reports and such forms and containing such
2.19information as the Federal Social Security Board may from time to time require, and
2.20comply with such provisions as such board may from time to time find necessary to assure
2.21the correctness and verification of such reports;
2.22    (6) may cooperate with other state agencies in establishing reciprocal agreements in
2.23instances where a child receiving Minnesota family investment program assistance moves
2.24or contemplates moving into or out of the state, in order that such child may continue to
2.25receive supervised aid from the state moved from until the child shall have resided for
2.26one year in the state moved to;
2.27    (7) (5) on or before October 1 in each even-numbered year make a biennial report
2.28to the governor concerning the activities of the agency;
2.29    (8) (6) enter into agreements with other departments of the state as necessary to meet
2.30all requirements of the federal government; and
2.31    (9) (7) cooperate with the commissioner of education to enforce the requirements
2.32for program integrity and fraud prevention for investigation for child care assistance
2.33under chapter 119B.
2.34    (b) The state agency may:
2.35    (1) subpoena witnesses and administer oaths, make rules, and take such action as
2.36may be necessary or desirable for carrying out the provisions of Laws 1937, chapter 438.
3.1All rules made by the state agency shall be binding on the counties and shall be complied
3.2with by the respective county agencies;
3.3    (2) cooperate with other state agencies in establishing reciprocal agreements in
3.4instances where a child receiving Minnesota family investment program assistance moves
3.5or contemplates moving into or out of the state, in order that the child may continue
3.6to receive supervised aid from the state moved from until the child has resided for one
3.7year in the state moved to; and
3.8    (3) administer oaths and affirmations, take depositions, certify to official acts, and
3.9issue subpoenas to compel the attendance of individuals and the production of documents
3.10and other personal property necessary in connection with the administration of programs
3.11administered by the Department of Human Services.
3.12    (c) The fees for service of a subpoena in paragraph (b), clause (3), must be paid in
3.13the same manner as prescribed by law for a service of process issued by a district court.
3.14Witnesses must receive the same fees and mileage as in civil actions.
3.15    (d) The subpoena in paragraph (b), clause (3), shall be enforceable through the
3.16district court in the district where the subpoena is issued.

3.17    Sec. 3. Minnesota Statutes 2006, section 256.01, subdivision 18, is amended to read:
3.18    Subd. 18. Immigration status verifications. (a) Notwithstanding any waiver of
3.19this requirement by the secretary of the United States Department of Health and Human
3.20Services, effective July 1, 2001, the commissioner shall utilize the Systematic Alien
3.21Verification for Entitlements (SAVE) program to conduct immigration status verifications:
3.22    (1) as required under United States Code, title 8, section 1642;
3.23    (2) for all applicants and recipients at recertification for food assistance benefits,
3.24whether under the federal food stamp program, the MFIP or work first program, or the
3.25Minnesota food assistance program;
3.26    (3) for all applicants and recipients at recertification for general assistance medical
3.27care, except assistance for an emergency medical condition, for immunization with respect
3.28to an immunizable disease, or for testing and treatment of symptoms of a communicable
3.29disease; and
3.30    (4) for all applicants and recipients at recertification for general assistance,
3.31Minnesota supplemental aid, MinnesotaCare, or group residential housing, when the
3.32benefits provided by these programs would fall under the definition of "federal public
3.33benefit" under United States Code, title 8, section 1642, if federal funds were used to
3.34pay for all or part of the benefits.
4.1    (b) The commissioner shall comply with the reporting requirements under United
4.2States Code, title 42, section 611a, and any federal regulation or guidance adopted under
4.3that law.

4.4    Sec. 4. Minnesota Statutes 2006, section 256.01, is amended by adding a subdivision
4.5to read:
4.6    Subd. 23. Administrative simplification; county cost study. (a) The commissioner
4.7shall establish and convene the first meeting of an advisory committee to identify ways
4.8to simplify and streamline human services laws and administrative requirements. The
4.9advisory committee shall select its chair from its membership at the first meeting.
4.10    (b) The committee shall consist of three senators appointed by the senate Committee
4.11on Rules and Administration, three state representatives appointed by the speaker of the
4.12house of representatives, four department staff, and five county representatives appointed
4.13by the Association of Minnesota Counties after consultation with other relevant county
4.14organizations.
4.15    (c) The committee shall annually select up to two topics for review. The goals of
4.16the reviews are to discuss opportunities for administrative improvements and increased
4.17simplification and streamlining to improve consistency, efficiency, fairness, and to reduce
4.18the risk of recipient noncompliance. In reviewing the topics selected, consideration shall
4.19be given to:
4.20    (1) current challenges in administrative complexity and service delivery and whether
4.21the sharing of responsibilities between the state and the county should be altered in any
4.22way, including transferring responsibilities from one entity to the other;
4.23    (2) methods of reducing inconsistency with similar programs; and
4.24    (3) the current funding mechanism, whether funding formulas should be adjusted for
4.25special demographic or geographic factors that influence program costs, differences in
4.26county property tax contributions and maintenance of effort obligations, and whether the
4.27mix of state and county obligations for financial support of this service should be changed.
4.28    (d) The committee members shall assume responsibility for reporting progress to
4.29the appropriate leadership of the groups they represent. The commissioner, in partnership
4.30with the advisory committee, shall report to the legislative committees and divisions with
4.31jurisdiction over the Department of Human Services on the findings and recommendations
4.32of the advisory committee by December 15 of each year.
4.33    (e) This section expires June 30, 2012.

4.34    Sec. 5. Minnesota Statutes 2006, section 256.015, subdivision 7, is amended to read:
4.35    Subd. 7. Cooperation required. Upon the request of the Department of Human
4.36Services, any state agency or third party payer shall cooperate with the department in
5.1furnishing information to help establish a third party liability. Upon the request of the
5.2Department of Human Services or county child support or human service agencies, any
5.3employer or third party payer shall cooperate in furnishing information about group health
5.4insurance plans or medical benefit plans available to its employees. For purposes of
5.5section 176.191, subdivision 4, the Department of Labor and Industry may allow the
5.6Department of Human Services and county agencies direct access and data matching on
5.7information relating to workers' compensation claims in order to determine whether the
5.8claimant has reported the fact of a pending claim and the amount paid to or on behalf of
5.9the claimant to the Department of Human Services. The Department of Human Services
5.10and county agencies shall limit its use of information gained from agencies, third party
5.11payers, and employers to purposes directly connected with the administration of its public
5.12assistance and child support programs. The provision of information by agencies, third
5.13party payers, and employers to the department under this subdivision is not a violation of
5.14any right of confidentiality or data privacy.

5.15    Sec. 6. Minnesota Statutes 2006, section 256.0471, subdivision 1, is amended to read:
5.16    Subdivision 1. Qualifying overpayment. Any overpayment for assistance granted
5.17under chapter 119B, the MFIP program formerly codified under sections 256.031 to
5.18256.0361 , and the AFDC program formerly codified under sections 256.72 to 256.871;
5.19chapters 256B, 256D, 256I, 256J, and 256K, and 256L; and the food stamp or food support
5.20program, except agency error claims, become a judgment by operation of law 90 days
5.21after the notice of overpayment is personally served upon the recipient in a manner that
5.22is sufficient under rule 4.03(a) of the Rules of Civil Procedure for district courts, or by
5.23certified mail, return receipt requested. This judgment shall be entitled to full faith and
5.24credit in this and any other state.

5.25    Sec. 7. Minnesota Statutes 2006, section 256.984, subdivision 1, is amended to read:
5.26    Subdivision 1. Declaration. Every application for public assistance under this
5.27chapter or chapters 256B, 256D, 256J, and 256L; child care programs under chapter 119B;
5.28and food stamps or food support under chapter 393 shall be in writing or reduced to
5.29writing as prescribed by the state agency and shall contain the following declaration which
5.30shall be signed by the applicant:
5.31"I declare under the penalties of perjury that this application has been examined
5.32by me and to the best of my knowledge is a true and correct statement of every
5.33material point. I understand that a person convicted of perjury may be sentenced
5.34to imprisonment of not more than five years or to payment of a fine of not more
5.35than $10,000, or both."

6.1    Sec. 8. [256F.15] GRANT PROGRAM FOR CRISIS NURSERIES.
6.2    Subdivision 1. Crisis nurseries. The commissioner of human services shall
6.3establish a grant program to assist private and public agencies and organizations to
6.4provide crisis nurseries to offer services and temporary care to families experiencing crisis
6.5situations including children who are at high risk of abuse and neglect, children who have
6.6been abused and neglected, and children who are in families receiving child protective
6.7services. This service shall be provided without a fee for a maximum of 30 days in any
6.8year. Crisis nurseries shall provide short-term case management, family support services,
6.9parent education, crisis intervention, referrals, and resources, as needed.
6.10    (a) The crisis nurseries must provide a spectrum of services that may include, but
6.11are not limited to:
6.12    (1) being available 24 hours a day, seven days a week;
6.13    (2) providing services for children up to 72 hours at any one time;
6.14    (3) providing short-term case management to bridge the gap between crisis and
6.15successful living;
6.16    (4) making referrals for parents to counseling services and other community
6.17resources to help alleviate the underlying cause of the precipitating stress or crisis;
6.18    (5) providing services without a fee for a maximum of 30 days in any year;
6.19    (6) providing services to families with children from birth through 12 years of age,
6.20as services are available;
6.21    (7) providing an immediate response to family needs and strengths with an initial
6.22assessment and intake interview, making referrals to appropriate agencies or programs,
6.23and providing temporary care of children, as needed;
6.24    (8) maintaining the clients' confidentiality to the extent required by law, and also
6.25complying with statutory reporting requirements which may mandate a report to child
6.26protective services;
6.27    (9) providing a volunteer component and support for volunteers;
6.28    (10) providing preservice training and ongoing training to providers and volunteers;
6.29    (11) evaluating the services provided by documenting use of services, the result of
6.30family referrals made to community resources, and how the services reduced the risk of
6.31maltreatment;
6.32    (12) providing developmental assessments;
6.33    (13) providing medical assessments as determined by using a risk screening tool;
6.34    (14) providing parent education classes or programs that include parent-child
6.35interaction either on site or in collaboration with other community agencies; and
7.1    (15) having a multidisciplinary advisory board which may include one or more
7.2parents who have used the crisis nursery services.
7.3    (b) The crisis nurseries are encouraged to provide opportunities for parents to
7.4volunteer, if appropriate.
7.5    (c) Parents shall retain custody of their children during placement in a crisis facility.
7.6    Subd. 2. Fund distribution. In distributing funds, the commissioner shall give
7.7priority consideration to agencies and organizations with experience in working with
7.8abused or neglected children and their families, and with children at high risk of abuse and
7.9neglect and their families, and serve communities which demonstrate the greatest need
7.10for these services. Funds shall be distributed to crisis nurseries according to a formula
7.11developed by the commissioner in consultation with the Minnesota Crisis Nursery
7.12Association. The formula shall include funding for all existing crisis nursery programs
7.13that have been previously funded through the Department of Human Services and that
7.14meet program requirements as specified in subdivision 1, paragraph (a), and consideration
7.15of factors reflecting the need for services in each service area, including but not limited to
7.16the number of children 18 years of age and under living in the service area, the percent
7.17of children 18 years of age and under living in poverty in the service area, and factors
7.18reflecting the cost of providing services, including but not limited to the number of hours
7.19of service provided in the previous year.

7.20    Sec. 9. Minnesota Statutes 2006, section 256J.01, is amended by adding a subdivision
7.21to read:
7.22    Subd. 6. Legislative approval to move programs or activities. The commissioner
7.23shall not move programs or activities funded with MFIP or TANF maintenance of effort
7.24funds to other funding sources without legislative approval.

7.25    Sec. 10. Minnesota Statutes 2006, section 256J.02, subdivision 1, is amended to read:
7.26    Subdivision 1. Commissioner's authority to administer block grant funds. The
7.27commissioner of human services is authorized to receive, administer, and expend funds
7.28available under the TANF block grant authorized under title I of Public Law 104-193, the
7.29Personal Responsibility and Work Opportunity Reconciliation Act of 1996, and under
7.30Public Law 109-171, the Deficit Reduction Act of 2005.

7.31    Sec. 11. Minnesota Statutes 2006, section 256J.02, subdivision 4, is amended to read:
7.32    Subd. 4. Authority to transfer. Subject to limitations of title I of Public Law
7.33104-193, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
7.34as amended, and under Public Law 109-171, the Deficit Reduction Act of 2005, the
8.1legislature may transfer money from the TANF block grant to the child care fund under
8.2chapter 119B, or the Title XX block grant.

8.3    Sec. 12. Minnesota Statutes 2006, section 256J.021, is amended to read:
8.4256J.021 SEPARATE STATE PROGRAM FOR USE OF STATE MONEY.
8.5    Families receiving assistance under this section must comply with all applicable
8.6requirements in this chapter.
8.7    (a) Until October 1, 2006, the commissioner of human services must treat MFIP
8.8expenditures made to or on behalf of any minor child under section 256J.02, subdivision
8.92
, clause (1), who is a resident of this state under section 256J.12, and who is part of a
8.10two-parent eligible household as expenditures under a separately funded state program
8.11and report those expenditures to the federal Department of Health and Human Services
8.12as separate state program expenditures under Code of Federal Regulations, title 45,
8.13section 263.5.
8.14    (b) Beginning October 1, 2006, and each year thereafter, the commissioner of human
8.15services must treat MFIP expenditures made to or on behalf of any minor child under
8.16section 256J.02, subdivision 2, clause (1), who is a resident of this state under section
8.17256J.12, and who is part of a two-parent eligible household, as expenditures under a
8.18separately funded state program. These expenditures shall not count toward the state's
8.19maintenance of effort (MOE) requirements under the federal Temporary Assistance to
8.20Needy Families (TANF) program except if counting certain families would allow the
8.21commissioner to avoid a federal penalty. Families receiving assistance under this section
8.22must comply with all applicable requirements in this chapter.

8.23    Sec. 13. Minnesota Statutes 2006, section 256J.21, subdivision 2, is amended to read:
8.24    Subd. 2. Income exclusions. The following must be excluded in determining a
8.25family's available income:
8.26    (1) payments for basic care, difficulty of care, and clothing allowances received for
8.27providing family foster care to children or adults under Minnesota Rules, parts 9555.5050
8.28to 9555.6265, 9560.0521, and 9560.0650 to 9560.0655, and payments received and used
8.29for care and maintenance of a third-party beneficiary who is not a household member;
8.30    (2) reimbursements for employment training received through the Workforce
8.31Investment Act of 1998, United States Code, title 20, chapter 73, section 9201;
8.32    (3) reimbursement for out-of-pocket expenses incurred while performing volunteer
8.33services, jury duty, employment, or informal carpooling arrangements directly related to
8.34employment;
8.35    (4) all educational assistance, except the county agency must count graduate student
8.36teaching assistantships, fellowships, and other similar paid work as earned income and,
9.1after allowing deductions for any unmet and necessary educational expenses, shall
9.2count scholarships or grants awarded to graduate students that do not require teaching
9.3or research as unearned income;
9.4    (5) loans, regardless of purpose, from public or private lending institutions,
9.5governmental lending institutions, or governmental agencies;
9.6    (6) loans from private individuals, regardless of purpose, provided an applicant or
9.7participant documents that the lender expects repayment;
9.8    (7)(i) state income tax refunds; and
9.9    (ii) federal income tax refunds;
9.10    (8)(i) federal earned income credits;
9.11    (ii) Minnesota working family credits;
9.12    (iii) state homeowners and renters credits under chapter 290A; and
9.13    (iv) federal or state tax rebates;
9.14    (9) funds received for reimbursement, replacement, or rebate of personal or real
9.15property when these payments are made by public agencies, awarded by a court, solicited
9.16through public appeal, or made as a grant by a federal agency, state or local government,
9.17or disaster assistance organizations, subsequent to a presidential declaration of disaster;
9.18    (10) the portion of an insurance settlement that is used to pay medical, funeral, and
9.19burial expenses, or to repair or replace insured property;
9.20    (11) reimbursements for medical expenses that cannot be paid by medical assistance;
9.21    (12) payments by a vocational rehabilitation program administered by the state
9.22under chapter 268A, except those payments that are for current living expenses;
9.23    (13) in-kind income, including any payments directly made by a third party to a
9.24provider of goods and services;
9.25    (14) assistance payments to correct underpayments, but only for the month in which
9.26the payment is received;
9.27    (15) payments for short-term emergency needs under section 256J.626, subdivision
9.282
;
9.29    (16) funeral and cemetery payments as provided by section 256.935;
9.30    (17) nonrecurring cash gifts of $30 or less, not exceeding $30 per participant in
9.31a calendar month;
9.32    (18) any form of energy assistance payment made through Public Law 97-35,
9.33Low-Income Home Energy Assistance Act of 1981, payments made directly to energy
9.34providers by other public and private agencies, and any form of credit or rebate payment
9.35issued by energy providers;
10.1    (19) Supplemental Security Income (SSI), including retroactive SSI payments and
10.2other income of an SSI recipient, except as described in section 256J.37, subdivision 3b;
10.3    (20) Minnesota supplemental aid, including retroactive payments;
10.4    (21) proceeds from the sale of real or personal property;
10.5    (22) state adoption assistance payments under section 259.67, and up to an equal
10.6amount of county adoption assistance payments;
10.7    (23) state-funded family subsidy program payments made under section 252.32
10.8to help families care for children with developmental disabilities, consumer support
10.9grant funds under section 256.476, and resources and services for a disabled household
10.10member under one of the home and community-based waiver services programs under
10.11chapter 256B;
10.12    (24) interest payments and dividends from property that is not excluded from and
10.13that does not exceed the asset limit;
10.14    (25) rent rebates;
10.15    (26) income earned by a minor caregiver, minor child through age 6, or a minor
10.16child who is at least a half-time student in an approved elementary or secondary education
10.17program;
10.18    (27) income earned by a caregiver under age 20 who is at least a half-time student in
10.19an approved elementary or secondary education program;
10.20    (28) MFIP child care payments under section 119B.05;
10.21    (29) all other payments made through MFIP to support a caregiver's pursuit of
10.22greater economic stability;
10.23    (30) income a participant receives related to shared living expenses;
10.24    (31) reverse mortgages;
10.25    (32) benefits provided by the Child Nutrition Act of 1966, United States Code, title
10.2642, chapter 13A, sections 1771 to 1790;
10.27    (33) benefits provided by the women, infants, and children (WIC) nutrition program,
10.28United States Code, title 42, chapter 13A, section 1786;
10.29    (34) benefits from the National School Lunch Act, United States Code, title 42,
10.30chapter 13, sections 1751 to 1769e;
10.31    (35) relocation assistance for displaced persons under the Uniform Relocation
10.32Assistance and Real Property Acquisition Policies Act of 1970, United States Code, title
10.3342, chapter 61, subchapter II, section 4636, or the National Housing Act, United States
10.34Code, title 12, chapter 13, sections 1701 to 1750jj;
10.35    (36) benefits from the Trade Act of 1974, United States Code, title 19, chapter
10.3612, part 2, sections 2271 to 2322;
11.1    (37) war reparations payments to Japanese Americans and Aleuts under United
11.2States Code, title 50, sections 1989 to 1989d;
11.3    (38) payments to veterans or their dependents as a result of legal settlements
11.4regarding Agent Orange or other chemical exposure under Public Law 101-239, section
11.510405, paragraph (a)(2)(E);
11.6    (39) income that is otherwise specifically excluded from MFIP consideration in
11.7federal law, state law, or federal regulation;
11.8    (40) security and utility deposit refunds;
11.9    (41) American Indian tribal land settlements excluded under Public Laws 98-123,
11.1098-124, and 99-377 to the Mississippi Band Chippewa Indians of White Earth, Leech
11.11Lake, and Mille Lacs reservations and payments to members of the White Earth Band,
11.12under United States Code, title 25, chapter 9, section 331, and chapter 16, section 1407;
11.13    (42) all income of the minor parent's parents and stepparents when determining the
11.14grant for the minor parent in households that include a minor parent living with parents or
11.15stepparents on MFIP with other children;
11.16    (43) income of the minor parent's parents and stepparents equal to 200 percent of the
11.17federal poverty guideline for a family size not including the minor parent and the minor
11.18parent's child in households that include a minor parent living with parents or stepparents
11.19not on MFIP when determining the grant for the minor parent. The remainder of income is
11.20deemed as specified in section 256J.37, subdivision 1b;
11.21    (44) payments made to children eligible for relative custody assistance under section
11.22257.85 ;
11.23    (45) vendor payments for goods and services made on behalf of a client unless the
11.24client has the option of receiving the payment in cash; and
11.25    (46) the principal portion of a contract for deed payment.; and
11.26    (47) cash payments to individuals enrolled for full-time service as a volunteer under
11.27AmeriCorps programs including AmeriCorps VISTA, AmeriCorps State, AmeriCorps
11.28National, and AmeriCorps NCCC.

11.29    Sec. 14. Minnesota Statutes 2006, section 256J.24, subdivision 10, is amended to read:
11.30    Subd. 10. MFIP exit level. The commissioner shall adjust the MFIP earned income
11.31disregard to ensure that most participants do not lose eligibility for MFIP until their
11.32income reaches at least 115 140 percent of the federal poverty guidelines in effect in
11.33October of each fiscal year. The adjustment to the disregard shall be based on a household
11.34size of three, and the resulting earned income disregard percentage must be applied to all
11.35household sizes. The adjustment under this subdivision must be implemented at the same
12.1time as the October food stamp or food support cost-of-living adjustment is reflected in
12.2the food portion of MFIP transitional standard as required under subdivision 5a.

12.3    Sec. 15. Minnesota Statutes 2006, section 256J.42, subdivision 1, is amended to read:
12.4    Subdivision 1. Time limit. (a) Except as otherwise provided for in this section, an
12.5assistance unit in which any adult caregiver has received 60 months of cash assistance
12.6funded in whole or in part by the TANF block grant in this or any other state or
12.7United States territory, or from a tribal TANF program, MFIP, the AFDC program
12.8formerly codified in sections 256.72 to 256.87, or the family general assistance program
12.9formerly codified in sections 256D.01 to 256D.23, funded in whole or in part by state
12.10appropriations, is ineligible to receive MFIP. Any cash assistance funded with TANF
12.11dollars in this or any other state or United States territory, or from a tribal TANF program,
12.12or MFIP assistance funded in whole or in part by state appropriations, that was received
12.13by the unit on or after the date TANF was implemented, including any assistance received
12.14in states or United States territories of prior residence, counts toward the 60-month
12.15limitation. Months during which any cash assistance is received by an assistance unit
12.16with a mandatory member who is disqualified for wrongfully obtaining public assistance
12.17under section 256.98, subdivision 8, counts toward the time limit for the disqualified
12.18member. The 60-month limit applies to a minor caregiver except under subdivision 5. The
12.1960-month time period does not need to be consecutive months for this provision to apply.
12.20    (b) The months before July 1998 in which individuals received assistance as part of
12.21the field trials as an MFIP, MFIP-R, or MFIP or MFIP-R comparison group family are
12.22not included in the 60-month time limit.
12.23EFFECTIVE DATE.This section is effective October 1, 2007.

12.24    Sec. 16. Minnesota Statutes 2006, section 256J.425, subdivision 3, is amended to read:
12.25    Subd. 3. Hard-to-employ participants. An assistance unit subject to the time
12.26limit in section 256J.42, subdivision 1, is eligible to receive months of assistance under
12.27a hardship extension if the participant who reached the time limit belongs to any of the
12.28following groups:
12.29    (1) a person who is diagnosed by a licensed physician, psychological practitioner,
12.30or other qualified professional, as developmentally disabled or mentally ill, and that
12.31condition prevents the person from obtaining or retaining unsubsidized employment;
12.32    (2) a person who:
12.33    (i) has been assessed by a vocational specialist or the county agency to be
12.34unemployable for purposes of this subdivision; or
13.1    (ii) has an IQ below 80 who has been assessed by a vocational specialist or a county
13.2agency to be employable, but not at a level that makes the participant eligible for an
13.3extension under subdivision 4. The determination of IQ level must be made by a qualified
13.4professional. In the case of a non-English-speaking person: (A) the determination must
13.5be made by a qualified professional with experience conducting culturally appropriate
13.6assessments, whenever possible; (B) the county may accept reports that identify an
13.7IQ range as opposed to a specific score; (C) these reports must include a statement of
13.8confidence in the results;
13.9    (3) a person who is determined by a qualified professional to be learning disabled,
13.10and the disability severely limits the person's ability to obtain, perform, or maintain
13.11suitable employment. For purposes of the initial approval of a learning disability
13.12extension, the determination must have been made or confirmed within the previous 12
13.13months. In the case of a non-English-speaking person: (i) the determination must be made
13.14by a qualified professional with experience conducting culturally appropriate assessments,
13.15whenever possible; and (ii) these reports must include a statement of confidence in the
13.16results. If a rehabilitation plan for a participant extended as learning disabled is developed
13.17or approved by the county agency, the plan must be incorporated into the employment
13.18plan. However, a rehabilitation plan does not replace the requirement to develop and
13.19comply with an employment plan under section 256J.521; or
13.20    (4) a person who has been granted a family violence waiver, and who is complying
13.21with an employment plan under section 256J.521, subdivision 3; or
13.22    (5) a participant under section 256J.561, subdivision 2, paragraph (d), who is
13.23complying with an employment plan tailored to recognize the special circumstances of
13.24the caregivers and family, including limitations due to illness or disability, and caregiving
13.25needs.

13.26    Sec. 17. Minnesota Statutes 2006, section 256J.425, subdivision 4, is amended to read:
13.27    Subd. 4. Employed participants. (a) An assistance unit subject to the time limit
13.28under section 256J.42, subdivision 1, is eligible to receive assistance under a hardship
13.29extension if the participant who reached the time limit belongs to:
13.30    (1) a one-parent assistance unit in which the participant is participating in work
13.31activities for at least 30 hours per week, of which an average of at least 25 hours per week
13.32every month are spent participating in employment;
13.33    (2) a two-parent assistance unit in which the participants are participating in work
13.34activities for at least 55 hours per week, of which an average of at least 45 hours per week
13.35every month are spent participating in employment; or
14.1    (3) an assistance unit in which a participant is participating in employment for fewer
14.2hours than those specified in clause (1) or (2), and the participant submits verification from
14.3a qualified professional, in a form acceptable to the commissioner, stating that the number
14.4of hours the participant may work is limited due to illness or disability, as long as the
14.5participant is participating in employment for at least the number of hours specified by the
14.6qualified professional. The participant must be following the treatment recommendations
14.7of the qualified professional providing the verification. The commissioner shall develop a
14.8form to be completed and signed by the qualified professional, documenting the diagnosis
14.9and any additional information necessary to document the functional limitations of the
14.10participant that limit work hours. If the participant is part of a two-parent assistance unit,
14.11the other parent must be treated as a one-parent assistance unit for purposes of meeting the
14.12work requirements under this subdivision.
14.13    (b) For purposes of this section, employment means:
14.14    (1) unsubsidized employment under section 256J.49, subdivision 13, clause (1);
14.15    (2) subsidized employment under section 256J.49, subdivision 13, clause (2);
14.16    (3) on-the-job training under section 256J.49, subdivision 13, clause (2);
14.17    (4) an apprenticeship under section 256J.49, subdivision 13, clause (1);
14.18    (5) supported work under section 256J.49, subdivision 13, clause (2);
14.19    (6) a combination of clauses (1) to (5); or
14.20    (7) child care under section 256J.49, subdivision 13, clause (7), if it is in combination
14.21with paid employment.
14.22    (c) If a participant is complying with a child protection plan under chapter 260C,
14.23the number of hours required under the child protection plan count toward the number
14.24of hours required under this subdivision.
14.25    (d) (c) The county shall provide the opportunity for subsidized employment to
14.26participants needing that type of employment within available appropriations.
14.27    (e) (d) To be eligible for a hardship extension for employed participants under this
14.28subdivision, a participant must be in compliance for at least ten out of the 12 months
14.29the participant received MFIP immediately preceding the participant's 61st month on
14.30assistance. If ten or fewer months of eligibility for TANF assistance remain at the time the
14.31participant from another state applies for assistance, the participant must be in compliance
14.32every month.
14.33    (f) (e) The employment plan developed under section 256J.521, subdivision 2, for
14.34participants under this subdivision must contain at least the minimum number of hours
14.35specified in paragraph (a) for the purpose of meeting the requirements for an extension
14.36under this subdivision. The job counselor and the participant must sign the employment
15.1plan to indicate agreement between the job counselor and the participant on the contents
15.2of the plan.
15.3    (g) (f) Participants who fail to meet the requirements in paragraph (a), without
15.4good cause under section 256J.57, shall be sanctioned or permanently disqualified under
15.5subdivision 6. Good cause may only be granted for that portion of the month for which
15.6the good cause reason applies. Participants must meet all remaining requirements in the
15.7approved employment plan or be subject to sanction or permanent disqualification.
15.8    (h) (g) If the noncompliance with an employment plan is due to the involuntary loss
15.9of employment, the participant is exempt from the hourly employment requirement under
15.10this subdivision for one month. Participants must meet all remaining requirements in the
15.11approved employment plan or be subject to sanction or permanent disqualification. This
15.12exemption is available to each participant two times in a 12-month period.

15.13    Sec. 18. Minnesota Statutes 2006, section 256J.46, is amended by adding a subdivision
15.14to read:
15.15    Subd. 3. Restrictions on sanctions. A participant shall not be sanctioned for failure
15.16to meet the agreed upon hours in a participant's employment plan under section 256J.521,
15.17subdivision 2, when the participant:
15.18    (1) fails to meet the agreed upon hours of participation in paid employment because
15.19the participant is not eligible for holiday pay and the participant's place of employment is
15.20closed for a holiday; or
15.21    (2) is otherwise meeting or exceeding the federal TANF work participation rate
15.22hourly requirements.

15.23    Sec. 19. Minnesota Statutes 2006, section 256J.49, subdivision 13, is amended to read:
15.24    Subd. 13. Work activity. "Work activity" means any activity in a participant's
15.25approved employment plan that leads to employment. For purposes of the MFIP program,
15.26this includes activities that meet the definition of work activity under the participation
15.27requirements of TANF. Work activity includes:
15.28    (1) unsubsidized employment, including work study and paid apprenticeships or
15.29internships;
15.30    (2) subsidized private sector or public sector employment, including grant diversion
15.31as specified in section 256J.69, on-the-job training as specified in section 256J.66,
15.32the self-employment investment demonstration program (SEID) as specified in section
15.33256J.65 , paid work experience, and supported work when a wage subsidy is provided;
15.34    (3) unpaid work experience, including community service, volunteer work,
15.35the community work experience program as specified in section 256J.67, unpaid
15.36apprenticeships or internships, and supported work when a wage subsidy is not provided.
16.1Unpaid work performed in return for cash assistance is prohibited and does not count
16.2as a work activity, unless the participant voluntarily agrees, in writing, to engage in
16.3unpaid work in return for cash assistance. The participant may terminate the unpaid
16.4work arrangement, in writing, at any time;
16.5    (4) job search including job readiness assistance, job clubs, job placement,
16.6job-related counseling, and job retention services;
16.7    (5) job readiness education, including English as a second language (ESL) or
16.8functional work literacy classes as limited by the provisions of section 256J.531,
16.9subdivision 2
, general educational development (GED) course work, high school
16.10completion, and adult basic education as limited by the provisions of section 256J.531,
16.11subdivision 1
;
16.12    (6) job skills training directly related to employment, including education and
16.13training that can reasonably be expected to lead to employment, as limited by the
16.14provisions of section 256J.53;
16.15    (7) providing child care services to a participant who is working in a community
16.16service program;
16.17    (8) activities included in the employment plan that is developed under section
16.18256J.521, subdivision 3 ; and
16.19    (9) preemployment activities including chemical and mental health assessments,
16.20treatment, and services; learning disabilities services; child protective services; family
16.21stabilization services; or other programs designed to enhance employability.

16.22    Sec. 20. Minnesota Statutes 2006, section 256J.521, subdivision 2, is amended to read:
16.23    Subd. 2. Employment plan; contents. (a) Based on the assessment under
16.24subdivision 1, the job counselor and the participant must develop an employment plan
16.25that includes participation in activities and hours that meet the requirements of section
16.26256J.55, subdivision 1 . The purpose of the employment plan is to identify for each
16.27participant the most direct path to unsubsidized employment and any subsequent steps that
16.28support long-term economic stability. The employment plan should be developed using
16.29the highest level of activity appropriate for the participant. Activities must be chosen from
16.30clauses (1) to (6), which are listed in order of preference. Notwithstanding this order of
16.31preference for activities, priority must be given for activities related to a family violence
16.32waiver when developing the employment plan. The employment plan must also list the
16.33specific steps the participant will take to obtain employment, including steps necessary
16.34for the participant to progress from one level of activity to another, and a timetable for
16.35completion of each step. Levels of activity include:
16.36    (1) unsubsidized employment;
17.1    (2) job search;
17.2    (3) subsidized employment or unpaid work experience;
17.3    (4) unsubsidized employment and job readiness education or job skills training;
17.4    (5) unsubsidized employment or unpaid work experience and activities related to
17.5a family violence waiver or preemployment needs; and
17.6    (6) activities related to a family violence waiver or preemployment needs.
17.7    (b) Participants who are determined to possess sufficient skills such that the
17.8participant is likely to succeed in obtaining unsubsidized employment must job search at
17.9least 30 hours per week for up to six weeks and accept any offer of suitable employment.
17.10The remaining hours necessary to meet the requirements of section 256J.55, subdivision
17.111
, may be met through participation in other work activities under section 256J.49,
17.12subdivision 13
. The participant's employment plan must specify, at a minimum: (1)
17.13whether the job search is supervised or unsupervised; (2) support services that will
17.14be provided; and (3) how frequently the participant must report to the job counselor.
17.15Participants who are unable to find suitable employment after six weeks must meet
17.16with the job counselor to determine whether other activities in paragraph (a) should be
17.17incorporated into the employment plan. Job search activities which are continued after six
17.18weeks must be structured and supervised.
17.19    (c) Beginning July 1, 2004, activities and hourly requirements in the employment
17.20plan may be adjusted as necessary to accommodate the personal and family circumstances
17.21of participants identified under section 256J.561, subdivision 2, paragraph (d). Participants
17.22who no longer meet the provisions of section 256J.561, subdivision 2, paragraph (d),
17.23must meet with the job counselor within ten days of the determination to revise the
17.24employment plan.
17.25    (d) Participants who are determined to have barriers to obtaining or retaining
17.26employment that will not be overcome during six weeks of job search under paragraph (b)
17.27must work with the job counselor to develop an employment plan that addresses those
17.28barriers by incorporating appropriate activities from paragraph (a), clauses (1) to (6).
17.29The employment plan must include enough hours to meet the participation requirements
17.30in section 256J.55, subdivision 1, unless a compelling reason to require fewer hours
17.31is noted in the participant's file.
17.32    (e) The job counselor and the participant must sign the employment plan to indicate
17.33agreement on the contents.
17.34    (f) Except as provided under paragraphs (g) and (h), failure to develop or comply
17.35with activities in the plan, or voluntarily quitting suitable employment without good
17.36cause, will result in the imposition of a sanction under section 256J.46. The job counselor
18.1is encouraged to allow participants who are participating in at least 20 hours of work
18.2activities to also participate in employment and training activities in order to meet the
18.3federal hourly participation rates.
18.4    (g) When a participant fails to meet the agreed upon hours of participation in paid
18.5employment because the participant is not eligible for holiday pay and the participant's
18.6place of employment is closed for a holiday, the job counselor shall not impose a sanction
18.7or increase the hours of participation in any other activity, including paid employment, to
18.8offset the hours that were missed due to the holiday.
18.9    (h) The job counselor shall not impose a sanction for failure to meet the agreed upon
18.10hours in a participant's employment plan under this subdivision when the participant
18.11is otherwise meeting or exceeding the federal TANF work participation rate hourly
18.12requirements.
18.13    (f) (i) Employment plans must be reviewed at least every three months to determine
18.14whether activities and hourly requirements should be revised.

18.15    Sec. 21. Minnesota Statutes 2006, section 256J.521, is amended by adding a
18.16subdivision to read:
18.17    Subd. 7. Employment plan; nonmaintenance of effort; single caregivers. (a)
18.18When a single caregiver is moved to the nonmaintenance of effort state-funded program
18.19under section 256J.021, paragraphs (a) and (b), the single caregiver shall develop or revise
18.20the employment plan as specified in this subdivision with a job counselor or county. The
18.21plan must address issues interfering with employment, including physical and mental
18.22health, substance use, and social service issues of the caregiver and the caregiver's family.
18.23Job search and employment must also be included in the plan to the extent possible.
18.24    (b) Counties must coordinate services by ensuring that all workers involved with
18.25the family communicate on a regular basis, and that expectations for the family across
18.26service areas lead to common goals.
18.27    (c) Activities and hourly requirements in the employment plan may be adjusted as
18.28necessary to accommodate the personal and family circumstances of the participant.
18.29Participants who no longer meet the criteria for the nonmaintenance of effort state-funded
18.30program shall meet with the job counselor or county within ten days of the determination
18.31to revise the employment plan.

18.32    Sec. 22. Minnesota Statutes 2006, section 256J.53, subdivision 2, is amended to read:
18.33    Subd. 2. Approval of postsecondary education or training. (a) In order for a
18.34postsecondary education or training program to be an approved activity in an employment
18.35plan, the participant must be working in unsubsidized employment at least 20 hours per
18.36week.
19.1    (b) Participants seeking approval of a postsecondary education or training plan
19.2must provide documentation that:
19.3    (1) the employment goal can only be met with the additional education or training;
19.4    (2) there are suitable employment opportunities that require the specific education or
19.5training in the area in which the participant resides or is willing to reside;
19.6    (3) the education or training will result in significantly higher wages for the
19.7participant than the participant could earn without the education or training;
19.8    (4) the participant can meet the requirements for admission into the program; and
19.9    (5) there is a reasonable expectation that the participant will complete the training
19.10program based on such factors as the participant's MFIP assessment, previous education,
19.11training, and work history; current motivation; and changes in previous circumstances.
19.12    (c) The hourly unsubsidized employment requirement does not apply for intensive
19.13education or training programs lasting 12 weeks or less when full-time attendance is
19.14required.
19.15    (d) (b) Participants with an approved employment plan in place on July 1, 2003,
19.16which includes more than 12 months of postsecondary education or training shall be
19.17allowed to complete that plan provided that hourly requirements in section 256J.55,
19.18subdivision 1
, and conditions specified in paragraph (b) (a), and subdivisions 3 and 5 are
19.19met. A participant whose case is subsequently closed for three months or less for reasons
19.20other than noncompliance with program requirements and who returns to MFIP shall
19.21be allowed to complete that plan provided that hourly requirements in section 256J.55,
19.22subdivision 1
, and conditions specified in paragraph (b) (a) and subdivisions 3 and 5 are
19.23met.

19.24    Sec. 23. Minnesota Statutes 2006, section 256J.55, subdivision 1, is amended to read:
19.25    Subdivision 1. Participation requirements. (a) All caregivers must participate
19.26in employment services under sections 256J.515 to 256J.57 concurrent with receipt of
19.27MFIP assistance.
19.28    (b) Until July 1, 2004, participants who meet the requirements of section 256J.56 are
19.29exempt from participation requirements.
19.30    (c) Participants under paragraph (a) must develop and comply with an employment
19.31plan under section 256J.521 or section 256J.54 in the case of a participant under the age of
19.3220 who has not obtained a high school diploma or its equivalent.
19.33    (d) With the exception of participants under the age of 20 who must meet the
19.34education requirements of section 256J.54, all participants must meet the hourly
19.35participation requirements of TANF or the hourly requirements listed in clauses (1) to
19.36(3), whichever is higher.
20.1    (1) In single-parent families with no children under six years of age, the job
20.2counselor and the caregiver must develop an employment plan that includes 30 to 35 hours
20.3per week of work activities 130 hours per month of work activities.
20.4    (2) In single-parent families with a child under six years of age, the job counselor
20.5and the caregiver must develop an employment plan that includes 20 to 35 hours per week
20.6of work activities 87 hours per month of work activities.
20.7    (3) In two-parent families, the job counselor and the caregivers must develop
20.8employment plans which result in a combined total of at least 55 hours per week of work
20.9activities.
20.10    (e) Failure to participate in employment services, including the requirement to
20.11develop and comply with an employment plan, including hourly requirements, without
20.12good cause under section 256J.57, shall result in the imposition of a sanction under section
20.13256J.46 .

20.14    Sec. 24. Minnesota Statutes 2006, section 256J.626, subdivision 6, is amended to read:
20.15    Subd. 6. Base allocation to counties and tribes; definitions. (a) For purposes of
20.16this section, the following terms have the meanings given.
20.17    (1) "2002 historic spending base" means the commissioner's determination of
20.18the sum of the reimbursement related to fiscal year 2002 of county or tribal agency
20.19expenditures for the base programs listed in clause (6), items (i) through (iv), and earnings
20.20related to calendar year 2002 in the base program listed in clause (6), item (v), and the
20.21amount of spending in fiscal year 2002 in the base program listed in clause (6), item (vi),
20.22issued to or on behalf of persons residing in the county or tribal service delivery area.
20.23    (2) "Adjusted caseload factor" means a factor weighted:
20.24    (i) 47 percent on the MFIP cases in each county at four points in time in the most
20.25recent 12-month period for which data is available multiplied by the county's caseload
20.26difficulty factor; and
20.27    (ii) 53 percent on the count of adults on MFIP in each county and tribe at four points
20.28in time in the most recent 12-month period for which data is available multiplied by the
20.29county or tribe's caseload difficulty factor.
20.30    (3) "Caseload difficulty factor" means a factor determined by the commissioner for
20.31each county and tribe based upon the self-support index described in section 256J.751,
20.32subdivision 2
, clause (7).
20.33    (4) "Initial allocation" means the amount potentially available to each county or tribe
20.34based on the formula in paragraphs (b) through (h).
20.35    (5) "Final allocation" means the amount available to each county or tribe based on
20.36the formula in paragraphs (b) through (h), after adjustment by subdivision 7.
21.1    (6) "Base programs" means the:
21.2    (i) MFIP employment and training services under Minnesota Statutes 2002, section
21.3256J.62, subdivision 1 , in effect June 30, 2002;
21.4    (ii) bilingual employment and training services to refugees under Minnesota Statutes
21.52002, section 256J.62, subdivision 6, in effect June 30, 2002;
21.6    (iii) work literacy language programs under Minnesota Statutes 2002, section
21.7256J.62, subdivision 7 , in effect June 30, 2002;
21.8    (iv) supported work program authorized in Laws 2001, First Special Session chapter
21.99, article 17, section 2, in effect June 30, 2002;
21.10    (v) administrative aid program under section 256J.76 in effect December 31, 2002;
21.11and
21.12    (vi) emergency assistance program under Minnesota Statutes 2002, section 256J.48,
21.13in effect June 30, 2002.
21.14    (b) The commissioner shall:
21.15    (1) beginning July 1, 2003, determine the initial allocation of funds available under
21.16this section according to clause (2);
21.17    (2) allocate all of the funds available for the period beginning July 1, 2003, and
21.18ending December 31, 2004, to each county or tribe in proportion to the county's or tribe's
21.19share of the statewide 2002 historic spending base;
21.20    (3) determine for calendar year 2005 the initial allocation of funds to be made
21.21available under this section in proportion to the county or tribe's initial allocation for the
21.22period of July 1, 2003, to December 31, 2004;
21.23    (4) determine for calendar year 2006 the initial allocation of funds to be made
21.24available under this section based 90 percent on the proportion of the county or tribe's
21.25share of the statewide 2002 historic spending base and ten percent on the proportion of
21.26the county or tribe's share of the adjusted caseload factor;
21.27    (5) determine for calendar year 2007 the initial allocation of funds to be made
21.28available under this section based 70 percent on the proportion of the county or tribe's
21.29share of the statewide 2002 historic spending base and 30 percent on the proportion of the
21.30county or tribe's share of the adjusted caseload factor; and
21.31    (6) determine for calendar year 2008 and subsequent years the initial allocation of
21.32funds to be made available under this section based 50 percent on the proportion of the
21.33county or tribe's share of the statewide 2002 historic spending base and 50 percent on the
21.34proportion of the county or tribe's share of the adjusted caseload factor.
21.35    (c) With the commencement of a new or expanded tribal TANF program or an
21.36agreement under section 256.01, subdivision 2, paragraph (g), in which some or all of
22.1the responsibilities of particular counties under this section are transferred to a tribe,
22.2the commissioner shall:
22.3    (1) in the case where all responsibilities under this section are transferred to a tribal
22.4program, determine the percentage of the county's current caseload that is transferring to a
22.5tribal program and adjust the affected county's allocation accordingly; and
22.6    (2) in the case where a portion of the responsibilities under this section are
22.7transferred to a tribal program, the commissioner shall consult with the affected county or
22.8counties to determine an appropriate adjustment to the allocation.
22.9    (d) Effective January 1, 2005, counties and tribes will have their final allocations
22.10adjusted based on the performance provisions of subdivision 7.

22.11    Sec. 25. Minnesota Statutes 2006, section 256J.751, subdivision 2, is amended to read:
22.12    Subd. 2. Quarterly comparison report. The commissioner shall report quarterly to
22.13all counties on each county's performance on the following measures:
22.14    (1) percent of MFIP caseload working in paid employment;
22.15    (2) percent of MFIP caseload receiving only the food portion of assistance;
22.16    (3) number of MFIP cases that have left assistance;
22.17    (4) median placement wage rate;
22.18    (5) caseload by months of TANF assistance;
22.19    (6) percent of MFIP and diversionary work program (DWP) cases off cash assistance
22.20or working 30 or more hours per week at one-year, two-year, and three-year follow-up
22.21points from a baseline quarter. This measure is called the self-support index. The
22.22commissioner shall report quarterly an expected range of performance for each county,
22.23county grouping, and tribe on the self-support index. The expected range shall be derived
22.24by a statistical methodology developed by the commissioner in consultation with the
22.25counties and tribes. The statistical methodology shall control differences across counties
22.26in economic conditions and demographics of the MFIP and DWP case load; and
22.27    (7) the MFIP TANF work participation rate, defined as the participation requirements
22.28specified in title 1 of Public Law 104-193 applied to all MFIP cases except child only
22.29cases under Public Law 109-171, the Deficit Reduction Act of 2005.

22.30    Sec. 26. Minnesota Statutes 2006, section 256J.751, subdivision 5, is amended to read:
22.31    Subd. 5. Failure to meet federal performance standards. (a) If sanctions occur
22.32for failure to meet the performance standards specified in title 1 of Public Law 104-193
22.33of the Personal Responsibility and Work Opportunity Act of 1996, and under Public
22.34Law 109-171, the Deficit Reduction Act of 2005, the state shall pay 88 percent of the
22.35sanction. The remaining 12 percent of the sanction will be paid by the counties. The
22.36county portion of the sanction will be distributed across all counties in proportion to each
23.1county's percentage of the MFIP average monthly caseload during the period for which
23.2the sanction was applied.
23.3    (b) If a county fails to meet the performance standards specified in title 1 of Public
23.4Law 104-193 of the Personal Responsibility and Work Opportunity Act of 1996, and
23.5Public Law 109-171, the Deficit Reduction Act of 2005, for any year, the commissioner
23.6shall work with counties to organize a joint state-county technical assistance team to work
23.7with the county. The commissioner shall coordinate any technical assistance with other
23.8departments and agencies including the Departments of Employment and Economic
23.9Development and Education as necessary to achieve the purpose of this paragraph.
23.10    (c) For state performance measures, a low-performing county is one that:
23.11    (1) performs below the bottom of their expected range for the measure in subdivision
23.122, clause (7) (6), in an annualized measurement reported in October of each year; or
23.13    (2) performs below 40 percent for the measure in subdivision 2, clause (8) (7), as
23.14averaged across the four quarterly measurements for the year, or the ten counties with the
23.15lowest rates if more than ten are below 40 percent.
23.16    (d) Low-performing counties under paragraph (c) must engage in corrective action
23.17planning as defined by the commissioner. The commissioner may coordinate technical
23.18assistance as specified in paragraph (b) for low-performing counties under paragraph (c).

23.19    Sec. 27. Minnesota Statutes 2006, section 256J.95, subdivision 3, is amended to read:
23.20    Subd. 3. Eligibility for diversionary work program. (a) Except for the categories
23.21of family units listed below, all family units who apply for cash benefits and who
23.22meet MFIP eligibility as required in sections 256J.11 to 256J.15 are eligible and must
23.23participate in the diversionary work program. Family units that are not eligible for the
23.24diversionary work program include:
23.25    (1) child only cases;
23.26    (2) a single-parent family unit that includes a child under 12 weeks of age. A parent
23.27is eligible for this exception once in a parent's lifetime and is not eligible if the parent
23.28has already used the previously allowed child under age one exemption from MFIP
23.29employment services;
23.30    (3) a minor parent without a high school diploma or its equivalent;
23.31    (4) an 18- or 19-year-old caregiver without a high school diploma or its equivalent
23.32who chooses to have an employment plan with an education option;
23.33    (5) a caregiver age 60 or over;
23.34    (6) family units with a caregiver who received DWP benefits in the 12 months prior
23.35to the month the family applied for DWP, except as provided in paragraph (c);
24.1    (7) family units with a caregiver who received MFIP within the 12 months prior to
24.2the month the family unit applied for DWP;
24.3    (8) a family unit with a caregiver who received 60 or more months of TANF
24.4assistance; and
24.5    (9) a family unit with a caregiver who is disqualified from DWP or MFIP due to
24.6fraud.; and
24.7    (10) refugees as defined in Code of Federal Regulations, title 45, chapter IV, section
24.8444.43, who arrived in the United States in the 12 months prior to the date of application
24.9for family cash assistance.
24.10    (b) A two-parent family must participate in DWP unless both caregivers meet the
24.11criteria for an exception under paragraph (a), clauses (1) through (5), or the family unit
24.12includes a parent who meets the criteria in paragraph (a), clause (6), (7), (8), or (9).
24.13    (c) Once DWP eligibility is determined, the four months run consecutively. If a
24.14participant leaves the program for any reason and reapplies during the four-month period,
24.15the county must redetermine eligibility for DWP.
24.16EFFECTIVE DATE.This section is effective the day following final enactment.

24.17    Sec. 28. Minnesota Statutes 2006, section 256J.95, subdivision 13, is amended to read:
24.18    Subd. 13. Immediate referral to employment services. Within one working day of
24.19determination that the applicant is eligible for the diversionary work program, but before
24.20benefits are issued to or on behalf of the family unit, the county shall refer all caregivers to
24.21employment services. The referral to the DWP employment services must be in writing
24.22and must contain the following information:
24.23    (1) notification that, as part of the application process, applicants are required to
24.24develop an employment plan or the DWP application will be denied;
24.25    (2) the employment services provider name and phone number;
24.26    (3) the date, time, and location of the scheduled employment services interview;
24.27    (4) (3) the immediate availability of supportive services, including, but not limited
24.28to, child care, transportation, and other work-related aid; and
24.29    (5) (4) the rights, responsibilities, and obligations of participants in the program,
24.30including, but not limited to, the grounds for good cause, the consequences of refusing or
24.31failing to participate fully with program requirements, and the appeal process.

24.32    Sec. 29. Minnesota Statutes 2006, section 256M.30, subdivision 1, is amended to read:
24.33    Subdivision 1. Service plan submitted to commissioner. Effective January 1,
24.342004, and each two-year period thereafter, each county must have a biennial service plan
24.35approved by the commissioner in order to receive funds. Only one biennial service plan
25.1is required under this chapter, regardless of whether counties receive funding under this
25.2chapter, chapter 256N, or both. Counties may submit multicounty or regional service
25.3plans.

25.4    Sec. 30. Minnesota Statutes 2006, section 256M.30, subdivision 2, is amended to read:
25.5    Subd. 2. Contents. The service plan shall be completed in a form prescribed by
25.6the commissioner. The plan must include:
25.7    (1) a statement of the needs of the children, adolescents, and adults who experience
25.8the conditions defined in section 256M.10, subdivision 2, paragraph (a), and strengths and
25.9resources available in the community to address those needs;
25.10    (2) strategies the county will implement to meet the child safety system performance
25.11standards in the child safety system in chapter 256N;
25.12    (2) (3) strategies the county will pursue to achieve the performance targets.
25.13Strategies must include specification of how funds under this section and other community
25.14resources will be used to achieve desired performance targets;
25.15    (3) (4) a description of the county's process to solicit public input and a summary
25.16of that input;
25.17    (4) (5) beginning with the service plans submitted for the period from January 1,
25.182006, through December 31, 2007, performance targets on statewide indicators for each
25.19county to measure outcomes of children's mental health, and child safety, permanency,
25.20and well-being. The commissioner shall consult with counties and other stakeholders to
25.21develop these indicators and collect baseline data to inform the establishment of individual
25.22county performance targets for the 2006-2007 biennium and subsequent plans; and
25.23    (5) (6) a budget for services to be provided with funds under this section. The
25.24county must budget at least 40 percent of funds appropriated under sections 256M.01 to
25.25256M.80 for services to ensure the mental health, safety, permanency, and well-being of
25.26children from low-income families. The commissioner may reduce the portion of child
25.27and community services funds that must be budgeted by a county for services to children
25.28in low-income families if:
25.29    (i) the incidence of children in low-income families within the county's population is
25.30significantly below the statewide median; or
25.31    (ii) the county has successfully achieved past performance targets for children's
25.32mental health, and child safety, permanency, and well-being and its proposed service plan
25.33is judged by the commissioner to provide an adequate level of service to the population
25.34with less funding.

25.35    Sec. 31. [256N.01] CITATION.
26.1    Sections 256N.01 to 256N.20 may be cited as the "Child Protection and Safety
26.2Act." This act creates a child safety working group to establish performance-based
26.3accountability for the safety, permanency, and well-being of children and establishes a
26.4child safety fund to address the needs of children within each county.

26.5    Sec. 32. [256N.10] DEFINITIONS.
26.6    Subdivision 1. Scope. For the purposes of sections 256N.01 to 256N.20, the terms
26.7defined in this section have the meanings given.
26.8    Subd. 2. Child safety system. "Child safety system" means a performance-based
26.9system that ensures the safety, permanency, and well-being of children and is accountable
26.10to federal and state performance standards.
26.11    Subd. 3. Child safety system performance standards. "Child safety system
26.12performance standards" means the performance standards in section 256N.20, subdivision
26.131.
26.14    Subd. 4. Commissioner. "Commissioner" means the commissioner of human
26.15services.
26.16    Subd. 5. County board. "County board" means the board of county commissioners
26.17in each county.

26.18    Sec. 33. [256N.20] DUTIES OF COMMISSIONER.
26.19    Subdivision 1. Performance standards and compliance; work group. (a) The
26.20commissioner shall convene a work group to establish:
26.21    (1) the child safety system performance standards, including a procedure to review
26.22and revise the performance standards every two years to ensure compliance with the
26.23federal data measures, data composites, and national standards in United States Code, title
26.2445, section 1355.34(a)(1), and defined in the Federal Register;
26.25    (2) a procedure by which the commissioner can measure compliance with the child
26.26safety system performance standards;
26.27    (3) how a county's compliance with the child safety system performance standards
26.28should affect performance-based funding; and
26.29    (4) whether sanctions or corrective action procedures should be implemented to
26.30enhance the county's ability to meet the child safety system performance standards.
26.31    (b) The work group shall report back to the chairs of house and senate committees
26.32having jurisdiction over human services by January 1, 2008, with recommendations for
26.33potential legislation to be offered in the 2008 legislative session.
26.34    (c) The commissioner shall consult with county associations to determine the
26.35representatives to the work group.
27.1    Subd. 2. Technical assistance and training. The commissioner shall:
27.2    (1) provide necessary information and assistance to each county for establishing
27.3performance baselines and performance targets on safety, permanency, and well-being for
27.4children and adolescents;
27.5    (2) provide training, technical assistance, and other supports, which may include a
27.6qualitative case review, to each county to assist in planning, implementing services, and
27.7improving performance;
27.8    (3) use data collection to determine county compliance with child safety system
27.9performance standards; and
27.10    (4) specify requirements for reports, including fiscal reports, to account for funds
27.11distributed.
27.12    Subd. 3. Tribal participation work group; report. The commissioner shall
27.13convene a work group comprised of tribes, counties, and the Department of Human
27.14Services to establish opportunities and mechanisms for tribes to participate in the child
27.15safety system to ensure the safety, permanency, and well-being of American Indian
27.16children. The work group shall report back to the chairs of house and senate committees
27.17having jurisdiction by January 1, 2008, with recommendations for potential legislation to
27.18be offered in the 2008 legislative session.

27.19    Sec. 34. Minnesota Statutes 2006, section 259.67, subdivision 4, is amended to read:
27.20    Subd. 4. Eligibility conditions. (a) The placing agency shall use the AFDC
27.21requirements as specified in federal law as of July 16, 1996, when determining the child's
27.22eligibility for adoption assistance under title IV-E of the Social Security Act. If the child
27.23does not qualify, the placing agency shall certify a child as eligible for state funded
27.24adoption assistance only if the following criteria are met:
27.25    (1) Due to the child's characteristics or circumstances it would be difficult to provide
27.26the child an adoptive home without adoption assistance.
27.27    (2)(i) A placement agency has made reasonable efforts to place the child for adoption
27.28without adoption assistance, but has been unsuccessful; or
27.29    (ii) the child's licensed foster parents desire to adopt the child and it is determined by
27.30the placing agency that the adoption is in the best interest of the child.
27.31    (3) The child has been a ward of the commissioner, a Minnesota-licensed
27.32child-placing agency, or a tribal social service agency of Minnesota recognized by the
27.33Secretary of the Interior. The placing agency shall not certify a child who remains
27.34under the jurisdiction of the sending agency pursuant to section 260.851, article 5, for
27.35state-funded adoption assistance when Minnesota is the receiving state.
28.1    (b) For purposes of this subdivision, the characteristics or circumstances that may
28.2be considered in determining whether a child is a child with special needs under United
28.3States Code, title 42, chapter 7, subchapter IV, part E, or meets the requirements of
28.4paragraph (a), clause (1), are the following:
28.5    (1) The child is a member of a sibling group to be placed as one unit in which at
28.6least one sibling is older than 15 months of age or is described in clause (2) or (3).
28.7    (2) The child has documented physical, mental, emotional, or behavioral disabilities.
28.8    (3) The child has a high risk of developing physical, mental, emotional, or behavioral
28.9disabilities.
28.10    (4) The child is adopted according to tribal law without a termination of parental
28.11rights or relinquishment, provided that the tribe has documented the valid reason why the
28.12child cannot or should not be returned to the home of the child's parent.
28.13    (5) The child is five years of age or older.
28.14    (c) When a child's eligibility for adoption assistance is based upon the high risk of
28.15developing physical, mental, emotional, or behavioral disabilities, payments shall not be
28.16made under the adoption assistance agreement unless and until the potential disability
28.17manifests itself as documented by an appropriate health care professional.

28.18    Sec. 35. KINSHIP NAVIGATOR PROGRAM; DEMONSTRATION GRANT.
28.19    (a) The commissioner of human services shall fund a two-year demonstration grant
28.20to be transferred to a nonprofit organization experienced in kinship advocacy and policy
28.21that has:
28.22    (1) experience working with grandparents and relatives who are raising kinship
28.23children;
28.24    (2) an established statewide outreach network;
28.25    (3) established kinship support groups;
28.26    (4) an intergenerational approach to programming; and
28.27    (5) a board of directors consisting of 50 percent grandparents and relatives raising
28.28kinship children.
28.29    (b) The purpose of the grant is to provide support to grandparents or relatives raising
28.30kinship children. One site must be in the metropolitan area, and the other in the Bemidji
28.31region. One-stop services may include, but are not limited to, legal services, education,
28.32information, family activities, support groups, mental health access, advocacy, mentors,
28.33and information related to foster care licensing. Funds may also be used for a media
28.34campaign to inform kinship families about available information and services, support
28.35sites, and other program development.

28.36    Sec. 36. MFIP PILOT PROGRAM; WORKFORCE U.
29.1    Subdivision 1. Establishment. A pilot program is established in Stearns and
29.2Benton Counties to expand the Workforce U program administered by the Stearns-Benton
29.3Employment and Training Council.
29.4    Subd. 2. Evaluation. The Workforce U pilot program must be evaluated by a
29.5research and evaluation organization with experience evaluating welfare programs. The
29.6evaluation must include information on the total number of persons served, percentage
29.7of participants exiting the program, percentage of former participants reentering the
29.8program, average wages of program participants, and recommendations to the legislature
29.9for possible statewide implementation of the program. The evaluation must be presented
29.10to the legislature by February 15, 2011.
29.11    Subd. 3. Expiration. The Workforce U pilot program expires on June 30, 2011.

29.12    Sec. 37. LEECH LAKE YOUTH TREATMENT CENTER PROPOSAL.
29.13    (a) The commissioner of human services shall provide a planning grant to address
29.14the unmet need for local, effective, culturally relevant alcohol and drug treatment for
29.15American Indian youth, and develop a plan for a family-based youth treatment center in
29.16the Leech Lake area. The planning grant must be provided to a volunteer board consisting
29.17of at least four members appointed by the commissioner, to include at least the following:
29.18    (1) two members of the Leech Lake Tribal Council or their designees;
29.19    (2) one member appointed by the Cass County Social Services administrator; and
29.20    (3) one member appointed by the Cass Lake-Bena Public School superintendent.
29.21    (b) The plan must include:
29.22    (1) an interest, feasibility, and suitability of location study;
29.23    (2) defining scope of programs and services to be offered;
29.24    (3) defining site use limitations and restrictions, including physical and capacity;
29.25    (4) defining facilities required for programs and services offered;
29.26    (5) identifying partners, partnership roles, and partner resources;
29.27    (6) developing proposed operating and maintenance budgets;
29.28    (7) identifying funding sources;
29.29    (8) developing a long-term funding plan; and
29.30    (9) developing a formal steering committee, structure, and bylaws.
29.31    (c) The plan is due to the legislative committees having jurisdiction over chemical
29.32health issues no later than September 2008 in order to provide the 12 months necessary to
29.33complete the plan.

29.34    Sec. 38. REPEALER.
30.1Minnesota Statutes 2006, sections 256J.29; 256J.37, subdivisions 3a and 3b; and
30.2256J.626, subdivisions 7 and 9, are repealed.

30.3ARTICLE 2
30.4LICENSING

30.5    Section 1. Minnesota Statutes 2006, section 245A.035, is amended to read:
30.6245A.035 RELATIVE FOSTER CARE; UNLICENSED EMERGENCY
30.7LICENSE RELATIVE PLACEMENT.
30.8    Subdivision 1. Grant of Emergency license placement. Notwithstanding section
30.9245A.03, subdivision 2a , or 245C.13, subdivision 2, a county agency may place a child
30.10for foster care with a relative who is not licensed to provide foster care, provided the
30.11requirements of subdivision 2 this section are met. As used in this section, the term
30.12"relative" has the meaning given it under section 260C.007, subdivision 27.
30.13    Subd. 2. Cooperation with emergency licensing placement process. (a) A county
30.14agency that places a child with a relative who is not licensed to provide foster care must
30.15begin the process of securing an emergency license for the relative as soon as possible
30.16and must conduct the initial inspection required by subdivision 3, clause (1), whenever
30.17possible, prior to placing the child in the relative's home, but no later than three working
30.18days after placing the child in the home. A child placed in the home of a relative who is
30.19not licensed to provide foster care must be removed from that home if the relative fails
30.20to cooperate with the county agency in securing an emergency foster care license. The
30.21commissioner may issue an emergency foster care license to a relative with whom the
30.22county agency wishes to place or has placed a child for foster care, or to a relative with
30.23whom a child has been placed by court order.
30.24    (b) If a child is to be placed in the home of a relative not licensed to provide foster
30.25care, either the placing agency or the county agency in the county in which the relative
30.26lives shall conduct the emergency licensing placement process as required in this section.
30.27    Subd. 3. Requirements for emergency license placement. Before an emergency
30.28license placement may be issued made, the following requirements must be met:
30.29    (1) the county agency must conduct an initial inspection of the premises where
30.30the foster care placement is to be provided made to ensure the health and safety of any
30.31child placed in the home. The county agency shall conduct the inspection using a form
30.32developed by the commissioner;
30.33    (2) at the time of the inspection or placement, whichever is earlier, the county
30.34agency must provide the relative being considered for an emergency license shall receive
30.35placement an application form for a child foster care license;
31.1    (3) whenever possible, prior to placing the child in the relative's home, the relative
31.2being considered for an emergency license placement shall provide the information
31.3required by section 245C.05; and
31.4    (4) if the county determines, prior to the issuance of an emergency license
31.5placement, that anyone requiring a background study may be prior to licensure of the
31.6home is disqualified under section 245C.14 and chapter 245C, and the disqualification
31.7is one which the commissioner cannot set aside, an emergency license shall placement
31.8must not be issued made.
31.9    Subd. 4. Applicant study. When the county agency has received the information
31.10required by section 245C.05, the county agency shall begin an applicant study according to
31.11the procedures in chapter 245C. The commissioner may issue an emergency license upon
31.12recommendation of the county agency once the initial inspection has been successfully
31.13completed and the information necessary to begin the applicant background study has been
31.14provided. If the county agency does not recommend that the emergency license be granted,
31.15the agency shall notify the relative in writing that the agency is recommending denial to the
31.16commissioner; shall remove any child who has been placed in the home prior to licensure;
31.17and shall inform the relative in writing of the procedure to request review pursuant to
31.18subdivision 6. An emergency license shall be effective until a child foster care license is
31.19granted or denied, but shall in no case remain in effect more than 120 days from the date
31.20of placement submit the information to the commissioner according to section 245C.05.
31.21    Subd. 5. Child foster care license application. (a) The relatives with whom the
31.22emergency license holder placement has been made shall complete the child foster care
31.23license application and necessary paperwork within ten days of the placement. The county
31.24agency shall assist the emergency license holder applicant to complete the application.
31.25The granting of a child foster care license to a relative shall be under the procedures in this
31.26chapter and according to the standards set forth by foster care rule in Minnesota Rules,
31.27chapter 2960. In licensing a relative, the commissioner shall consider the importance of
31.28maintaining the child's relationship with relatives as an additional significant factor in
31.29determining whether to a background study disqualification should be set aside a licensing
31.30disqualifier under section 245C.22, or to grant a variance of licensing requirements should
31.31be granted under sections 245C.21 to 245C.27 section 245C.30.
31.32    (b) When the county or private child-placing agency is processing an application
31.33for child foster care licensure of a relative as defined in section 260B.007, subdivision
31.3412
, or 260C.007, subdivision 27, the county agency or child-placing agency must explain
31.35the licensing process to the prospective licensee, including the background study process
31.36and the procedure for reconsideration of an initial disqualification for licensure. The
32.1county or private child-placing agency must also provide the prospective relative licensee
32.2with information regarding appropriate options for legal representation in the pertinent
32.3geographic area. If a relative is initially disqualified under section 245C.14, the county
32.4or child-placing agency commissioner must provide written notice of the reasons for the
32.5disqualification and the right to request a reconsideration by the commissioner as required
32.6under section 245C.17.
32.7    (c) The commissioner shall maintain licensing data so that activities related to
32.8applications and licensing actions for relative foster care providers may be distinguished
32.9from other child foster care settings.
32.10    Subd. 6. Denial of emergency license. If the commissioner denies an application
32.11for an emergency foster care license under this section, that denial must be in writing and
32.12must include reasons for the denial. Denial of an emergency license is not subject to
32.13appeal under chapter 14. The relative may request a review of the denial by submitting
32.14to the commissioner a written statement of the reasons an emergency license should be
32.15granted. The commissioner shall evaluate the request for review and determine whether
32.16to grant the emergency license. The commissioner's review shall be based on a review
32.17of the records submitted by the county agency and the relative. Within 15 working
32.18days of the receipt of the request for review, the commissioner shall notify the relative
32.19requesting review in written form whether the emergency license will be granted. The
32.20commissioner's review shall be based on a review of the records submitted by the county
32.21agency and the relative. A child shall not be placed or remain placed in the relative's home
32.22while the request for review is pending. Denial of an emergency license shall not preclude
32.23an individual from reapplying for an emergency license or from applying for a child foster
32.24care license. The decision of the commissioner is the final administrative agency action.

32.25    Sec. 2. Minnesota Statutes 2006, section 245A.16, subdivision 1, is amended to read:
32.26    Subdivision 1. Delegation of authority to agencies. (a) County agencies and
32.27private agencies that have been designated or licensed by the commissioner to perform
32.28licensing functions and activities under section 245A.04 and; background studies for
32.29adult foster care, family adult day services, and family child care under chapter 245C,;
32.30to recommend denial of applicants under section 245A.05,; to issue correction orders,
32.31to issue variances, and recommend a conditional license under section 245A.06,; or to
32.32recommend suspending or revoking a license or issuing a fine under section 245A.07,
32.33shall comply with rules and directives of the commissioner governing those functions and
32.34with this section. The following variances are excluded from the delegation of variance
32.35authority and may be issued only by the commissioner:
33.1    (1) dual licensure of family child care and child foster care, dual licensure of child
33.2and adult foster care, and adult foster care and family child care;
33.3    (2) adult foster care maximum capacity;
33.4    (3) adult foster care minimum age requirement;
33.5    (4) child foster care maximum age requirement;
33.6    (5) variances regarding disqualified individuals except that county agencies may
33.7issue variances under section 245C.30 regarding disqualified individuals when the county
33.8is responsible for conducting a consolidated reconsideration according to sections 245C.25
33.9and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
33.10and a disqualification based on serious or recurring maltreatment; and
33.11    (6) the required presence of a caregiver in the adult foster care residence during
33.12normal sleeping hours.
33.13    (b) County agencies must report:
33.14    (1) information about disqualification reconsiderations under sections 245C.25 and
33.15245C.27, subdivision 2 , clauses paragraphs (a) and (b), and variances granted under
33.16paragraph (a), clause (5), to the commissioner at least monthly in a format prescribed by
33.17the commissioner; and.
33.18    (2) for relative child foster care applicants and license holders, the number of
33.19relatives, as defined in section 260C.007, subdivision 27, and household members of
33.20relatives who are disqualified under section 245C.14; the disqualifying characteristics
33.21under section 245C.15; the number of these individuals who requested reconsideration
33.22under section 245C.21; the number of set-asides under section 245C.22; and variances
33.23under section 245C.30 issued. This information shall be reported to the commissioner
33.24annually by January 15 of each year in a format prescribed by the commissioner.
33.25    (c) For family day care programs, the commissioner may authorize licensing reviews
33.26every two years after a licensee has had at least one annual review.
33.27    (d) For family adult day services programs, the commissioner may authorize
33.28licensing reviews every two years after a licensee has had at least one annual review.
33.29    (e) A license issued under this section may be issued for up to two years.

33.30    Sec. 3. Minnesota Statutes 2006, section 245A.16, subdivision 3, is amended to read:
33.31    Subd. 3. Recommendations to the commissioner. The county or private agency
33.32shall not make recommendations to the commissioner regarding licensure without
33.33first conducting an inspection, and for adult foster care, family adult day services, and
33.34family child care, a background study of the applicant, and evaluation pursuant to under
33.35chapter 245C. The county or private agency must forward its recommendation to the
34.1commissioner regarding the appropriate licensing action within 20 working days of
34.2receipt of a completed application.

34.3    Sec. 4. Minnesota Statutes 2006, section 245C.02, is amended by adding a subdivision
34.4to read:
34.5    Subd. 14a. Private agency. "Private agency" has the meaning given in section
34.6245A.02, subdivision 12.

34.7    Sec. 5. Minnesota Statutes 2006, section 245C.04, subdivision 1, is amended to read:
34.8    Subdivision 1. Licensed programs. (a) The commissioner shall conduct a
34.9background study of an individual required to be studied under section 245C.03,
34.10subdivision 1
, at least upon application for initial license for all license types.
34.11    (b) The commissioner shall conduct a background study of an individual required to
34.12be studied under section 245C.03, subdivision 1, at reapplication for a license for family
34.13child care, child foster care, and adult foster care, and family adult day services.
34.14    (c) The commissioner is not required to conduct a study of an individual at the time
34.15of reapplication for a license if the individual's background study was completed by the
34.16commissioner of human services for an adult foster care license holder that is also:
34.17    (1) registered under chapter 144D; or
34.18    (2) licensed to provide home and community-based services to people with
34.19disabilities at the foster care location and the license holder does not reside in the foster
34.20care residence; and
34.21    (3) the following conditions are met:
34.22    (i) a study of the individual was conducted either at the time of initial licensure or
34.23when the individual became affiliated with the license holder;
34.24    (ii) the individual has been continuously affiliated with the license holder since
34.25the last study was conducted; and
34.26    (iii) the last study of the individual was conducted on or after October 1, 1995.
34.27    (d) From July 1, 2007, to June 30, 2009, the commissioner of human services
34.28shall conduct a study of an individual required to be studied under section 245C.03, at
34.29the time of reapplication for a child foster care license. The county or private agency
34.30shall collect and forward to the commissioner the information required under section
34.31245C.05, subdivisions 1, paragraphs (a) and (b), and 5, paragraphs (a) and (b). The
34.32background study conducted by the commissioner of human services under this paragraph
34.33must include a review of the information required under section 245C.08, subdivisions
34.341, paragraph (a), clauses (1) to (4), and 3.
34.35    (e) The commissioner of human services shall conduct a background study of an
34.36individual specified under section 245C.03, subdivision 1, paragraph (a), clauses (2)
35.1to (6), who is newly affiliated with a child foster care license holder. The county or
35.2private agency shall collect and forward to the commissioner the information required
35.3under section 245C.05, subdivisions 1 and 5. The background study conducted by the
35.4commissioner of human services under this paragraph must include a review of the
35.5information required under section 245C.08, subdivisions 1, paragraph (a), and 3.
35.6    (f) Applicants for licensure, license holders, and other entities as provided in this
35.7chapter must submit completed background study forms to the commissioner before
35.8individuals specified in section 245C.03, subdivision 1, begin positions allowing direct
35.9contact in any licensed program.
35.10    (e) (g) For purposes of this section, a physician licensed under chapter 147 is
35.11considered to be continuously affiliated upon the license holder's receipt from the
35.12commissioner of health or human services of the physician's background study results.

35.13    Sec. 6. Minnesota Statutes 2006, section 245C.05, subdivision 1, is amended to read:
35.14    Subdivision 1. Individual studied. (a) The individual who is the subject of the
35.15background study must provide the applicant, license holder, or other entity under section
35.16245C.04 with sufficient information to ensure an accurate study, including:
35.17    (1) the individual's first, middle, and last name and all other names by which the
35.18individual has been known;
35.19    (2) home address, city, and state of residence;
35.20    (3) zip code;
35.21    (4) sex;
35.22    (5) date of birth; and
35.23    (6) Minnesota driver's license number or state identification number.
35.24    (b) Every subject of a background study conducted or initiated by counties or private
35.25agencies under this chapter must also provide the home address, city, county, and state of
35.26residence for the past five years.
35.27    (c) Every subject of a background study related to child foster care through a private
35.28agency shall also provide the commissioner a signed consent for the release of any
35.29information received from national crime information databases to the private agency that
35.30initiated the background study.
35.31    (d) The subject of a background study shall provide fingerprints as required in
35.32subdivision 5, paragraph (c).

35.33    Sec. 7. Minnesota Statutes 2006, section 245C.05, is amended by adding a subdivision
35.34to read:
36.1    Subd. 2a. County or private agency. For background studies related to child foster
36.2care, county and private agencies must collect the information under subdivision 1 and
36.3forward it to the commissioner.

36.4    Sec. 8. Minnesota Statutes 2006, section 245C.05, subdivision 4, is amended to read:
36.5    Subd. 4. Electronic transmission. For background studies conducted by the
36.6Department of Human Services, the commissioner shall implement a system for the
36.7electronic transmission of:
36.8    (1) background study information to the commissioner; and
36.9    (2) background study results to the license holder.; and
36.10    (3) background study results to county and private agencies for background studies
36.11conducted by the commissioner for child foster care.

36.12    Sec. 9. Minnesota Statutes 2006, section 245C.05, subdivision 5, is amended to read:
36.13    Subd. 5. Fingerprints. (a) Except as provided in paragraph (c), for any background
36.14study completed under this chapter, when the commissioner has reasonable cause to
36.15believe that further pertinent information may exist on the subject of the background
36.16study, the subject shall provide the commissioner with a set of classifiable fingerprints
36.17obtained from an authorized law enforcement agency.
36.18    (b) For purposes of requiring fingerprints, the commissioner has reasonable cause
36.19when, but not limited to, the:
36.20    (1) information from the Bureau of Criminal Apprehension indicates that the subject
36.21is a multistate offender;
36.22    (2) information from the Bureau of Criminal Apprehension indicates that multistate
36.23offender status is undetermined; or
36.24    (3) commissioner has received a report from the subject or a third party indicating
36.25that the subject has a criminal history in a jurisdiction other than Minnesota.
36.26    (c) Except as specified under section 245C.04, subdivision 1, paragraph (d), for
36.27background studies conducted by the commissioner for child foster care, the subject of the
36.28background study shall provide the commissioner with a set of classifiable fingerprints
36.29obtained from an authorized agency.

36.30    Sec. 10. Minnesota Statutes 2006, section 245C.05, subdivision 7, is amended to read:
36.31    Subd. 7. Probation officer and corrections agent. (a) A probation officer or
36.32corrections agent shall notify the commissioner of an individual's conviction if the
36.33individual is:
36.34    (1) affiliated with a program or facility regulated by the Department of Human
36.35Services or Department of Health, a facility serving children or youth licensed by the
37.1Department of Corrections, or any type of home care agency or provider of personal care
37.2assistance services; and
37.3    (2) convicted of a crime constituting a disqualification under section 245C.14.
37.4    (b) For the purpose of this subdivision, "conviction" has the meaning given it
37.5in section 609.02, subdivision 5.
37.6    (c) The commissioner, in consultation with the commissioner of corrections, shall
37.7develop forms and information necessary to implement this subdivision and shall provide
37.8the forms and information to the commissioner of corrections for distribution to local
37.9probation officers and corrections agents.
37.10    (d) The commissioner shall inform individuals subject to a background study that
37.11criminal convictions for disqualifying crimes will be reported to the commissioner by the
37.12corrections system.
37.13    (e) A probation officer, corrections agent, or corrections agency is not civilly or
37.14criminally liable for disclosing or failing to disclose the information required by this
37.15subdivision.
37.16    (f) Upon receipt of disqualifying information, the commissioner shall provide the
37.17notice required under section 245C.17, as appropriate, to agencies on record as having
37.18initiated a background study or making a request for documentation of the background
37.19study status of the individual.
37.20    (g) This subdivision does not apply to family child care and child foster care
37.21programs.

37.22    Sec. 11. Minnesota Statutes 2006, section 245C.08, subdivision 1, is amended to read:
37.23    Subdivision 1. Background studies conducted by commissioner of human
37.24services. (a) For a background study conducted by the commissioner, the commissioner
37.25shall review:
37.26    (1) information related to names of substantiated perpetrators of maltreatment of
37.27vulnerable adults that has been received by the commissioner as required under section
37.28626.557, subdivision 9c , paragraph (i);
37.29    (2) the commissioner's records relating to the maltreatment of minors in licensed
37.30programs, and from county agency findings of maltreatment of minors as indicated
37.31through the social service information system;
37.32    (3) information from juvenile courts as required in subdivision 4 for individuals
37.33listed in section 245C.03, subdivision 1, clauses (2), (5), and (6); and
37.34    (4) information from the Bureau of Criminal Apprehension.; and
37.35    (5) for a background study related to a child foster care application for licensure, the
37.36commissioner shall also review:
38.1    (i) information from the child abuse and neglect registry for any state in which the
38.2background study subject has resided in for the past five years; and
38.3    (ii) information from national crime information databases.
38.4    (b) Notwithstanding expungement by a court, the commissioner may consider
38.5information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
38.6received notice of the petition for expungement and the court order for expungement is
38.7directed specifically to the commissioner.

38.8    Sec. 12. Minnesota Statutes 2006, section 245C.08, subdivision 2, is amended to read:
38.9    Subd. 2. Background studies conducted by a county or private agency. (a) For
38.10a background study conducted by a county or private agency for child foster care, adult
38.11foster care, family adult day services, and family child care homes, the commissioner
38.12shall review:
38.13    (1) information from the county agency's record of substantiated maltreatment
38.14of adults and the maltreatment of minors;
38.15    (2) information from juvenile courts as required in subdivision 4 for individuals
38.16listed in section 245C.03, subdivision 1, clauses (2), (5), and (6);
38.17    (3) information from the Bureau of Criminal Apprehension; and
38.18    (4) arrest and investigative records maintained by the Bureau of Criminal
38.19Apprehension, county attorneys, county sheriffs, courts, county agencies, local police, the
38.20National Criminal Records Repository, and criminal records from other states.
38.21    (b) If the individual has resided in the county for less than five years, the study shall
38.22include the records specified under paragraph (a) for the previous county or counties of
38.23residence for the past five years.
38.24    (c) Notwithstanding expungement by a court, the county or private agency may
38.25consider information obtained under paragraph (a), clauses (3) and (4), unless the
38.26commissioner received notice of the petition for expungement and the court order for
38.27expungement is directed specifically to the commissioner.

38.28    Sec. 13. Minnesota Statutes 2006, section 245C.10, is amended by adding a
38.29subdivision to read:
38.30    Subd. 4. Temporary personnel agencies, educational programs, and professional
38.31services agencies. The commissioner shall recover the cost of the background studies
38.32initiated by temporary personnel agencies, educational programs, and professional
38.33services agencies that initiate background studies under section 245C.03, subdivision 4,
38.34through a fee of no more than $20 per study charged to the agency. The fees collected
38.35under this subdivision are appropriated to the commissioner for the purpose of conducting
38.36background studies.

39.1    Sec. 14. Minnesota Statutes 2006, section 245C.11, subdivision 1, is amended to read:
39.2    Subdivision 1. Adult foster care; criminal conviction data. For individuals who
39.3are required to have background studies under section 245C.03, subdivisions 1 and 2, and
39.4who have been continuously affiliated with a an adult foster care provider that is licensed
39.5in more than one county, criminal conviction data may be shared among those counties in
39.6which the adult foster care programs are licensed. A county agency's receipt of criminal
39.7conviction data from another county agency shall meet the criminal data background
39.8study requirements of this chapter.

39.9    Sec. 15. Minnesota Statutes 2006, section 245C.11, subdivision 2, is amended to read:
39.10    Subd. 2. Jointly licensed programs. A county agency may accept a background
39.11study completed by the commissioner under this chapter in place of the background study
39.12required under section 245A.16, subdivision 3, in programs with joint licensure as home
39.13and community-based services and adult foster care for people with developmental
39.14disabilities when the license holder does not reside in the adult foster care residence and
39.15the subject of the study has been continuously affiliated with the license holder since the
39.16date of the commissioner's study.

39.17    Sec. 16. Minnesota Statutes 2006, section 245C.12, is amended to read:
39.18245C.12 BACKGROUND STUDY; TRIBAL ORGANIZATIONS.
39.19    (a) For the purposes of background studies completed by tribal organizations
39.20performing licensing activities otherwise required of the commissioner under this chapter,
39.21after obtaining consent from the background study subject, tribal licensing agencies shall
39.22have access to criminal history data in the same manner as county licensing agencies and
39.23private licensing agencies under this chapter.
39.24    (b) Tribal organizations may contract with the commissioner to obtain background
39.25study data on individuals under tribal jurisdiction related to adoptions according to
39.26section 245C.34. Tribal organizations may also contract with the commissioner to obtain
39.27background study data on individuals under tribal jurisdiction related to child foster care
39.28according to section 245C.34.

39.29    Sec. 17. Minnesota Statutes 2006, section 245C.16, subdivision 1, is amended to read:
39.30    Subdivision 1. Determining immediate risk of harm. (a) If the commissioner
39.31determines that the individual studied has a disqualifying characteristic, the commissioner
39.32shall review the information immediately available and make a determination as to the
39.33subject's immediate risk of harm to persons served by the program where the individual
39.34studied will have direct contact.
40.1    (b) The commissioner shall consider all relevant information available, including the
40.2following factors in determining the immediate risk of harm:
40.3    (1) the recency of the disqualifying characteristic;
40.4    (2) the recency of discharge from probation for the crimes;
40.5    (3) the number of disqualifying characteristics;
40.6    (4) the intrusiveness or violence of the disqualifying characteristic;
40.7    (5) the vulnerability of the victim involved in the disqualifying characteristic;
40.8    (6) the similarity of the victim to the persons served by the program where the
40.9individual studied will have direct contact; and
40.10    (7) whether the individual has a disqualification from a previous background study
40.11that has not been set aside.
40.12    (c) This section does not apply when the subject of a background study is regulated
40.13by a health-related licensing board as defined in chapter 214, and the subject is determined
40.14to be responsible for substantiated maltreatment under section 626.556 or 626.557.
40.15    (d) This section does not apply to a background study related to an initial application
40.16for a child foster care license.
40.17    (e) If the commissioner has reason to believe, based on arrest information or an
40.18active maltreatment investigation, that an individual poses an imminent risk of harm to
40.19persons receiving services, the commissioner may order that the person be continuously
40.20supervised or immediately removed pending the conclusion of the maltreatment
40.21investigation or criminal proceedings.

40.22    Sec. 18. Minnesota Statutes 2006, section 245C.17, is amended by adding a
40.23subdivision to read:
40.24    Subd. 5. Notice to county or private agency. For studies on individuals related to a
40.25license to provide child foster care, the commissioner shall also provide a notice of the
40.26background study results to the county or private agency that initiated the background
40.27study.

40.28    Sec. 19. Minnesota Statutes 2006, section 245C.21, is amended by adding a
40.29subdivision to read:
40.30    Subd. 1a. Submission of reconsideration request to county or private agency.
40.31    (a) For disqualifications related to studies conducted by county agencies, and for
40.32disqualifications related to studies conducted by the commissioner for child foster care,
40.33the individual shall submit the request for reconsideration to the county or private agency
40.34that initiated the background study.
40.35    (b) A reconsideration request shall be submitted within the time frames specified in
40.36subdivision 2.
41.1    (c) The county or private agency shall forward the individual's request for
41.2reconsideration and provide the commissioner with a recommendation whether to set aside
41.3the individual's disqualification.

41.4    Sec. 20. Minnesota Statutes 2006, section 245C.23, subdivision 2, is amended to read:
41.5    Subd. 2. Commissioner's notice of disqualification that is not set aside. (a) The
41.6commissioner shall notify the license holder of the disqualification and order the license
41.7holder to immediately remove the individual from any position allowing direct contact
41.8with persons receiving services from the license holder if:
41.9    (1) the individual studied does not submit a timely request for reconsideration
41.10under section 245C.21;
41.11    (2) the individual submits a timely request for reconsideration, but the commissioner
41.12does not set aside the disqualification for that license holder under section 245C.22;
41.13    (3) an individual who has a right to request a hearing under sections 245C.27 and
41.14256.045 , or 245C.28 and chapter 14 for a disqualification that has not been set aside, does
41.15not request a hearing within the specified time; or
41.16    (4) an individual submitted a timely request for a hearing under sections 245C.27
41.17and 256.045, or 245C.28 and chapter 14, but the commissioner does not set aside the
41.18disqualification under section 245A.08, subdivision 5, or 256.045.
41.19    (b) If the commissioner does not set aside the disqualification under section 245C.22,
41.20and the license holder was previously ordered under section 245C.17 to immediately
41.21remove the disqualified individual from direct contact with persons receiving services or
41.22to ensure that the individual is under continuous, direct supervision when providing direct
41.23contact services, the order remains in effect pending the outcome of a hearing under
41.24sections 245C.27 and 256.045, or 245C.28 and chapter 14.
41.25    (c) For background studies related to child foster care, the commissioner shall
41.26also notify the county or private agency that initiated the study of the results of the
41.27reconsideration.

41.28    Sec. 21. Minnesota Statutes 2006, section 245C.24, subdivision 2, is amended to read:
41.29    Subd. 2. Permanent bar to set aside a disqualification. (a) Except as provided in
41.30paragraph (b), the commissioner may not set aside the disqualification of any individual
41.31disqualified pursuant to this chapter, in connection with a license to provide family child
41.32care for children, foster care for children in the provider's home, or foster care or day care
41.33services for adults in the provider's home regardless of how much time has passed, if the
41.34individual was disqualified for a crime or conduct listed in section 245C.15, subdivision 1.
41.35    (b) For an individual in the chemical dependency field who was disqualified for a
41.36crime or conduct listed under section 245C.15, subdivision 1, and whose disqualification
42.1was set aside prior to July 1, 2005, the commissioner must consider granting a variance
42.2pursuant to section 245C.30 for the license holder for a program dealing primarily with
42.3adults. A request for reconsideration evaluated under this paragraph must include a
42.4letter of recommendation from the license holder that was subject to the prior set-aside
42.5decision addressing the individual's quality of care to children or vulnerable adults and the
42.6circumstances of the individual's departure from that service.

42.7    Sec. 22. [245C.33] ADOPTION BACKGROUND STUDY REQUIREMENTS.
42.8    Subdivision 1. Background studies conducted by commissioner. Before
42.9placement of a child for purposes of adoption, the commissioner shall conduct a
42.10background study on individuals listed in section 259.41, subdivision 3, for county
42.11agencies and private agencies licensed to place children for adoption.
42.12    Subd. 2. Information and data provided to county or private agency. The
42.13subject of the background study shall provide the following information to the county
42.14or private agency:
42.15    (1) the information specified in section 245C.05;
42.16    (2) a set of classifiable fingerprints obtained from an authorized agency; and
42.17    (3) for studies initiated by a private agency, a signed consent for the release of
42.18information received from national crime information databases to the private agency.
42.19    Subd. 3. Information and data provided to commissioner. The county or private
42.20agency shall forward the data collected under subdivision 2 to the commissioner.
42.21    Subd. 4. Information commissioner reviews. (a) The commissioner shall review
42.22the following information regarding the background study subject:
42.23    (1) the information under section 245C.08, subdivisions 1, 3, and 4;
42.24    (2) information from the child abuse and neglect registry for any state in which the
42.25subject has resided for the past five years; and
42.26    (3) information from national crime information databases.
42.27    (b) The commissioner shall provide any information collected under this subdivision
42.28to the county or private agency that initiated the background study. The commissioner
42.29shall indicate if the information collected shows that the subject of the background study
42.30has a conviction listed in United States Code, title 42, section 671(a)(20)(A).

42.31    Sec. 23. [245C.34] ADOPTION AND CHILD FOSTER CARE BACKGROUND
42.32STUDIES; TRIBAL ORGANIZATIONS.
42.33    Subdivision 1. Background studies may be conducted by commissioner. (a)
42.34Tribal organizations may contract with the commissioner under section 245C.12 to obtain
42.35background study data on individuals under tribal jurisdiction related to adoptions.
43.1    (b) Tribal organizations may contract with the commissioner under section 245C.12
43.2to obtain background study data on individuals under tribal jurisdiction related to child
43.3foster care.
43.4    (c) Background studies initiated by tribal organizations under paragraphs (a) and (b)
43.5must be conducted as provided in subdivisions 2 and 3.
43.6    Subd. 2. Information and data provided to tribal organization. The background
43.7study subject must provide the following information to the tribal organization:
43.8    (1) for background studies related to adoptions, the information under section
43.9245C.05;
43.10    (2) for background studies related to child foster care, the information under section
43.11245C.05;
43.12    (3) a set of classifiable fingerprints obtained from an authorized agency; and
43.13    (4) a signed consent for the release of information received from national crime
43.14information databases to the tribal organization.
43.15    Subd. 3. Information and data provided to commissioner. The tribal organization
43.16shall forward the data collected under subdivision 2 to the commissioner.
43.17    Subd. 4. Information commissioner reviews. (a) The commissioner shall review
43.18the following information regarding the background study subject:
43.19    (1) the information under section 245C.08, subdivisions 1, 3, and 4;
43.20    (2) information from the child abuse and neglect registry for any state in which the
43.21subject has resided for the past five years; and
43.22    (3) information from national crime information databases.
43.23    (b) The commissioner shall provide any information collected under this subdivision
43.24to the tribal organization that initiated the background study. The commissioner shall
43.25indicate if the information collected shows that the subject of the background study has a
43.26conviction listed in United States Code, title 42, section 671(a)(20)(A).

43.27    Sec. 24. Minnesota Statutes 2006, section 259.20, subdivision 2, is amended to read:
43.28    Subd. 2. Other applicable law. (a) Portions of chapters 245A, 245C, 257, 260, and
43.29317A may also affect the adoption of a particular child.
43.30    (b) Provisions of the Indian Child Welfare Act, United States Code, title 25, chapter
43.3121, sections 1901-1923, may also apply in the adoption of an Indian child, and may
43.32preempt specific provisions of this chapter.
43.33    (c) Consistent with chapters 245A and 245C and Public Law 109-248, a completed
43.34background study is required before the approval of any foster or adoptive placement in
43.35a related or an unrelated home.

44.1    Sec. 25. Minnesota Statutes 2006, section 259.29, subdivision 1, is amended to read:
44.2    Subdivision 1. Best interests of the child. (a) The policy of the state of Minnesota
44.3is to ensure that the best interests of the child are met by requiring individualized
44.4determination of the needs of the child and of how the adoptive placement will serve the
44.5needs of the child.
44.6    (b) Among the factors the agency shall consider in determining the needs of the child
44.7are those specified under section 260C.193, subdivision 3, paragraph (b).
44.8    (c) Consistent with chapters 245A and 245C and Public Law 109-248, a completed
44.9background study is required before the approval of any foster or adoptive placement in
44.10a related or an unrelated home.

44.11    Sec. 26. Minnesota Statutes 2006, section 259.41, is amended to read:
44.12259.41 ADOPTION STUDY.
44.13    Subdivision 1. Study required before placement; certain relatives excepted. (a)
44.14An approved adoption study; completed background study, as required under section
44.15245C.33; and written report must be completed before the child is placed in a prospective
44.16adoptive home under this chapter, except as allowed by section 259.47, subdivision 6.
44.17In an agency placement, the report must be filed with the court at the time the adoption
44.18petition is filed. In a direct adoptive placement, the report must be filed with the court in
44.19support of a motion for temporary preadoptive custody under section 259.47, subdivision
44.203
, or, if the study and report are complete, in support of an emergency order under section
44.21259.47, subdivision 6 . The study and report shall be completed by a licensed child-placing
44.22agency and must be thorough and comprehensive. The study and report shall be paid for
44.23by the prospective adoptive parent, except as otherwise required under section 259.67
44.24or 259.73.
44.25    (b) A placement for adoption with an individual who is related to the child, as
44.26defined by section 245A.02, subdivision 13, is not subject to this section except as required
44.27by section sections 245C.33 and 259.53, subdivision 2, paragraph (c).
44.28    (c) In the case of a licensed foster parent seeking to adopt a child who is in the foster
44.29parent's care, any portions of the foster care licensing process that duplicate requirements
44.30of the home study may be submitted in satisfaction of the relevant requirements of this
44.31section.
44.32    Subd. 2. Form of study. (a) The adoption study must include at least one in-home
44.33visit with the prospective adoptive parent. At a minimum, the study must include
44.34document the following information about the prospective adoptive parent:
44.35    (1) a background check study as required by subdivision 3 and section 245C.33,
44.36and including:
45.1    (i) an evaluation assessment of the data and information provided by section
45.2245C.33, subdivision 4, to determine if the prospective adoptive parent and any other
45.3person over the age of 13 living in the home has a felony conviction consistent with
45.4subdivision 3 and section 471(a)(2) of the Social Security Act; and
45.5    (ii) an assessment of the effect of a any conviction or finding of substantiated
45.6maltreatment on the ability to capacity of the prospective adoptive parent to safely care
45.7for and parent a child;
45.8    (2) a medical and social history and assessment of current health;
45.9    (3) an assessment of potential parenting skills;
45.10    (4) an assessment of ability to provide adequate financial support for a child; and
45.11    (5) an assessment of the level of knowledge and awareness of adoption issues
45.12including, where appropriate, matters relating to interracial, cross-cultural, and special
45.13needs adoptions.
45.14    (b) The adoption study is the basis for completion of a written report. The report
45.15must be in a format specified by the commissioner and must contain recommendations
45.16regarding the suitability of the subject of the study to be an adoptive parent.
45.17    Subd. 3. Background check; affidavit of history study. (a) At the time an adoption
45.18study is commenced, each prospective adoptive parent must:
45.19    (1) authorize access by the agency to any private data needed to complete the study;
45.20    (2) provide all addresses at which the prospective adoptive parent and anyone in the
45.21household over the age of 13 has resided in the previous five years; and
45.22    (3) disclose any names used previously other than the name used at the time of
45.23the study.
45.24    (b) When the requirements of paragraph (a) have been met, the agency shall
45.25immediately begin initiate a background check, study under section 245C.33 to be
45.26completed by the commissioner on each person over the age of 13 living in the home,
45.27consisting, at a minimum, of the following:. As required under section 245C.33 and Public
45.28Law 109-248, a completed background study is required before the approval of any foster
45.29or adoptive placement in a related or an unrelated home. The required background study
45.30must be completed as part of the home study.
45.31    (1) a check of criminal conviction data with the Bureau of Criminal Apprehension
45.32and local law enforcement authorities;
45.33    (2) a check for data on substantiated maltreatment of a child or vulnerable adult
45.34and domestic violence data with local law enforcement and social services agencies and
45.35district courts; and
45.36    (3) for those persons under the age of 25, a check of juvenile court records.
46.1    Notwithstanding the provisions of section 260B.171 or 260C.171, the Bureau of
46.2Criminal Apprehension, local law enforcement and social services agencies, district courts,
46.3and juvenile courts shall release the requested information to the agency completing
46.4the adoption study.
46.5    (c) When paragraph (b) requires checking the data or records of local law
46.6enforcement and social services agencies and district and juvenile courts, the agency
46.7shall check with the law enforcement and social services agencies and courts whose
46.8jurisdictions cover the addresses under paragraph (a), clause (2). In the event that the
46.9agency is unable to complete any of the record checks required by paragraph (b), the
46.10agency shall document the fact and the agency's efforts to obtain the information.
46.11    (d) For a study completed under this section, when the agency has reasonable
46.12cause to believe that further information may exist on the prospective adoptive parent or
46.13household member over the age of 13 that may relate to the health, safety, or welfare of
46.14the child, the prospective adoptive parent or household member over the age of 13 shall
46.15provide the agency with a set of classifiable fingerprints obtained from an authorized law
46.16enforcement agency and the agency may obtain criminal history data from the National
46.17Criminal Records Repository by submitting fingerprints to the Bureau of Criminal
46.18Apprehension. The agency has reasonable cause when, but not limited to, the:
46.19    (1) information from the Bureau of Criminal Apprehension indicates that the
46.20prospective adoptive parent or household member over the age of 13 is a multistate
46.21offender;
46.22    (2) information from the Bureau of Criminal Apprehension indicates that multistate
46.23offender status is undetermined;
46.24    (3) the agency has received a report from the prospective adoptive parent or
46.25household member over the age of 13 or a third party indicating that the prospective
46.26adoptive parent or household member over the age of 13 has a criminal history in a
46.27jurisdiction other than Minnesota; or
46.28    (4) the prospective adoptive parent or household member over the age of 13 is or has
46.29been a resident of a state other than Minnesota in the prior five years.
46.30    (e) At any time prior to completion of the background check required under
46.31paragraph (b), a prospective adoptive parent may submit to the agency conducting the
46.32study a sworn affidavit stating whether they or any person residing in the household have
46.33been convicted of a crime. The affidavit shall also state whether the adoptive parent or any
46.34other person residing in the household is the subject of an open investigation of, or have
46.35been the subject of a substantiated allegation of, child or vulnerable-adult maltreatment
46.36within the past ten years. A complete description of the crime, open investigation, or
47.1substantiated abuse, and a complete description of any sentence, treatment, or disposition
47.2must be included. The affidavit must contain an acknowledgment that if, at any time
47.3before the adoption is final, a court receives evidence leading to a conclusion that a
47.4prospective adoptive parent knowingly gave false information in the affidavit, it shall be
47.5determined that the adoption of the child by the prospective adoptive parent is not in the
47.6best interests of the child.
47.7    (f) For the purposes of subdivision 1 and section 259.47, subdivisions 3 and 6, an
47.8adoption study is complete for placement, even though the background checks required by
47.9paragraph (b) have not been completed, if each prospective adoptive parent has completed
47.10the affidavit allowed by paragraph (e) and the other requirements of this section have been
47.11met. The background checks required by paragraph (b) must be completed before an
47.12adoption petition is filed. If an adoption study has been submitted to the court under section
47.13259.47, subdivision 3 or 6, before the background checks required by paragraph (b) were
47.14complete, an updated adoption study report which includes the results of the background
47.15check must be filed with the adoption petition. In the event that an agency is unable to
47.16complete any of the records checks required by paragraph (b), the agency shall submit with
47.17the petition to adopt an affidavit documenting the agency's efforts to complete the checks.
47.18    (c) A home study under paragraph (b) used to consider placement of any child
47.19on whose behalf Title IV-E adoption assistance payments are to be made must not be
47.20approved if a background study reveals a felony conviction at any time for:
47.21    (1) child abuse or neglect;
47.22    (2) spousal abuse;
47.23    (3) a crime against children, including child pornography; or
47.24    (4) a crime involving violence, including rape, sexual assault, or homicide, but not
47.25including other physical assault or battery.
47.26    (d) A home study under paragraph (b) used to consider placement of any child
47.27on whose behalf Title IV-E adoption assistance payments are to be made must not be
47.28approved if a background study reveals a felony conviction within the past five years for:
47.29    (1) physical assault or battery; or
47.30    (2) a drug-related offense.
47.31    Subd. 4. Updates to adoption study; period of validity. An agency may update
47.32an adoption study and report as needed, regardless of when the original study and report
47.33or most recent update was completed. An update must be in a format specified by the
47.34commissioner and must verify the continuing accuracy of the elements of the original
47.35report and document any changes to elements of the original report. An update to a study
47.36and report not originally completed under this section must ensure that the study and
48.1report, as updated, meet the requirements of this section. An adoption study is valid if the
48.2report has been completed or updated within the previous 12 months.

48.3    Sec. 27. Minnesota Statutes 2006, section 259.47, subdivision 3, is amended to read:
48.4    Subd. 3. Preadoptive custody order. (a) Before a child is placed in a prospective
48.5adoptive home by a birth parent or legal guardian, other than an agency, the placement
48.6must be approved by the district court in the county where the prospective adoptive parent
48.7resides. Consistent with chapter 245C and Public Law 109-248, a completed background
48.8study is required before the approval of any foster or adoptive placement in a related or
48.9an unrelated home. An order under this subdivision or subdivision 6 shall state that the
48.10prospective adoptive parent's right to custody of the child is subject to the birth parent's
48.11right to custody until the consents to the child's adoption become irrevocable. At the time
48.12of placement, prospective adoptive parents must have for the child qualifying existing
48.13coverage as defined in section 62L.02, subdivision 24, or other similar comprehensive
48.14health care coverage. The preadoptive custody order must include any agreement reached
48.15between the prospective adoptive parent and the birth parent regarding authority to make
48.16decisions after placement for medical care of the child and responsibility for payment for
48.17medical care not provided by the adoptive parent's existing health care coverage. The
48.18prospective adoptive parent must meet the residence requirements of section 259.22,
48.19subdivision 1
, and must file with the court an affidavit of intent to remain a resident of
48.20the state for at least three months after the child is placed in the prospective adoptive
48.21home. The prospective adoptive parent shall file with the court a notice of intent to file
48.22an adoption petition and submit a written motion seeking an order granting temporary
48.23preadoptive custody. The notice and motion required under this subdivision may be
48.24considered by the court ex parte, without a hearing. The prospective adoptive parent
48.25shall serve a copy of the notice and motion upon any parent whose consent is required
48.26under section 259.24 or who is named in the affidavit required under paragraph (b) if that
48.27person's mailing address is known. The motion may be filed up to 60 days before the
48.28placement is to be made and must include:
48.29    (1) the adoption study required under section 259.41;
48.30    (2) affidavits from the birth parents indicating their support of the motion, or, if there
48.31is no affidavit from the birth father, an affidavit from the birth mother under paragraph (b);
48.32    (3) an itemized statement of expenses that have been paid and an estimate of
48.33expenses that will be paid by the prospective adoptive parents to the birth parents, any
48.34agency, attorney, or other party in connection with the prospective adoption;
48.35    (4) the name of counsel for each party, if any;
48.36    (5) a statement that the birth parents:
49.1    (i) have provided the social and medical history required under section 259.43 to
49.2the prospective adoptive parent;
49.3    (ii) have received the written statement of their legal rights and responsibilities
49.4under section 259.39; and
49.5    (iii) have been notified of their right to receive counseling under subdivision 4; and
49.6    (6) the name of the agency chosen by the adoptive parent to supervise the adoptive
49.7placement and complete the postplacement assessment required by section 259.53,
49.8subdivision 2
.
49.9    The court shall review the expense statement submitted under this subdivision to
49.10determine whether payments made or to be made by the prospective adoptive parent are
49.11lawful and in accordance with section 259.55, subdivision 1.
49.12    (b) If the birth mother submits the affidavit required in paragraph (a), clause (2),
49.13but the birth father fails to do so, the birth mother must submit an additional affidavit that
49.14describes her good faith efforts or efforts made on her behalf to identify and locate the
49.15birth father for purposes of securing his consent. In the following circumstances the
49.16birth mother may instead submit an affidavit stating on which ground she is exempt from
49.17making efforts to identify and locate the father:
49.18    (1) the child was conceived as the result of incest or rape;
49.19    (2) efforts to locate the father by the affiant or anyone acting on the affiant's behalf
49.20could reasonably result in physical harm to the birth mother or child; or
49.21    (3) efforts to locate the father by the affiant or anyone acting on the affiant's behalf
49.22could reasonably result in severe emotional distress of the birth mother or child.
49.23    A court shall consider the motion for temporary preadoptive custody within 30
49.24days of receiving the motion or by the anticipated placement date stated in the motion,
49.25whichever comes sooner.

49.26    Sec. 28. Minnesota Statutes 2006, section 259.53, subdivision 2, is amended to read:
49.27    Subd. 2. Adoption agencies; postplacement assessment and report. (a) The
49.28agency to which the petition has been referred under subdivision 1 shall conduct a
49.29postplacement assessment and file a report with the court within 90 days of receipt
49.30of a copy of the adoption petition. The agency shall send a copy of the report to the
49.31commissioner at the time it files the report with the court. The assessment and report
49.32must evaluate the environment and antecedents of the child to be adopted, the home of
49.33the petitioners, whether placement with the petitioners meets the needs of the child as
49.34described in section 259.57, subdivision 2. The report must include a recommendation to
49.35the court as to whether the petition should or should not be granted.
50.1    In making evaluations and recommendations, the postplacement assessment and
50.2report must, at a minimum, address the following:
50.3    (1) the level of adaptation by the prospective adoptive parents to parenting the child;
50.4    (2) the health and well-being of the child in the prospective adoptive parents' home;
50.5    (3) the level of incorporation by the child into the prospective adoptive parents'
50.6home, extended family, and community; and
50.7    (4) the level of inclusion of the child's previous history into the prospective adoptive
50.8home, such as cultural or ethnic practices, or contact with former foster parents or
50.9biological relatives.
50.10    (b) A postplacement adoption report is valid for 12 months following its date
50.11of completion.
50.12    (c) If the petitioner is an individual who is related to the child, as defined by section
50.13245A.02, subdivision 13, the agency, as part of its postplacement assessment and report
50.14under paragraph (a), shall conduct a background check meeting the requirements of
50.15section 259.41, subdivision 3, paragraph (b). The prospective adoptive parent shall
50.16cooperate in the completion of the background check by supplying the information and
50.17authorizations described in section 259.41, subdivision 3, paragraph (a).
50.18    (d) (c) If the report recommends that the court not grant the petition to adopt the
50.19child, the provisions of this paragraph apply. Unless the assessment and report were
50.20completed by the local social services agency, the agency completing the report, at the
50.21time it files the report with the court under paragraph (a), must provide a copy of the report
50.22to the local social services agency in the county where the prospective adoptive parent
50.23lives. The agency or local social services agency may recommend that the court dismiss
50.24the petition. If the local social services agency determines that continued placement in the
50.25home endangers the child's physical or emotional health, the agency shall seek a court
50.26order to remove the child from the home.
50.27    (e) (d) If, through no fault of the petitioner, the agency to whom the petition was
50.28referred under subdivision 1, paragraph (b), fails to complete the assessment and file the
50.29report within 90 days of the date it received a copy of the adoption petition, the court may
50.30hear the petition upon giving the agency and the local social services agency, if different,
50.31five days' notice by mail of the time and place of the hearing.

50.32    Sec. 29. Minnesota Statutes 2006, section 259.57, subdivision 2, is amended to read:
50.33    Subd. 2. Protection of child's best interests. (a) The policy of the state of
50.34Minnesota is to ensure that the best interests of children are met by requiring an
50.35individualized determination of the needs of the child and how the adoptive placement
50.36will serve the needs of the child.
51.1    (b) Among the factors the court shall consider in determining the needs of the child
51.2are those specified under section 260C.193, subdivision 3, paragraph (b). Consistent
51.3with chapters 245A and 245C and Public Law 109-248, a completed background study
51.4is required before the approval of any foster or adoptive placement in a related or an
51.5unrelated home.
51.6    (c) In reviewing adoptive placement and in determining appropriate adoption,
51.7the court shall consider placement, consistent with the child's best interests and in the
51.8following order, with (1) a relative or relatives of the child, or (2) an important friend with
51.9whom the child has resided or had significant contact. Placement of a child cannot be
51.10delayed or denied based on race, color, or national origin of the adoptive parent or the
51.11child. Whenever possible, siblings should be placed together unless it is determined
51.12not to be in the best interests of a sibling.
51.13    (d) If the child's birth parent or parents explicitly request that relatives and important
51.14friends not be considered, the court shall honor that request consistent with the best
51.15interests of the child.
51.16    If the child's birth parent or parents express a preference for placing the child in an
51.17adoptive home of the same or a similar religious background to that of the birth parent
51.18or parents, the court shall place the child with a family that also meets the birth parent's
51.19religious preference. Only if no family is available as described in clause (a) or (b)
51.20may the court give preference to a family described in clause (c) that meets the parent's
51.21religious preference.
51.22    (e) This subdivision does not affect the Indian Child Welfare Act, United States
51.23Code, title 25, sections 1901 to 1923, and the Minnesota Indian Family Preservation
51.24Act, sections 260.751 to 260.835.

51.25    Sec. 30. Minnesota Statutes 2006, section 260C.193, subdivision 3, is amended to read:
51.26    Subd. 3. Best interest of the child in foster care or residential care. (a) The
51.27policy of the state is to ensure that the best interests of children in foster or residential care
51.28are met by requiring individualized determinations under section 260C.212, subdivision 2,
51.29paragraph (b), of the needs of the child and of how the selected placement will serve the
51.30needs of the child in foster care placements.
51.31    (b) The court shall review whether the responsible social services agency made
51.32efforts as required under section 260C.212, subdivision 5, and made an individualized
51.33determination as required under section 260C.212, subdivision 2. If the court finds the
51.34agency has not made efforts as required under section 260C.212, subdivision 5, and there
51.35is a relative who qualifies to be licensed to provide family foster care under chapter 245A,
51.36the court may order the child placed with the relative consistent with the child's best
52.1interests. Consistent with chapters 245A and 245C and Public Law 109-248, a completed
52.2background study is required before the approval of any foster or adoptive placement in
52.3a related or an unrelated home.
52.4    (c) If the child's birth parent or parents explicitly request that a relative or important
52.5friend not be considered, the court shall honor that request if it is consistent with the best
52.6interests of the child. If the child's birth parent or parents express a preference for placing
52.7the child in a foster or adoptive home of the same or a similar religious background to
52.8that of the birth parent or parents, the court shall order placement of the child with an
52.9individual who meets the birth parent's religious preference.
52.10    (d) Placement of a child cannot be delayed or denied based on race, color, or national
52.11origin of the foster parent or the child.
52.12    (e) Whenever possible, siblings should be placed together unless it is determined
52.13not to be in the best interests of a sibling. If siblings are not placed together according to
52.14section 260C.212, subdivision 2, paragraph (d), the responsible social services agency
52.15shall report to the court the efforts made to place the siblings together and why the
52.16efforts were not successful. If the court is not satisfied with the agency's efforts to place
52.17siblings together, the court may order the agency to make further efforts. If siblings are
52.18not placed together the court shall review the responsible social services agency's plan
52.19for visitation among siblings required as part of the out-of-home placement plan under
52.20section 260C.212.
52.21    (f) This subdivision does not affect the Indian Child Welfare Act, United States
52.22Code, title 25, sections 1901 to 1923, and the Minnesota Indian Family Preservation
52.23Act, sections 260.751 to 260.835.

52.24    Sec. 31. Minnesota Statutes 2006, section 260C.209, is amended to read:
52.25260C.209 BACKGROUND CHECKS.
52.26    Subdivision 1. Subjects. The responsible social services agency must conduct
52.27initiate a background check study to be completed by the commissioner under this section
52.28of chapter 245C on the following individuals:
52.29    (1) a noncustodial parent or nonadjudicated parent who is being assessed for
52.30purposes of providing day-to-day care of a child temporarily or permanently under section
52.31260C.212, subdivision 4 , and any member of the parent's household who is over the age of
52.3213 when there is a reasonable cause to believe that the parent or household member over
52.33age 13 has a criminal history or a history of maltreatment of a child or vulnerable adult
52.34which would endanger the child's health, safety, or welfare;
53.1    (2) an individual whose suitability for relative placement under section 260C.212,
53.2subdivision 5
, is being determined and any member of the relative's household who is
53.3over the age of 13 when:
53.4    (i) the relative must be licensed for foster care; or
53.5    (ii) the agency must conduct a background study is required under section 259.53,
53.6subdivision 2
; or
53.7    (iii) the agency or the commissioner has reasonable cause to believe the relative
53.8or household member over the age of 13 has a criminal history which would not make
53.9transfer of permanent legal and physical custody to the relative under section 260C.201,
53.10subdivision 11
, in the child's best interest; and
53.11    (3) a parent, following an out-of-home placement, when the responsible social
53.12services agency has reasonable cause to believe that the parent has been convicted of a
53.13crime directly related to the parent's capacity to maintain the child's health, safety, or
53.14welfare or the parent is the subject of an open investigation of, or has been the subject
53.15of a substantiated allegation of, child or vulnerable-adult maltreatment within the past
53.16ten years.
53.17"Reasonable cause" means that the agency has received information or a report from the
53.18subject or a third person that creates an articulable suspicion that the individual has a
53.19history that may pose a risk to the health, safety, or welfare of the child. The information
53.20or report must be specific to the potential subject of the background check and shall not
53.21be based on the race, religion, ethnic background, age, class, or lifestyle of the potential
53.22subject.
53.23    Subd. 2. General procedures. (a) When conducting initiating a background check
53.24under subdivision 1, the agency may shall require the individual being assessed to provide
53.25sufficient information to ensure an accurate assessment under this section, including:
53.26    (1) the individual's first, middle, and last name and all other names by which the
53.27individual has been known;
53.28    (2) home address, zip code, city, county, and state of residence for the past ten five
53.29years;
53.30    (3) sex;
53.31    (4) date of birth; and
53.32    (5) driver's license number or state identification number.
53.33    (b) When notified by the commissioner or the responsible social services agency that
53.34it is conducting an assessment under this section, the Bureau of Criminal Apprehension,
53.35commissioners of health and human services, law enforcement, and county agencies must
53.36provide the commissioner or responsible social services agency or county attorney with
54.1the following information on the individual being assessed: criminal history data, reports
54.2about the maltreatment of adults substantiated under section 626.557, and reports of
54.3maltreatment of minors substantiated under section 626.556.
54.4    (c) Consistent with chapters 245A and 245C and Public Law 109-248, a completed
54.5background study is required before the approval of any foster or adoptive placement in
54.6a related or an unrelated home.
54.7    Subd. 3. Multistate information. (a) For any assessment every background study
54.8completed under this section, if the responsible social services agency has reasonable
54.9cause to believe that the individual is a multistate offender, the individual must the subject
54.10of the background study shall provide the responsible social services agency or the
54.11county attorney with a set of classifiable fingerprints obtained from an authorized law
54.12enforcement agency. The responsible social services agency or county attorney may shall
54.13provide the fingerprints to the commissioner, and the commissioner shall obtain criminal
54.14history data from the National Criminal Records Repository by submitting the fingerprints
54.15to the Bureau of Criminal Apprehension.
54.16    (b) For purposes of this subdivision, the responsible social services agency has
54.17reasonable cause when, but not limited to:
54.18    (1) information from the Bureau of Criminal Apprehension indicates that the
54.19individual is a multistate offender;
54.20    (2) information from the Bureau of Criminal Apprehension indicates that multistate
54.21offender status is undetermined;
54.22    (3) the social services agency has received a report from the individual or a third
54.23party indicating that the individual has a criminal history in a jurisdiction other than
54.24Minnesota; or
54.25    (4) the individual is or has been a resident of a state other than Minnesota at any
54.26time during the prior ten years.
54.27    Subd. 4. Notice upon receipt. The responsible social services agency commissioner
54.28must provide the subject of the background study with the results of the study as required
54.29under this section within 15 business days of receipt or at least 15 days prior to the hearing
54.30at which the results will be presented, whichever comes first. The subject may provide
54.31written information to the agency that the results are incorrect and may provide additional
54.32or clarifying information to the agency and to the court through a party to the proceeding.
54.33This provision does not apply to any background study conducted under chapters 245A
54.34and chapter 245C.

54.35    Sec. 32. Minnesota Statutes 2006, section 260C.212, subdivision 2, is amended to read:
55.1    Subd. 2. Placement decisions based on best interest of the child. (a) The policy
55.2of the state of Minnesota is to ensure that the child's best interests are met by requiring an
55.3individualized determination of the needs of the child and of how the selected placement
55.4will serve the needs of the child being placed. The authorized child-placing agency shall
55.5place a child, released by court order or by voluntary release by the parent or parents, in
55.6a family foster home selected by considering placement with relatives and important
55.7friends in the following order:
55.8    (1) with an individual who is related to the child by blood, marriage, or adoption; or
55.9    (2) with an individual who is an important friend with whom the child has resided or
55.10had significant contact.
55.11    (b) Among the factors the agency shall consider in determining the needs of the
55.12child are the following:
55.13    (1) the child's current functioning and behaviors;
55.14    (2) the medical, educational, and developmental needs of the child;
55.15    (3) the child's history and past experience;
55.16    (4) the child's religious and cultural needs;
55.17    (5) the child's connection with a community, school, and church;
55.18    (6) the child's interests and talents;
55.19    (7) the child's relationship to current caretakers, parents, siblings, and relatives; and
55.20    (8) the reasonable preference of the child, if the court, or the child-placing agency
55.21in the case of a voluntary placement, deems the child to be of sufficient age to express
55.22preferences.
55.23    (c) Placement of a child cannot be delayed or denied based on race, color, or national
55.24origin of the foster parent or the child.
55.25    (d) Siblings should be placed together for foster care and adoption at the earliest
55.26possible time unless it is determined not to be in the best interests of a sibling or unless it
55.27is not possible after appropriate efforts by the responsible social services agency.
55.28    (e) Placement of a child in a foster or an adoptive home must be consistent with
55.29chapters 245A and 245C and Public Law 109-248, which require a completed background
55.30study before the approval of any foster or adoptive placement in a related or an unrelated
55.31home.

55.32ARTICLE 3
55.33HEALTH CARE

55.34    Section 1. Minnesota Statutes 2006, section 16A.724, subdivision 2, is amended to
55.35read:
56.1    Subd. 2. Transfers. (a) Notwithstanding section 295.581, to the extent available
56.2resources in the health care access fund exceed expenditures in that fund, effective with
56.3the biennium beginning July 1, 2007, the commissioner shall transfer funds from the
56.4health care access fund to the general fund to offset the costs of MinnesotaCare enrollees
56.5shifting to medical assistance due to the implementation of an automated eligibility
56.6determination system. The medical assistance costs shall be identified and updated in the
56.7November and February forecasts.
56.8    (b) In addition to the amounts in paragraph (a), the commissioner of finance shall
56.9transfer the excess funds from the health care access fund to the general fund on June
56.1030 of each year, provided that the amount transferred in any fiscal biennium shall not
56.11exceed $96,000,000. For the biennium ending June 30, 2011, the transfer shall not exceed
56.12$48,000,000.
56.13    (b) (c) For fiscal years 2006 to 2009, MinnesotaCare shall be a forecasted program,
56.14and, if necessary, the commissioner shall reduce these transfers from the health care access
56.15fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary,
56.16transfer sufficient funds from the general fund to the health care access fund to meet
56.17annual MinnesotaCare expenditures.

56.18    Sec. 2. Minnesota Statutes 2006, section 62H.02, is amended to read:
56.1962H.02 REQUIRED PROVISIONS.
56.20    (a) A joint self-insurance plan must include aggregate excess stop-loss coverage and
56.21individual excess stop-loss coverage provided by an insurance company licensed by the
56.22state of Minnesota.
56.23    (b) Aggregate excess stop-loss coverage must include provisions to cover incurred,
56.24unpaid claim liability in the event of plan termination. In addition,
56.25    (c) The plan of self-insurance must have participating employers fund an amount at
56.26least equal to the point at which the excess or stop-loss insurer has contracted to assume
56.27100 percent of additional liability.
56.28    (d) A joint self-insurance plan must submit its proposed excess or stop-loss insurance
56.29contract to the commissioner of commerce at least 30 days prior to the proposed plan's
56.30effective date and at least 30 days subsequent to any renewal date. The commissioner shall
56.31review the contract to determine if they meet the standards established by sections 62H.01
56.32to 62H.08 and respond within a 30-day period.
56.33    (e) Any excess or stop-loss insurance plan must contain a provision that the excess
56.34or stop-loss insurer will give the plan and the commissioner of commerce a minimum of
56.35180 days' notice of termination or nonrenewal. If the plan fails to secure replacement
57.1coverage within 60 days after receipt of the notice of cancellation or nonrenewal, the
57.2commissioner shall issue an order providing for the orderly termination of the plan.
57.3    (f) The commissioner may waive the requirements of this section and of any rule
57.4relating to the requirements of this section, if the commissioner determines that a joint
57.5self-insurance plan has established alternative arrangements that fully fund the plan's
57.6liability or incurred but unpaid claims. The commissioner may not waive the requirement
57.7that a joint self-insurance plan have excess stop-loss coverage.
57.8EFFECTIVE DATE.This section is effective the day following final enactment.

57.9    Sec. 3. Minnesota Statutes 2006, section 62J.692, subdivision 4, is amended to read:
57.10    Subd. 4. Distribution of funds. (a) The commissioner shall annually distribute
57.1190 percent of available medical education funds to all qualifying applicants based on a
57.12distribution formula that reflects a summation of two factors:
57.13    (1) an education factor, which is determined by the total number of eligible trainee
57.14FTEs and the total statewide average costs per trainee, by type of trainee, in each clinical
57.15medical education program; and
57.16    (2) a public program volume factor, which is determined by the total volume of
57.17public program revenue received charges submitted by each training site as a percentage of
57.18all public program revenue received charges submitted by all training sites in the fund pool.
57.19    In this formula, the education factor is weighted at 67 percent and the public program
57.20volume factor is weighted at 33 percent.
57.21    Public program revenue charges for the distribution formula includes revenue from
57.22include charges for medical assistance, prepaid medical assistance, general assistance
57.23medical care, and prepaid general assistance medical care submitted for payment to this
57.24state and to contiguous states. Training sites that receive have no public program revenue
57.25charges are ineligible for funds available under this paragraph. Total statewide average
57.26costs per trainee for medical residents is based on audited clinical training costs per trainee
57.27in primary care clinical medical education programs for medical residents. Total statewide
57.28average costs per trainee for dental residents is based on audited clinical training costs
57.29per trainee in clinical medical education programs for dental students. Total statewide
57.30average costs per trainee for pharmacy residents is based on audited clinical training costs
57.31per trainee in clinical medical education programs for pharmacy students.
57.32    (b) The commissioner shall annually distribute ten percent of total available medical
57.33education funds to all qualifying applicants based on the percentage received by each
57.34applicant under paragraph (a). These funds are to be used to offset clinical education
57.35costs at eligible clinical training sites based on criteria developed by the clinical medical
58.1education program. Applicants may choose to distribute funds allocated under this
58.2paragraph based on the distribution formula described in paragraph (a).
58.3    (c) Funds distributed shall not be used to displace current funding appropriations
58.4from federal or state sources.
58.5    (d) Funds shall be distributed to the sponsoring institutions indicating the amount
58.6to be distributed to each of the sponsor's clinical medical education programs based on
58.7the criteria in this subdivision and in accordance with the commissioner's approval letter.
58.8Each clinical medical education program must distribute funds allocated under paragraph
58.9(a) to the training sites as specified in the commissioner's approval letter. Sponsoring
58.10institutions, which are accredited through an organization recognized by the Department
58.11of Education or the Centers for Medicare and Medicaid Services, may contract directly
58.12with training sites to provide clinical training. To ensure the quality of clinical training,
58.13those accredited sponsoring institutions must:
58.14    (1) develop contracts specifying the terms, expectations, and outcomes of the clinical
58.15training conducted at sites; and
58.16    (2) take necessary action if the contract requirements are not met. Action may
58.17include the withholding of payments under this section or the removal of students from
58.18the site.
58.19    (e) Any funds not distributed in accordance with the commissioner's approval letter
58.20must be returned to the medical education and research fund within 30 days of receiving
58.21notice from the commissioner. The commissioner shall distribute returned funds to the
58.22appropriate training sites in accordance with the commissioner's approval letter.
58.23    (f) The commissioner shall distribute by June 30 of each year an amount equal to
58.24the funds transferred under subdivision 10, plus five percent interest to the University of
58.25Minnesota Board of Regents for the instructional costs of health professional programs
58.26at the Academic Health Center and for interdisciplinary academic initiatives within the
58.27Academic Health Center.
58.28    (g) A maximum of $150,000 of the funds dedicated to the commissioner under
58.29section 297F.10, subdivision 1, paragraph (b), clause (2), may be used by the commissioner
58.30for administrative expenses associated with implementing this section.

58.31    Sec. 4. Minnesota Statutes 2006, section 256.01, subdivision 2b, is amended to read:
58.32    Subd. 2b. Performance payments. (a) The commissioner shall develop and
58.33implement a pay-for-performance system to provide performance payments to medical
58.34groups that demonstrate optimum care in serving individuals with chronic diseases who
58.35are enrolled in health care programs administered by the commissioner under chapters
58.36256B, 256D, and 256L. The commissioner may receive any federal matching money that
59.1is made available through the medical assistance program for managed care oversight
59.2contracted through vendors including consumer surveys, studies, and external quality
59.3reviews as required by the Federal Balanced Budget Act of 1997, Title 42, Code of Federal
59.4Regulations, Part 438, Subpart E. Any federal money received for managed care oversight
59.5is appropriated to the commissioner for this purpose. The commissioner may expend the
59.6federal money received in either year of the biennium.
59.7    (b) The commissioner shall also develop and implement a patient incentive health
59.8program to provide incentives and rewards to patients who are enrolled in health care
59.9programs administered by the commissioner under chapters 256B, 256D, and 256L, and
59.10who have agreed to and met personal health goals established with their primary care
59.11provider to manage a chronic disease or condition, including, but not limited to, diabetes,
59.12high blood pressure, and coronary artery disease.

59.13    Sec. 5. Minnesota Statutes 2006, section 256.969, subdivision 3a, is amended to read:
59.14    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
59.15assistance program must not be submitted until the recipient is discharged. However,
59.16the commissioner shall establish monthly interim payments for inpatient hospitals that
59.17have individual patient lengths of stay over 30 days regardless of diagnostic category.
59.18Except as provided in section 256.9693, medical assistance reimbursement for treatment
59.19of mental illness shall be reimbursed based on diagnostic classifications. Individual
59.20hospital payments established under this section and sections 256.9685, 256.9686, and
59.21256.9695 , in addition to third party and recipient liability, for discharges occurring during
59.22the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
59.23inpatient services paid for the same period of time to the hospital. This payment limitation
59.24shall be calculated separately for medical assistance and general assistance medical
59.25care services. The limitation on general assistance medical care shall be effective for
59.26admissions occurring on or after July 1, 1991. Services that have rates established under
59.27subdivision 11 or 12, must be limited separately from other services. After consulting with
59.28the affected hospitals, the commissioner may consider related hospitals one entity and
59.29may merge the payment rates while maintaining separate provider numbers. The operating
59.30and property base rates per admission or per day shall be derived from the best Medicare
59.31and claims data available when rates are established. The commissioner shall determine
59.32the best Medicare and claims data, taking into consideration variables of recency of the
59.33data, audit disposition, settlement status, and the ability to set rates in a timely manner.
59.34The commissioner shall notify hospitals of payment rates by December 1 of the year
59.35preceding the rate year. The rate setting data must reflect the admissions data used to
59.36establish relative values. Base year changes from 1981 to the base year established for the
60.1rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
60.2to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
60.31. The commissioner may adjust base year cost, relative value, and case mix index data
60.4to exclude the costs of services that have been discontinued by the October 1 of the year
60.5preceding the rate year or that are paid separately from inpatient services. Inpatient stays
60.6that encompass portions of two or more rate years shall have payments established based
60.7on payment rates in effect at the time of admission unless the date of admission preceded
60.8the rate year in effect by six months or more. In this case, operating payment rates for
60.9services rendered during the rate year in effect and established based on the date of
60.10admission shall be adjusted to the rate year in effect by the hospital cost index.
60.11    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
60.12payment, before third-party liability and spenddown, made to hospitals for inpatient
60.13services is reduced by .5 percent from the current statutory rates.
60.14    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
60.15admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
60.16before third-party liability and spenddown, is reduced five percent from the current
60.17statutory rates. Mental health services within diagnosis related groups 424 to 432, and
60.18facilities defined under subdivision 16, and, effective for admissions occurring on or after
60.19July 1, 2007, a long-term hospital as designated by the Medicare program that is located in
60.20a city of the first class as defined in section 410.01, are excluded from this paragraph.
60.21    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
60.22fee-for-service admissions occurring on or after July 1, 2005, made to hospitals for
60.23inpatient services before third-party liability and spenddown, is reduced 6.0 percent from
60.24the current statutory rates. Mental health services within diagnosis related groups 424 to
60.25432 and, facilities defined under subdivision 16, and, effective for admissions occurring
60.26on or after July 1, 2007, a long-term hospital as designated by the Medicare program
60.27that is located in a city of the first class as defined in section 410.01, are excluded from
60.28this paragraph. Notwithstanding section 256.9686, subdivision 7, for purposes of this
60.29paragraph, medical assistance does not include general assistance medical care. Payments
60.30made to managed care plans shall be reduced for services provided on or after January
60.311, 2006, to reflect this reduction.

60.32    Sec. 6. Minnesota Statutes 2006, section 256.969, subdivision 9, is amended to read:
60.33    Subd. 9. Disproportionate numbers of low-income patients served. (a) For
60.34admissions occurring on or after October 1, 1992, through December 31, 1992, the
60.35medical assistance disproportionate population adjustment shall comply with federal law
60.36and shall be paid to a hospital, excluding regional treatment centers and facilities of the
61.1federal Indian Health Service, with a medical assistance inpatient utilization rate in excess
61.2of the arithmetic mean. The adjustment must be determined as follows:
61.3    (1) for a hospital with a medical assistance inpatient utilization rate above the
61.4arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
61.5federal Indian Health Service but less than or equal to one standard deviation above the
61.6mean, the adjustment must be determined by multiplying the total of the operating and
61.7property payment rates by the difference between the hospital's actual medical assistance
61.8inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
61.9treatment centers and facilities of the federal Indian Health Service; and
61.10    (2) for a hospital with a medical assistance inpatient utilization rate above one
61.11standard deviation above the mean, the adjustment must be determined by multiplying
61.12the adjustment that would be determined under clause (1) for that hospital by 1.1. If
61.13federal matching funds are not available for all adjustments under this subdivision, the
61.14commissioner shall reduce payments on a pro rata basis so that all adjustments qualify for
61.15federal match. The commissioner may establish a separate disproportionate population
61.16operating payment rate adjustment under the general assistance medical care program.
61.17For purposes of this subdivision medical assistance does not include general assistance
61.18medical care. The commissioner shall report annually on the number of hospitals likely to
61.19receive the adjustment authorized by this paragraph. The commissioner shall specifically
61.20report on the adjustments received by public hospitals and public hospital corporations
61.21located in cities of the first class.
61.22    (b) For admissions occurring on or after July 1, 1993, the medical assistance
61.23disproportionate population adjustment shall comply with federal law and shall be paid to
61.24a hospital, excluding regional treatment centers and facilities of the federal Indian Health
61.25Service, with a medical assistance inpatient utilization rate in excess of the arithmetic
61.26mean. The adjustment must be determined as follows:
61.27    (1) for a hospital with a medical assistance inpatient utilization rate above the
61.28arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
61.29federal Indian Health Service but less than or equal to one standard deviation above the
61.30mean, the adjustment must be determined by multiplying the total of the operating and
61.31property payment rates by the difference between the hospital's actual medical assistance
61.32inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
61.33treatment centers and facilities of the federal Indian Health Service;
61.34    (2) for a hospital with a medical assistance inpatient utilization rate above one
61.35standard deviation above the mean, the adjustment must be determined by multiplying
61.36the adjustment that would be determined under clause (1) for that hospital by 1.1. The
62.1commissioner may establish a separate disproportionate population operating payment
62.2rate adjustment under the general assistance medical care program. For purposes of this
62.3subdivision, medical assistance does not include general assistance medical care. The
62.4commissioner shall report annually on the number of hospitals likely to receive the
62.5adjustment authorized by this paragraph. The commissioner shall specifically report on
62.6the adjustments received by public hospitals and public hospital corporations located
62.7in cities of the first class;
62.8    (3) for a hospital that had medical assistance fee-for-service payment volume during
62.9calendar year 1991 in excess of 13 percent of total medical assistance fee-for-service
62.10payment volume, a medical assistance disproportionate population adjustment shall be
62.11paid in addition to any other disproportionate payment due under this subdivision as
62.12follows: $1,515,000 due on the 15th of each month after noon, beginning July 15, 1995.
62.13For a hospital that had medical assistance fee-for-service payment volume during calendar
62.14year 1991 in excess of eight percent of total medical assistance fee-for-service payment
62.15volume and was the primary hospital affiliated with the University of Minnesota, a
62.16medical assistance disproportionate population adjustment shall be paid in addition to any
62.17other disproportionate payment due under this subdivision as follows: $505,000 due on
62.18the 15th of each month after noon, beginning July 15, 1995; and
62.19    (4) effective August 1, 2005, the payments in paragraph (b), clause (3), shall be
62.20reduced to zero.
62.21    (c) The commissioner shall adjust rates paid to a health maintenance organization
62.22under contract with the commissioner to reflect rate increases provided in paragraph (b),
62.23clauses (1) and (2), on a nondiscounted hospital-specific basis but shall not adjust those
62.24rates to reflect payments provided in clause (3).
62.25    (d) If federal matching funds are not available for all adjustments under paragraph
62.26(b), the commissioner shall reduce payments under paragraph (b), clauses (1) and (2), on a
62.27pro rata basis so that all adjustments under paragraph (b) qualify for federal match.
62.28    (e) For purposes of this subdivision, medical assistance does not include general
62.29assistance medical care.
62.30    (f) For hospital services occurring on or after July 1, 2005, to June 30, 2007, general
62.31assistance medical care expenditures for fee-for-service inpatient and outpatient hospital
62.32services made by the department and by prepaid health plans participating in general
62.33assistance medical care effective July 1, 2007, payments under section 256B.199 shall be
62.34considered Medicaid disproportionate share hospital payments, except as limited below:
62.35by clauses (1) to (5);
63.1    (1) only the portion of Minnesota's disproportionate share hospital allotment under
63.2section 1923(f) of the Social Security Act that is not spent on the disproportionate
63.3population adjustments in paragraph (b), clauses (1) and (2), may be used for general
63.4assistance medical care expenditures;
63.5    (2) only those general assistance medical care expenditures made to hospitals that
63.6qualify for disproportionate share payments under section 1923 of the Social Security Act
63.7and the Medicaid state plan may be considered disproportionate share hospital payments;
63.8    (3) only those general assistance medical care expenditures made to an individual
63.9hospital that would not cause the hospital to exceed its individual hospital limits under
63.10section 1923 of the Social Security Act may be considered; and
63.11    (4) general assistance medical care expenditures may be considered only to the
63.12extent of Minnesota's aggregate allotment under section 1923 of the Social Security Act.
63.13All hospitals and prepaid health plans participating in general assistance medical care
63.14must provide any necessary expenditure, cost, and revenue information required by
63.15the commissioner as necessary for purposes of obtaining federal Medicaid matching
63.16funds for general assistance medical care expenditures. Medicaid disproportionate share
63.17payments; and
63.18    (5) expenditures under general assistance medical care shall be used to the fullest
63.19extent before payments under section 256B.199.
63.20    (g) Upon federal approval of the related state plan amendment, paragraph (f) is
63.21effective retroactively from July 1, 2005, or the earliest effective date approved by the
63.22Centers for Medicare and Medicaid Services.

63.23    Sec. 7. Minnesota Statutes 2006, section 256B.0625, subdivision 13d, is amended to
63.24read:
63.25    Subd. 13d. Drug formulary. (a) The commissioner shall establish a drug
63.26formulary. Its establishment and publication shall not be subject to the requirements of the
63.27Administrative Procedure Act, but the Formulary Committee shall review and comment
63.28on the formulary contents.
63.29    (b) The formulary shall not include:
63.30    (1) drugs or products for which there is no federal funding;
63.31    (2) over-the-counter drugs, except as provided in subdivision 13;
63.32    (3) drugs used for weight loss, except that medically necessary lipase inhibitors may
63.33be covered for a recipient with type II diabetes;
63.34    (4) drugs when used for the treatment of impotence or erectile dysfunction;
63.35    (5) drugs for which medical value has not been established; and
64.1    (6) drugs from manufacturers who have not signed a rebate agreement with the
64.2Department of Health and Human Services pursuant to section 1927 of title XIX of the
64.3Social Security Act.
64.4    (c) If a single-source drug used by at least two percent of the fee-for-service
64.5medical assistance recipients is removed from the formulary due to the failure of the
64.6manufacturer to sign a rebate agreement with the Department of Health and Human
64.7Services, the commissioner shall notify prescribing practitioners within 30 days of
64.8receiving notification from the Centers for Medicare and Medicaid Services (CMS) that a
64.9rebate agreement was not signed.
64.10EFFECTIVE DATE.This section is effective the day following final enactment.

64.11    Sec. 8. Minnesota Statutes 2006, section 256B.0625, is amended by adding a
64.12subdivision to read:
64.13    Subd. 13i. Medicare Part D co-payments. For medical assistance recipients who
64.14are enrolled in a Medicare Part D prescription drug plan or Medicare Advantage plan,
64.15medical assistance covers the co-payments that the recipient is responsible for under the
64.16Medicare Part D prescription drug plan or Medicare Advantage plan.
64.17EFFECTIVE DATE.This section is effective July 1, 2007.

64.18    Sec. 9. Minnesota Statutes 2006, section 256B.0625, subdivision 17, is amended to
64.19read:
64.20    Subd. 17. Transportation costs. (a) Medical assistance covers transportation costs
64.21incurred solely for obtaining emergency medical care or transportation costs incurred
64.22by eligible persons in obtaining emergency or nonemergency medical care when paid
64.23directly to an ambulance company, common carrier, or other recognized providers of
64.24transportation services.
64.25    (b) Medical assistance covers special transportation, as defined in Minnesota Rules,
64.26part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
64.27would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
64.28transportation, or private automobile.
64.29The commissioner may use an order by the recipient's attending physician to certify that
64.30the recipient requires special transportation services. Special transportation includes
64.31driver-assisted service to eligible individuals. Driver-assisted service includes passenger
64.32pickup at and return to the individual's residence or place of business, assistance with
64.33admittance of the individual to the medical facility, and assistance in passenger securement
64.34or in securing of wheelchairs or stretchers in the vehicle. Special transportation providers
64.35must obtain written documentation from the health care service provider who is serving
65.1the recipient being transported, identifying the time that the recipient arrived. Special
65.2transportation providers may not bill for separate base rates for the continuation of a trip
65.3beyond the original destination. Special transportation providers must take recipients
65.4to the nearest appropriate health care provider, using the most direct quickest route
65.5available as determined by a commercially available mileage software program approved
65.6by the commissioner. The maximum medical assistance reimbursement rates for special
65.7transportation services are:
65.8    (1) $17 for the base rate and $1.35 $1.43 per mile for services to eligible persons
65.9who need a wheelchair-accessible van;
65.10    (2) $11.50 for the base rate and $1.30 per mile for services to eligible persons who
65.11do not need a wheelchair-accessible van; and
65.12    (3) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for
65.13services to eligible persons who need a stretcher-accessible vehicle.

65.14    Sec. 10. Minnesota Statutes 2006, section 256B.0625, subdivision 18a, is amended to
65.15read:
65.16    Subd. 18a. Access to medical services. (a) Medical assistance reimbursement for
65.17meals for persons traveling to receive medical care may not exceed $5.50 for breakfast,
65.18$6.50 for lunch, or $8 for dinner.
65.19    (b) Medical assistance reimbursement for lodging for persons traveling to receive
65.20medical care may not exceed $50 per day unless prior authorized by the local agency.
65.21    (c) Medical assistance direct mileage reimbursement to the an eligible person or the
65.22an eligible person's driver may not exceed 20 cents per mile friend, neighbor, or relative
65.23that is providing direct transportation to a covered service shall be at 15 cents below the
65.24current Internal Revenue Service mileage reimbursement for business purposes.
65.25    (d) Medical assistance covers oral language interpreter services when provided by
65.26an enrolled health care provider during the course of providing a direct, person-to-person
65.27covered health care service to an enrolled recipient with limited English proficiency.

65.28    Sec. 11. Minnesota Statutes 2006, section 256B.0625, subdivision 30, is amended to
65.29read:
65.30    Subd. 30. Other clinic services. (a) Medical assistance covers rural health clinic
65.31services, federally qualified health center services, nonprofit community health clinic
65.32services, public health clinic services, and the services of a clinic meeting the criteria
65.33established in rule by the commissioner. Rural health clinic services and federally
65.34qualified health center services mean services defined in United States Code, title 42,
65.35section 1396d(a)(2)(B) and (C). Payment for rural health clinic and federally qualified
65.36health center services shall be made according to applicable federal law and regulation.
66.1    (b) A federally qualified health center that is beginning initial operation shall submit
66.2an estimate of budgeted costs and visits for the initial reporting period in the form and
66.3detail required by the commissioner. A federally qualified health center that is already in
66.4operation shall submit an initial report using actual costs and visits for the initial reporting
66.5period. Within 90 days of the end of its reporting period, a federally qualified health
66.6center shall submit, in the form and detail required by the commissioner, a report of
66.7its operations, including allowable costs actually incurred for the period and the actual
66.8number of visits for services furnished during the period, and other information required
66.9by the commissioner. Federally qualified health centers that file Medicare cost reports
66.10shall provide the commissioner with a copy of the most recent Medicare cost report filed
66.11with the Medicare program intermediary for the reporting year which support the costs
66.12claimed on their cost report to the state.
66.13    (c) In order to continue cost-based payment under the medical assistance program
66.14according to paragraphs (a) and (b), a federally qualified health center or rural health clinic
66.15must apply for designation as an essential community provider within six months of final
66.16adoption of rules by the Department of Health according to section 62Q.19, subdivision
66.177
. For those federally qualified health centers and rural health clinics that have applied
66.18for essential community provider status within the six-month time prescribed, medical
66.19assistance payments will continue to be made according to paragraphs (a) and (b) for the
66.20first three years after application. For federally qualified health centers and rural health
66.21clinics that either do not apply within the time specified above or who have had essential
66.22community provider status for three years, medical assistance payments for health services
66.23provided by these entities shall be according to the same rates and conditions applicable
66.24to the same service provided by health care providers that are not federally qualified
66.25health centers or rural health clinics.
66.26    (d) Effective July 1, 1999, the provisions of paragraph (c) requiring a federally
66.27qualified health center or a rural health clinic to make application for an essential
66.28community provider designation in order to have cost-based payments made according
66.29to paragraphs (a) and (b) no longer apply.
66.30    (e) Effective January 1, 2000, payments made according to paragraphs (a) and (b)
66.31shall be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
66.32    (f) (d) Effective January 1, 2001, each federally qualified health center and
66.33rural health clinic may elect to be paid either under the prospective payment system
66.34established in United States Code, title 42, section 1396a(aa), or under an alternative
66.35payment methodology consistent with the requirements of United States Code, title 42,
66.36section 1396a(aa), and approved by the Centers for Medicare and Medicaid Services.
67.1The alternative payment methodology shall be 100 percent of cost costs as determined
67.2according to by generally accepted accounting principles and annual Medicare cost
67.3principles reports, including Medicaid-eligible cost add-ons.

67.4    Sec. 12. Minnesota Statutes 2006, section 256B.0625, is amended by adding a
67.5subdivision to read:
67.6    Subd. 49. Community health worker. (a) Medical assistance covers the care
67.7coordination and patient education services provided by a community health worker if
67.8the community health worker has:
67.9    (1) received a certificate from the Minnesota State Colleges and Universities System
67.10approved community health worker curriculum; or
67.11    (2) at least five years of supervised experience.
67.12Community health workers eligible for payment under clause (2) must complete the
67.13certification program by January 1, 2010, to continue to be eligible for payment.
67.14    (b) Community health workers must work under the supervision of a medical
67.15assistance enrolled provider.

67.16    Sec. 13. Minnesota Statutes 2006, section 256B.0644, is amended to read:
67.17256B.0644 REIMBURSEMENT UNDER OTHER STATE HEALTH CARE
67.18PROGRAMS.
67.19    (a) A vendor of medical care, as defined in section 256B.02, subdivision 7, and a
67.20health maintenance organization, as defined in chapter 62D, must participate as a provider
67.21or contractor in the medical assistance program, general assistance medical care program,
67.22and MinnesotaCare as a condition of participating as a provider in health insurance plans
67.23and programs or contractor for state employees established under section 43A.18, the
67.24public employees insurance program under section 43A.316, for health insurance plans
67.25offered to local statutory or home rule charter city, county, and school district employees,
67.26the workers' compensation system under section 176.135, and insurance plans provided
67.27through the Minnesota Comprehensive Health Association under sections 62E.01 to
67.2862E.19 . The limitations on insurance plans offered to local government employees shall
67.29not be applicable in geographic areas where provider participation is limited by managed
67.30care contracts with the Department of Human Services.
67.31    (b) For providers other than health maintenance organizations, participation in the
67.32medical assistance program means that:
67.33     (1) the provider accepts new medical assistance, general assistance medical care,
67.34and MinnesotaCare patients or;
68.1    (2) for providers other than dental service providers, at least 20 percent of the
68.2provider's patients are covered by medical assistance, general assistance medical care, and
68.3MinnesotaCare as their primary source of coverage, or; or
68.4    (3) for dental service providers, at least ten percent of the provider's patients are
68.5covered by medical assistance, general assistance medical care, and MinnesotaCare as
68.6their primary source of coverage, or the provider accepts new medical assistance and
68.7MinnesotaCare patients who are children with special health care needs. For purposes
68.8of this section, "children with special health care needs" means children up to age 18
68.9who: (i) require health and related services beyond that required by children generally;
68.10and (ii) have or are at risk for a chronic physical, developmental, behavioral, or emotional
68.11condition, including: bleeding and coagulation disorders; immunodeficiency disorders;
68.12cancer; endocrinopathy; developmental disabilities; epilepsy, cerebral palsy, and other
68.13neurological diseases; visual impairment or deafness; Down syndrome and other genetic
68.14disorders; autism; fetal alcohol syndrome; and other conditions designated by the
68.15commissioner after consultation with representatives of pediatric dental providers and
68.16consumers.
68.17    (c) Patients seen on a volunteer basis by the provider at a location other than the
68.18provider's usual place of practice may be considered in meeting this the participation
68.19requirement in this section. The commissioner shall establish participation requirements
68.20for health maintenance organizations. The commissioner shall provide lists of
68.21participating medical assistance providers on a quarterly basis to the commissioner of
68.22employee relations, the commissioner of labor and industry, and the commissioner of
68.23commerce. Each of the commissioners shall develop and implement procedures to exclude
68.24as participating providers in the program or programs under their jurisdiction those
68.25providers who do not participate in the medical assistance program. The commissioner
68.26of employee relations shall implement this section through contracts with participating
68.27health and dental carriers.

68.28    Sec. 14. [256B.0751] CARE COORDINATION FOR CHILDREN WITH
68.29HIGH-COST MEDICAL CONDITIONS.
68.30    Subdivision 1. Care coordination required. (a) The commissioner of human
68.31services shall contract with the U special kids program to provide care coordination,
68.32beginning October 1, 2007, for medical assistance enrollees who are children with
68.33high-cost medical conditions, and to perform the other duties specified in this section.
68.34    (b) For purposes of this section, "care coordination" means collaboration with
68.35primary care physicians and specialists to manage care, development of medical
68.36management plans for recurrent acute illnesses, oversight and coordination of all aspects
69.1of care in partnership with families, organization of medical information into a summary
69.2of critical information, coordination and appropriate sequencing of tests and multiple
69.3appointments, information and assistance with accessing resources, and telephone triage
69.4for acute illnesses or problems.
69.5    Subd. 2. Referrals. The commissioner shall develop a mechanism to refer
69.6children to the U special kids program for care coordination. Beginning October 1, 2007,
69.7and subject to the limits on total program enrollment specified in subdivision 3, the
69.8commissioner shall refer to the U special kids program children who:
69.9    (1) incur medical expenses that exceed the qualifying level specified in subdivision 3;
69.10    (2) have medical conditions that involve four or more major systems; require
69.11multiple specialists; require use of technology such as G-tube, trach, central line, or
69.12oxygen; and require multiple medications;
69.13    (3) do not have a medical case manager for cancer, organ transplantation, epilepsy,
69.14or bone marrow replacement; and
69.15    (4) voluntarily agree to participate in the program.
69.16    Subd. 3. Qualifying level of medical expenses. (a) For the period October 1, 2007,
69.17through September 30, 2008, the commissioner shall refer children for care coordination
69.18under this section if they incurred medical expenses of $500,000 or more during the
69.19fiscal year ending June 30, 2007.
69.20    (b) For the period October 1, 2008, through September 30, 2009, the commissioner
69.21shall refer children for care coordination under this section if they incurred medical
69.22expenses of $400,000 or more during the fiscal year ending June 30, 2008.
69.23    (c) For the period October 1, 2009, through September 30, 2010, the commissioner
69.24shall refer children for care coordination under this section if they incurred medical
69.25expenses of $300,000 or more during the fiscal year ending June 30, 2009.
69.26    (d) Beginning October 1, 2010, the commissioner shall refer children for care
69.27coordination under this section if they incurred medical expenses of $250,000 or more
69.28during the previous fiscal year.
69.29    (e) The commissioner shall limit referrals to the extent necessary to ensure that
69.30total enrollment in the U special kids program does not exceed 100 children for the
69.31period October 1, 2007, through September 30, 2008, and does not exceed 150 children
69.32beginning October 1, 2008.
69.33    Subd. 4. Case management. Beginning October 1, 2007, the U special kids
69.34program shall coordinate all nonmedical case management services provided to children
69.35who are required to receive care coordination under this section. The program may
70.1require all nonmedical case managers, including, but not limited to, county case managers
70.2and case managers for children served under a home and community-based waiver,
70.3to submit care plans for approval, and to document client compliance with the care
70.4plans. The U special kids program, beginning October 1, 2008, may employ or contract
70.5with nonmedical case managers to provide all nonmedical case management services to
70.6children required to receive care coordination under this section. The commissioner shall
70.7reimburse the U special kids program for case management services through the medical
70.8assistance program.
70.9    Subd. 5. Statewide availability of care coordination. The U special kids program
70.10may contract with other entities to provide care coordination services as defined in
70.11subdivision 1, in order to ensure the availability of these services in all regions of the state.
70.12    Subd. 6. Advance practice nurse telephone triage system. The U special kids
70.13program shall establish and operate an advance practice nurse telephone triage system that
70.14is available statewide, 24 hours a day, seven days per week. The system must provide
70.15advance practice nurses with access to a Web-based information system to appropriately
70.16triage medical problems, manage care, and reduce unnecessary hospitalizations.
70.17    Subd. 7. Monitoring and evaluation. The commissioner shall monitor program
70.18outcomes and evaluate the extent to which referrals to the U special kids program have
70.19improved the quality and coordination of care and provided financial savings to the
70.20medical assistance program. The U special kids program shall submit to the commissioner,
70.21in the form and manner specified by the commissioner, all data and information necessary
70.22to monitor program outcomes and evaluate the program. The commissioner shall present a
70.23preliminary evaluation to the legislature by January 15, 2008, and a final evaluation to the
70.24legislature by January 15, 2010.
70.25EFFECTIVE DATE.This section is effective October 1, 2007, or upon federal
70.26approval, whichever is later.

70.27    Sec. 15. [256B.0752] CARE COORDINATION FOR CHILDREN WITH
70.28HIGH-COST MENTAL HEALTH CONDITIONS.
70.29    Subdivision 1. Care coordination required. (a) The commissioner of human
70.30services shall contract with the U special kids program to provide care coordination,
70.31beginning October 1, 2007, for medical assistance enrollees who are children with
70.32high-cost mental health conditions and behavioral problems, and to perform the other
70.33duties specified in this section.
70.34    (b) For purposes of this section, "care coordination" means: collaboration with
70.35primary care physicians and specialists to manage care; development of mental health
71.1management plans for recurrent mental health issues; oversight and coordination of all
71.2aspects of care in partnership with families; organization of medical, treatment, and
71.3therapy information into a summary of critical information; coordination and appropriate
71.4sequencing of evaluations and multiple appointments; information and assistance with
71.5accessing resources; and telephone triage for behavior or other problems.
71.6    Subd. 2. Referrals. The commissioner shall develop a mechanism to refer children
71.7to the program for care coordination. Beginning October 1, 2007, and subject to the limits
71.8on total program enrollment specified in subdivision 3, the commissioner shall refer to
71.9the U special kids program children who:
71.10    (1) incur mental health expenses that exceed the qualifying level specified in
71.11subdivision 3;
71.12    (2) are currently receiving or at risk of needing inpatient mental health treatment,
71.13foster home care, or both; and
71.14    (3) voluntarily agree to participate in the program.
71.15    Subd. 3. Qualifying level of medical expenses. (a) Beginning October 1, 2007, the
71.16commissioner shall refer children for care coordination under this section if they incurred
71.17medical and mental health expenses of $250,000 or more in the previous fiscal year.
71.18    (b) The commissioner shall limit referrals to the extent necessary to ensure that total
71.19enrollment in the U special kids program does not exceed 25 children for the period
71.20October 1, 2007, through September 30, 2008; does not exceed 75 children for the
71.21period October 1, 2008, through September 30, 2009; and does not exceed 125 children
71.22beginning October 1, 2009.
71.23    Subd. 4. Case management. The U special kids program, beginning October 1,
71.242007, shall coordinate all nonmedical case management services provided to children who
71.25are required to receive care coordination under this section. The program may require all
71.26nonmedical case managers, including but not limited to county case managers and case
71.27managers for children served under a home and community-based waiver, to submit care
71.28plans for approval, and to document client compliance with the care plans. The U special
71.29kids program, beginning October 1, 2008, may employ or contract with nonmedical case
71.30managers to provide all nonmedical case management services to children required to
71.31receive care coordination under this section. The commissioner shall reimburse the
71.32U special kids program for case management services through the medical assistance
71.33program.
72.1    Subd. 5. Statewide availability of care coordination. The program may contract
72.2with other entities to provide care coordination services as defined in subdivision 1, in
72.3order to ensure the availability of these services in all regions of the state.
72.4    Subd. 6. Monitoring and evaluation. The commissioner shall monitor program
72.5outcomes and shall evaluate the extent to which referrals to the U special kids program
72.6have improved the quality and coordination of care and provided financial savings to the
72.7medical assistance program. The U special kids program shall submit to the commissioner,
72.8in the form and manner specified by the commissioner, all data and information necessary
72.9to monitor program outcomes and evaluate the program. The commissioner shall present a
72.10preliminary evaluation to the legislature by January 15, 2008, and a final evaluation to the
72.11legislature by January 15, 2010.
72.12EFFECTIVE DATE.This section is effective October 1, 2007, or upon federal
72.13approval, whichever is later. The commissioner shall notify the Office of the Revisor of
72.14Statutes when federal approval is obtained.

72.15    Sec. 16. [256B.194] FEDERAL PAYMENTS.
72.16    Subdivision 1. Payments at actual cost. If the Centers for Medicare & Medicaid
72.17Services (CMS) promulgates a final rule consistent with its stated intent in the proposed
72.18rule published at 72 Federal Register, No. 11, January 18, 2007, regarding limiting
72.19payments to units of government, and notwithstanding Minnesota Statutes or Minnesota
72.20Rules to the contrary, for providers that are units of government, the commissioner may
72.21limit medical assistance and MinnesotaCare payments to a provider's actual cost of
72.22providing services, in accordance with the CMS final rule. If a final rule is promulgated,
72.23the commissioner may also require medical assistance and MinnesotaCare providers to
72.24provide any information necessary to determine Medicaid-related costs, and require the
72.25cooperation of providers in any audit or review necessary to ensure payments are limited
72.26to cost. This section does not apply to providers who are exempt from the provisions of
72.27the CMS final rule.
72.28    Subd. 2. Loss of federal financial participation. For all transfers, certified
72.29expenditures, and medical assistance payments listed below, if the commissioner
72.30determines that federal financial participation is no longer available for the medical
72.31assistance payments listed, then related obligations for the nonfederal share of payments
72.32and the medical assistance payments shall terminate. The commissioner shall notify all
72.33affected parties of the loss of federal financial participation, and the resulting payments
72.34and obligations that are terminated. If the commissioner determines that federal financial
72.35participation is no longer available for any medical assistance payments or contributions
73.1to the nonfederal share of medical assistance payments that have already been made, the
73.2commissioner may collect the medical assistance payments from providers and return
73.3contributions of the nonfederal share to its source. The transfers, certified expenditures,
73.4and medical assistance payments subject to this section are those specified in: sections
73.562J.692, subdivision 7, paragraphs (b) and (c); 256B.19, subdivisions 1c and 1d;
73.6256B.195; 256B.431, subdivision 23; and 256B.69, subdivision 5c, paragraph (a), clauses
73.7(2), (3), and (4); Laws 2002, chapter 220, article 17, section 2, subdivision 3; and Laws
73.82005, First Special Session chapter 4, article 9, section 2, subdivision 1.

73.9    Sec. 17. Minnesota Statutes 2006, section 256B.199, is amended to read:
73.10256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
73.11    (a) Hennepin County, and Hennepin County Medical Center, Ramsey County,
73.12Regions Hospital, the University of Minnesota, and Fairview-University Medical Center
73.13shall report quarterly to the commissioner beginning June 1, 2007, payments made during
73.14the second previous quarter that may qualify for reimbursement under federal law.
73.15    (b) Based on these reports, the commissioner shall apply for federal matching funds.
73.16These funds are appropriated to the commissioner for the payments under section 256.969,
73.17subdivision 27
to Hennepin County Medical Center.
73.18    (c) By May 1 of each year, beginning May 1, 2007, the commissioner shall inform
73.19the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
73.20hospital payment money expected to be available in the current federal fiscal year.
73.21    (d) This section sunsets on June 30, 2009. The commissioner shall report to
73.22the legislature by December 15, 2008, with recommendations for maximizing federal
73.23disproportionate share hospital payments after June 30, 2009.

73.24    Sec. 18. Minnesota Statutes 2006, section 256B.75, is amended to read:
73.25256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
73.26    (a) For outpatient hospital facility fee payments for services rendered on or after
73.27October 1, 1992, the commissioner of human services shall pay the lower of (1) submitted
73.28charge, or (2) 32 percent above the rate in effect on June 30, 1992, except for those
73.29services for which there is a federal maximum allowable payment. Effective for services
73.30rendered on or after January 1, 2000, payment rates for nonsurgical outpatient hospital
73.31facility fees and emergency room facility fees shall be increased by eight percent over the
73.32rates in effect on December 31, 1999, except for those services for which there is a federal
73.33maximum allowable payment. Services for which there is a federal maximum allowable
73.34payment shall be paid at the lower of (1) submitted charge, or (2) the federal maximum
73.35allowable payment. Total aggregate payment for outpatient hospital facility fee services
73.36shall not exceed the Medicare upper limit. If it is determined that a provision of this
74.1section conflicts with existing or future requirements of the United States government with
74.2respect to federal financial participation in medical assistance, the federal requirements
74.3prevail. The commissioner may, in the aggregate, prospectively reduce payment rates to
74.4avoid reduced federal financial participation resulting from rates that are in excess of
74.5the Medicare upper limitations.
74.6    (b) Notwithstanding paragraph (a), payment for outpatient, emergency, and
74.7ambulatory surgery hospital facility fee services for critical access hospitals designated
74.8under section 144.1483, clause (10), shall be paid on a cost-based payment system that
74.9is based on the cost-finding methods and allowable costs of the Medicare program. All
74.10hospital outpatient services provided by any hospital exclusively devoted to the care
74.11of pediatric patients that is located in a Minnesota metropolitan statistical area, and all
74.12pediatric outpatient services provided by a hospital that includes the operations of the
74.13hospital formerly owned by the University of Minnesota, must be paid for using the
74.14methodology established for critical access hospitals at a rate equal to fee-for-service rates
74.15plus 93 percent, as limited by allowable costs.
74.16    (c) Effective for services provided on or after July 1, 2003, rates that are based
74.17on the Medicare outpatient prospective payment system shall be replaced by a budget
74.18neutral prospective payment system that is derived using medical assistance data. The
74.19commissioner shall provide a proposal to the 2003 legislature to define and implement
74.20this provision.
74.21    (d) For fee-for-service services provided on or after July 1, 2002, the total payment,
74.22before third-party liability and spenddown, made to hospitals for outpatient hospital
74.23facility services is reduced by .5 percent from the current statutory rate.
74.24    (e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
74.25services provided on or after July 1, 2003, made to hospitals for outpatient hospital
74.26facility services before third-party liability and spenddown, is reduced five percent from
74.27the current statutory rates. Facilities defined under section 256.969, subdivision 16, are
74.28excluded from this paragraph.
74.29EFFECTIVE DATE.This section is effective July 1, 2007, and applies to services
74.30provided on or after that date.

74.31    Sec. 19. Minnesota Statutes 2006, section 256B.76, is amended to read:
74.32256B.76 PHYSICIAN AND DENTAL REIMBURSEMENT.
74.33    (a) Effective for services rendered on or after October 1, 1992, the commissioner
74.34shall make payments for physician services as follows:
75.1    (1) payment for level one Centers for Medicare and Medicaid Services' common
75.2procedural coding system codes titled "office and other outpatient services," "preventive
75.3medicine new and established patient," "delivery, antepartum, and postpartum care,"
75.4"critical care," cesarean delivery and pharmacologic management provided to psychiatric
75.5patients, and level three codes for enhanced services for prenatal high risk, shall be paid
75.6at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
75.730, 1992. If the rate on any procedure code within these categories is different than the
75.8rate that would have been paid under the methodology in section 256B.74, subdivision 2,
75.9then the larger rate shall be paid;
75.10    (2) payments for all other services shall be paid at the lower of (i) submitted charges,
75.11or (ii) 15.4 percent above the rate in effect on June 30, 1992;
75.12    (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
75.13percentile of 1989, less the percent in aggregate necessary to equal the above increases
75.14except that payment rates for home health agency services shall be the rates in effect
75.15on September 30, 1992;
75.16    (4) effective for services rendered on or after January 1, 2000, payment rates for
75.17physician and professional services shall be increased by three percent over the rates in
75.18effect on December 31, 1999, except for home health agency and family planning agency
75.19services; and
75.20    (5) the increases in clause (4) shall be implemented January 1, 2000, for managed
75.21care.
75.22    (b) Effective for services rendered on or after October 1, 1992, the commissioner
75.23shall make payments for dental services as follows:
75.24    (1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25
75.25percent above the rate in effect on June 30, 1992;
75.26    (2) dental rates shall be converted from the 50th percentile of 1982 to the 50th
75.27percentile of 1989, less the percent in aggregate necessary to equal the above increases;
75.28    (3) effective for services rendered on or after January 1, 2000, payment rates for
75.29dental services shall be increased by three percent over the rates in effect on December
75.3031, 1999;
75.31    (4) the commissioner shall award grants to community clinics or other nonprofit
75.32community organizations, political subdivisions, professional associations, or other
75.33organizations that demonstrate the ability to provide dental services effectively to public
75.34program recipients. Grants may be used to fund the costs related to coordinating access for
75.35recipients, developing and implementing patient care criteria, upgrading or establishing
75.36new facilities, acquiring furnishings or equipment, recruiting new providers, or other
76.1development costs that will improve access to dental care in a region. In awarding grants,
76.2the commissioner shall give priority to applicants that plan to serve areas of the state in
76.3which the number of dental providers is not currently sufficient to meet the needs of
76.4recipients of public programs or uninsured individuals. The commissioner shall consider
76.5the following in awarding the grants:
76.6    (i) potential to successfully increase access to an underserved population;
76.7    (ii) the ability to raise matching funds;
76.8    (iii) the long-term viability of the project to improve access beyond the period
76.9of initial funding;
76.10    (iv) the efficiency in the use of the funding; and
76.11    (v) the experience of the proposers in providing services to the target population.
76.12    The commissioner shall monitor the grants and may terminate a grant if the grantee
76.13does not increase dental access for public program recipients. The commissioner shall
76.14consider grants for the following:
76.15    (i) implementation of new programs or continued expansion of current access
76.16programs that have demonstrated success in providing dental services in underserved
76.17areas;
76.18    (ii) a pilot program for utilizing hygienists outside of a traditional dental office to
76.19provide dental hygiene services; and
76.20    (iii) a program that organizes a network of volunteer dentists, establishes a system to
76.21refer eligible individuals to volunteer dentists, and through that network provides donated
76.22dental care services to public program recipients or uninsured individuals;
76.23    (5) beginning October 1, 1999, the payment for tooth sealants and fluoride treatments
76.24shall be the lower of (i) submitted charge, or (ii) 80 percent of median 1997 charges;
76.25    (6) the increases listed in clauses (3) and (5) shall be implemented January 1, 2000,
76.26for managed care; and
76.27    (7) effective for services provided on or after January 1, 2002, payment for
76.28diagnostic examinations and dental x-rays provided to children under age 21 shall be the
76.29lower of (i) the submitted charge, or (ii) 85 percent of median 1999 charges.
76.30    (c) Effective for dental services rendered on or after January 1, 2002, the
76.31commissioner may, within the limits of available appropriation, increase reimbursements
76.32to dentists and dental clinics deemed by the commissioner to be critical access dental
76.33providers. Reimbursement to a critical access dental provider may be increased by not
76.34more than 50 percent above the reimbursement rate that would otherwise be paid to the
76.35provider. Payments to For dental services rendered after June 30, 2007, the commissioner
76.36shall increase reimbursement by 33 percent above the reimbursement rate that would
77.1otherwise be paid to the provider. The commissioner shall pay the health plan companies
77.2shall be adjusted in amounts sufficient to reflect increased reimbursements to critical
77.3access dental providers as approved by the commissioner. In determining which dentists
77.4and dental clinics shall be deemed critical access dental providers, the commissioner
77.5shall review:
77.6    (1) the utilization rate in the service area in which the dentist or dental clinic operates
77.7for dental services to patients covered by medical assistance, general assistance medical
77.8care, or MinnesotaCare as their primary source of coverage;
77.9    (2) the level of services provided by the dentist or dental clinic to patients covered
77.10by medical assistance, general assistance medical care, or MinnesotaCare as their primary
77.11source of coverage; and
77.12    (3) whether the level of services provided by the dentist or dental clinic is critical to
77.13maintaining adequate levels of patient access within the service area.
77.14In the absence of a critical access dental provider in a service area, the commissioner may
77.15designate a dentist or dental clinic as a critical access dental provider if the dentist or
77.16dental clinic is willing to provide care to patients covered by medical assistance, general
77.17assistance medical care, or MinnesotaCare at a level which significantly increases access
77.18to dental care in the service area.
77.19    The commissioner shall annually establish a reimbursement schedule for critical
77.20access dental providers and provider-specific limits on total reimbursement received
77.21under the reimbursement schedule, and shall notify each critical access dental provider
77.22of the schedule and limit.
77.23    (d) An entity that operates both a Medicare certified comprehensive outpatient
77.24rehabilitation facility and a facility which was certified prior to January 1, 1993, that is
77.25licensed under Minnesota Rules, parts 9570.2000 to 9570.3600, and for whom at least 33
77.26percent of the clients receiving rehabilitation services in the most recent calendar year are
77.27medical assistance recipients, shall be reimbursed by the commissioner for rehabilitation
77.28services at rates that are 38 percent greater than the maximum reimbursement rate
77.29allowed under paragraph (a), clause (2), when those services are (1) provided within the
77.30comprehensive outpatient rehabilitation facility and (2) provided to residents of nursing
77.31facilities owned by the entity.
77.32    (e) Effective for services rendered on or after January 1, 2007, the commissioner
77.33shall make payments for physician and professional services based on the Medicare
77.34relative value units (RVU's). This change shall be budget neutral and the cost of
77.35implementing RVU's will be incorporated in the established conversion factor.

77.36    Sec. 20. Minnesota Statutes 2006, section 256L.11, subdivision 7, is amended to read:
78.1    Subd. 7. Critical access dental providers. Effective for dental services provided
78.2to MinnesotaCare enrollees on or after between January 1, 2007, and June 30, 2007, the
78.3commissioner shall increase payment rates to dentists and dental clinics deemed by the
78.4commissioner to be critical access providers under section 256B.76, paragraph (c), by 50
78.5percent above the payment rate that would otherwise be paid to the provider. Effective
78.6for dental services provided to MinnesotaCare enrollees on or after July 1, 2007, the
78.7commissioner shall increase payment rates to dentists and dental clinics deemed by the
78.8commissioner to be critical access providers under section 256B.76, paragraph (c), by
78.933 percent above the payment rate that would otherwise be paid to the provider. The
78.10commissioner shall adjust the rates paid on or after January 1, 2007, to pay the prepaid
78.11health plans under contract with the commissioner amounts sufficient to reflect this rate
78.12increase. The prepaid health plan must pass this rate increase to providers who have
78.13been identified by the commissioner as critical access dental providers under section
78.14256B.76 , paragraph (c).

78.15    Sec. 21. AGRICULTURAL COOPERATIVE HEALTH PLAN FOR FARMERS.
78.16    Subdivision 1. Pilot project requirements. The commissioner of commerce shall
78.17authorize a joint self-insurance pilot project administered by a trust sponsored by one
78.18or more agricultural cooperatives organized under Minnesota Statutes, chapter 308A,
78.19or under a federal charter for the purpose of offering health coverage to members of
78.20the cooperatives and their families, provided the project satisfies the requirements of
78.21Minnesota Statutes, chapter 62H, except as follows:
78.22    (1) Minnesota Statutes, section 62H.02, subdivision 1, paragraph (b), does not apply;
78.23    (2) the notice period required under Minnesota Statutes, section 62H.02, subdivision
78.241, paragraph (e), is 90 days;
78.25    (3) the commissioner shall grant necessary waivers and approve an alternative
78.26arrangement that fully funds the plan's liability or incurred but unpaid claims under
78.27Minnesota Statutes, section 62H.02, subdivision 1, paragraph (f), unless the commissioner
78.28provides evidence demonstrating that the insolvency protection proposed is substantially
78.29less than that typically provided by self-insured group plans of a similar size in Minnesota;
78.30    (4) notwithstanding Minnesota Statutes, section 62H.04, paragraph (a), the joint
78.31self-insurance plan shall be considered a large group and not subject to the small group
78.32insurance requirements in Minnesota Statutes, chapter 62L, even if some employer
78.33groups enrolled in the plan would be defined as small employers, except that the joint
78.34self-insurance plan may elect to treat the sale of a health plan to or for an employer that
78.35has only one eligible employee who has not waived coverage as the sale of an individual
78.36health plan as allowed under Minnesota Statutes, section 62L.02, subdivision 26;
79.1    (5) Minnesota Statutes, section 297I.05, subdivision 12, paragraph (c), does not
79.2apply; and
79.3    (6) the trust must pay the assessment for the Minnesota comprehensive health
79.4association as provided under Minnesota Statutes, section 62E.11.
79.5    Subd. 2. Evaluation and renewal. The pilot project authorized under this section
79.6is for a period of four years from the date of initial enrollment. The commissioner shall
79.7grant an extension of four additional years if the trust provides evidence that it remains in
79.8compliance with the requirements of this section and other applicable laws and rules. If the
79.9commissioner determines that the operation of the trust has not improved access, expanded
79.10health plan choices, or improved affordability of health coverage for farm families, or
79.11that it has significantly damaged access, choice, or affordability for other consumers not
79.12enrolled in the trust, the commissioner shall provide at least 180 days' advance written
79.13notice to the trust and to the chairs of the senate and house finance and policy committees
79.14with jurisdiction over health and insurance matters of the commissioner's intention not to
79.15renew the pilot project at the expiration of a four-year period.
79.16EFFECTIVE DATE.This section is effective the day following final enactment.

79.17    Sec. 22. HENNEPIN COUNTY PILOT PROJECT.
79.18    The commissioner of human services shall support a pilot project in Hennepin
79.19County to demonstrate the effectiveness of alternative strategies to redetermine eligibility
79.20for certain recipient populations in the medical assistance program. The target populations
79.21for the demonstration are persons who are eligible based upon disability or age, who
79.22have chronic medical conditions, and who are expected to experience minimal change in
79.23income or assets from month to month. The commissioner and the county shall analyze
79.24the issues and strategies employed and the outcomes to determine reasonable efforts to
79.25streamline eligibility statewide. The commissioner shall apply for any federal waivers
79.26needed to implement this section.

79.27    Sec. 23. COUNTY-BASED PURCHASING STUDY.
79.28    The commissioner of health shall study county-based purchasing initiatives
79.29established under Minnesota Statutes, section 256B.692, and compare these initiatives
79.30to managed care plans serving medical assistance, general assistance medical care, and
79.31MinnesotaCare enrollees. The study must:
79.32    (1) provide a history and description of county-based purchasing initiatives,
79.33including state and federal requirements and any federal waivers Minnesota counties have
79.34applied for or received;
80.1    (2) provide a history and description of managed care plan participation in the
80.2prepaid medical assistance, prepaid general assistance medical care, and prepaid
80.3Minnesota programs, and the provision by managed care plans of third-party administrator
80.4services for county-based purchasing initiatives;
80.5    (3) provide relevant data, including limitations on data, data that was requested but
80.6not received, and explanations for why requested data was not received;
80.7    (4) provide recommendations for further data collection and research;
80.8    (5) summarize successes and challenges of the two service delivery methods;
80.9    (6) provide recommendations for possible expansion of county-based purchasing
80.10in rural and urban settings; and
80.11    (7) identify and describe features of county-based purchasing and managed care
80.12plans serving medical assistance, general assistance medical care, and MinnesotaCare
80.13enrollees, to provide a comparison of cost, quality, access, and community health
80.14improvement that includes, but is not limited to:
80.15    (i) descriptions of how health care and social services are integrated and coordinated
80.16for persons with complex care needs, including persons with high-risk pregnancies,
80.17adolescents, persons who are disabled, persons who are elderly, and persons with chronic
80.18health care and social needs;
80.19    (ii) use of monetary grants and surpluses to:
80.20    (A) increase provider reimbursement, including dental care reimbursement, in order
80.21to improve health care access; and
80.22    (B) improve community health beyond the requirements of the public health care
80.23programs, such as the funding of public education, research, and community initiatives to
80.24enhance utilization of preventive services, social services, or mental health care;
80.25    (iii) administrative costs, including billing and collection of unpaid fees, co-pays or
80.26other charges, and top five management salaries;
80.27    (iv) reporting requirements of contracts with the Department of Human Services;
80.28    (v) public access to all information about management and administration, including
80.29but not limited to provider contracts and reimbursement, models of care management and
80.30coordination, utilization review, contracts with consultants and other vendors, handling of
80.31monetary grants and surpluses, and health outcomes data;
80.32    (vi) provider reimbursement by clinical practice area;
80.33    (vii) populations served, described by age, disability, income, race, language,
80.34occupation, and other demographic characteristics;
80.35    (viii) utilization of community-based prevention interventions, including but not
80.36limited to public health nursing visits to new parents, use of nurse-managed interventions
81.1to reduce cardiac hospitalizations, and the use of medical homes for chronic disease
81.2management;
81.3    (ix) utilization of cancer screening;
81.4    (x) utilization of interpreter services;
81.5    (xi) immunization rates for children age five and under;
81.6    (xii) hospitalization rates for conditions related to diabetes, asthma, or cardiac
81.7illnesses;
81.8    (xiii) rates of rehospitalization within a month of hospital discharge;
81.9    (xiv) coordination with county agencies to increase enrollment;
81.10    (xv) number of new program enrollees and the rate of enrollment, including the
81.11percentage of eligible persons who become enrollees;
81.12    (xvi) enrollee satisfaction with their care; and
81.13    (xvii) number of enrollees who do not receive care.
81.14    Managed care plans, county-based purchasing initiatives, health care providers,
81.15counties, and the commissioner of human services shall, upon request, provide data to
81.16the commissioner of health that is necessary to complete the study. The commissioner of
81.17health shall submit the study to the legislature by December 31, 2007.

81.18    Sec. 24. REPEALER.
81.19Minnesota Statutes 2006, section 256.969, subdivision 27, is repealed effective
81.20July 1, 2007.

81.21ARTICLE 4
81.22CONTINUING CARE

81.23    Section 1. Minnesota Statutes 2006, section 144A.071, subdivision 4c, is amended to
81.24read:
81.25    Subd. 4c. Exceptions for replacement beds after June 30, 2003. (a) The
81.26commissioner of health, in coordination with the commissioner of human services, may
81.27approve the renovation, replacement, upgrading, or relocation of a nursing home or
81.28boarding care home, under the following conditions:
81.29    (1) to license and certify an 80-bed city-owned facility in Nicollet County to be
81.30constructed on the site of a new city-owned hospital to replace an existing 85-bed facility
81.31attached to a hospital that is also being replaced. The threshold allowed for this project
81.32under section 144A.073 shall be the maximum amount available to pay the additional
81.33medical assistance costs of the new facility;
81.34    (2) to license and certify 29 beds to be added to an existing 69-bed facility in St.
81.35Louis County, provided that the 29 beds must be transferred from active or layaway status
81.36at an existing facility in St. Louis County that had 235 beds on April 1, 2003.
82.1The licensed capacity at the 235-bed facility must be reduced to 206 beds, but the payment
82.2rate at that facility shall not be adjusted as a result of this transfer. The operating payment
82.3rate of the facility adding beds after completion of this project shall be the same as it was
82.4on the day prior to the day the beds are licensed and certified. This project shall not
82.5proceed unless it is approved and financed under the provisions of section 144A.073;
82.6    (3) to license and certify a new 60-bed facility in Austin, provided that: (i) 45 of
82.7the new beds are transferred from a 45-bed facility in Austin under common ownership
82.8that is closed and 15 of the new beds are transferred from a 182-bed facility in Albert Lea
82.9under common ownership; (ii) the commissioner of human services is authorized by the
82.102004 legislature to negotiate budget-neutral planned nursing facility closures; and (iii)
82.11money is available from planned closures of facilities under common ownership to make
82.12implementation of this clause budget-neutral to the state. The bed capacity of the Albert
82.13Lea facility shall be reduced to 167 beds following the transfer. Of the 60 beds at the
82.14new facility, 20 beds shall be used for a special care unit for persons with Alzheimer's
82.15disease or related dementias; and
82.16    (4) to license and certify up to 80 beds transferred from an existing state-owned
82.17nursing facility in Cass County to a new facility located on the grounds of the
82.18Ah-Gwah-Ching campus. The operating cost payment rates for the new facility shall be
82.19determined based on the interim and settle-up payment provisions of Minnesota Rules,
82.20part 9549.0057, and the reimbursement provisions of section 256B.431. The property
82.21payment rate for the first three years of operation shall be $35 per day. For subsequent
82.22years, the property payment rate of $35 per day shall be adjusted for inflation as provided
82.23in section 256B.434, subdivision 4, paragraph (c), as long as the facility has a contract
82.24under section 256B.434.; and
82.25    (5) to license and certify 180 beds transferred from an existing facility in
82.26Minneapolis to a new facility in Robbinsdale; provided that the beds are transferred from a
82.27219-bed facility under common ownership that shall be closed following the transfer. The
82.28operating payment rate of the new facility after completion of this project shall be adjusted
82.29upward by $35 per day and the property payment rate shall be $34.049 per day.
82.30    (b) Projects approved under this subdivision shall be treated in a manner equivalent
82.31to projects approved under subdivision 4a.
82.32EFFECTIVE DATE.This section is effective the day following final enactment.

82.33    Sec. 2. Minnesota Statutes 2006, section 252.27, subdivision 2a, is amended to read:
82.34    Subd. 2a. Contribution amount. (a) The natural or adoptive parents of a minor
82.35child, including a child determined eligible for medical assistance without consideration of
83.1parental income, must contribute to the cost of services used by making monthly payments
83.2on a sliding scale based on income, unless the child is married or has been married,
83.3parental rights have been terminated, or the child's adoption is subsidized according to
83.4section 259.67 or through title IV-E of the Social Security Act. The parental contribution
83.5is a partial or full payment for medical services provided for diagnostic, therapeutic,
83.6curing, treating, mitigating, rehabilitation, and maintenance and personal care services as
83.7defined in United States Code, title 26, section 213, needed by the child with a chronic
83.8illness or disability.
83.9    (b) For households with adjusted gross income equal to or greater than 100 percent
83.10of federal poverty guidelines, the parental contribution shall be computed by applying the
83.11following schedule of rates to the adjusted gross income of the natural or adoptive parents:
83.12    (1) if the adjusted gross income is equal to or greater than 100 percent of federal
83.13poverty guidelines and less than 175 percent of federal poverty guidelines, the parental
83.14contribution is $4 per month;
83.15    (2) if the adjusted gross income is equal to or greater than 175 percent of federal
83.16poverty guidelines and less than or equal to 545 percent of federal poverty guidelines,
83.17the parental contribution shall be determined using a sliding fee scale established by the
83.18commissioner of human services which begins at one percent of adjusted gross income
83.19at 175 percent of federal poverty guidelines and increases to 7.5 percent of adjusted
83.20gross income for those with adjusted gross income up to 545 percent of federal poverty
83.21guidelines;
83.22    (3) if the adjusted gross income is greater than 545 percent of federal poverty
83.23guidelines and less than 675 percent of federal poverty guidelines, the parental
83.24contribution shall be 7.5 percent of adjusted gross income;
83.25    (4) if the adjusted gross income is equal to or greater than 675 percent of federal
83.26poverty guidelines and less than 975 percent of federal poverty guidelines, the parental
83.27contribution shall be determined using a sliding fee scale established by the commissioner
83.28of human services which begins at 7.5 percent of adjusted gross income at 675 percent of
83.29federal poverty guidelines and increases to ten percent of adjusted gross income for those
83.30with adjusted gross income up to 975 percent of federal poverty guidelines; and
83.31    (5) if the adjusted gross income is equal to or greater than 975 percent of federal
83.32poverty guidelines, the parental contribution shall be 12.5 percent of adjusted gross
83.33income.
83.34    If the child lives with the parent, the annual adjusted gross income parental
83.35contribution is reduced by $2,400 prior to calculating the parental contribution $100
83.36per month. If the child resides in an institution specified in section 256B.35, the parent
84.1is responsible for the personal needs allowance specified under that section in addition
84.2to the parental contribution determined under this section. The parental contribution is
84.3reduced by any amount required to be paid directly to the child pursuant to a court order,
84.4but only if actually paid.
84.5    (c) The household size to be used in determining the amount of contribution under
84.6paragraph (b) includes natural and adoptive parents and their dependents, including the
84.7child receiving services. Adjustments in the contribution amount due to annual changes
84.8in the federal poverty guidelines shall be implemented on the first day of July following
84.9publication of the changes.
84.10    (d) For purposes of paragraph (b), "income" means the adjusted gross income of the
84.11natural or adoptive parents determined according to the previous year's federal tax form,
84.12except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
84.13have been used to purchase a home shall not be counted as income.
84.14    (e) The contribution shall be explained in writing to the parents at the time eligibility
84.15for services is being determined. The contribution shall be made on a monthly basis
84.16effective with the first month in which the child receives services. Annually upon
84.17redetermination or at termination of eligibility, if the contribution exceeded the cost of
84.18services provided, the local agency or the state shall reimburse that excess amount to
84.19the parents, either by direct reimbursement if the parent is no longer required to pay
84.20a contribution, or by a reduction in or waiver of parental fees until the excess amount
84.21is exhausted.
84.22    (f) The monthly contribution amount must be reviewed at least every 12 months;
84.23when there is a change in household size; and when there is a loss of or gain in income
84.24from one month to another in excess of ten percent. The local agency shall mail a written
84.25notice 30 days in advance of the effective date of a change in the contribution amount.
84.26A decrease in the contribution amount is effective in the month that the parent verifies a
84.27reduction in income or change in household size.
84.28    (g) Parents of a minor child who do not live with each other shall each pay the
84.29contribution required under paragraph (a). An amount equal to the annual court-ordered
84.30child support payment actually paid on behalf of the child receiving services shall be
84.31deducted from the adjusted gross income of the parent making the payment prior to
84.32calculating the parental contribution under paragraph (b).
84.33    (h) The contribution under paragraph (b) shall be increased by an additional five
84.34percent if the local agency determines that insurance coverage is available but not
84.35obtained for the child. For purposes of this section, "available" means the insurance is a
84.36benefit of employment for a family member at an annual cost of no more than five percent
85.1of the family's annual income. For purposes of this section, "insurance" means health
85.2and accident insurance coverage, enrollment in a nonprofit health service plan, health
85.3maintenance organization, self-insured plan, or preferred provider organization.
85.4    Parents who have more than one child receiving services shall not be required
85.5to pay more than the amount for the child with the highest expenditures. There shall
85.6be no resource contribution from the parents. The parent shall not be required to pay
85.7a contribution in excess of the cost of the services provided to the child, not counting
85.8payments made to school districts for education-related services. Notice of an increase in
85.9fee payment must be given at least 30 days before the increased fee is due.
85.10    (i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if,
85.11in the 12 months prior to July 1:
85.12    (1) the parent applied for insurance for the child;
85.13    (2) the insurer denied insurance;
85.14    (3) the parents submitted a complaint or appeal, in writing to the insurer, submitted
85.15a complaint or appeal, in writing, to the commissioner of health or the commissioner of
85.16commerce, or litigated the complaint or appeal; and
85.17    (4) as a result of the dispute, the insurer reversed its decision and granted insurance.
85.18    For purposes of this section, "insurance" has the meaning given in paragraph (h).
85.19    A parent who has requested a reduction in the contribution amount under this
85.20paragraph shall submit proof in the form and manner prescribed by the commissioner or
85.21county agency, including, but not limited to, the insurer's denial of insurance, the written
85.22letter or complaint of the parents, court documents, and the written response of the insurer
85.23approving insurance. The determinations of the commissioner or county agency under this
85.24paragraph are not rules subject to chapter 14.

85.25    Sec. 3. Minnesota Statutes 2006, section 252.32, subdivision 3, is amended to read:
85.26    Subd. 3. Amount of support grant; use. Support grant amounts shall be
85.27determined by the county social service agency. Services and items purchased with a
85.28support grant must:
85.29    (1) be over and above the normal costs of caring for the dependent if the dependent
85.30did not have a disability;
85.31    (2) be directly attributable to the dependent's disabling condition; and
85.32    (3) enable the family to delay or prevent the out-of-home placement of the dependent.
85.33    The design and delivery of services and items purchased under this section must suit
85.34the dependent's chronological age and be provided in the least restrictive environment
85.35possible, consistent with the needs identified in the individual service plan.
86.1    Items and services purchased with support grants must be those for which there
86.2are no other public or private funds available to the family. Fees assessed to parents
86.3for health or human services that are funded by federal, state, or county dollars are not
86.4reimbursable through this program.
86.5    In approving or denying applications, the county shall consider the following factors:
86.6    (1) the extent and areas of the functional limitations of the disabled child;
86.7    (2) the degree of need in the home environment for additional support; and
86.8    (3) the potential effectiveness of the grant to maintain and support the person in
86.9the family environment.
86.10    The maximum monthly grant amount shall be $250 per eligible dependent, or
86.11$3,000 per eligible dependent per state fiscal year, within the limits of available funds and
86.12as adjusted by any legislatively authorized cost of living adjustment. The county social
86.13service agency may consider the dependent's supplemental security income in determining
86.14the amount of the support grant.
86.15    Any adjustments to their monthly grant amount must be based on the needs of the
86.16family and funding availability.

86.17    Sec. 4. Minnesota Statutes 2006, section 256.9741, subdivision 1, is amended to read:
86.18    Subdivision 1. Long-term care facility. "Long-term care facility" means a nursing
86.19home licensed under sections 144A.02 to 144A.10 or; a boarding care home licensed
86.20under sections 144.50 to 144.56; or a licensed or registered residential setting which
86.21provides or arranges for the provision of home care services.

86.22    Sec. 5. Minnesota Statutes 2006, section 256.9741, subdivision 3, is amended to read:
86.23    Subd. 3. Client. "Client" means an individual who requests, or on whose behalf a
86.24request is made for, ombudsman services and is (a) a resident of a long-term care facility
86.25or (b) a Medicare beneficiary who requests assistance relating to access, discharge, or
86.26denial of inpatient or outpatient services, or (c) an individual reserving, receiving, or
86.27requesting a home care service.

86.28    Sec. 6. Minnesota Statutes 2006, section 256.9742, subdivision 3, is amended to read:
86.29    Subd. 3. Posting. Every long-term care facility and acute care facility shall post in a
86.30conspicuous place the address and telephone number of the office. A home care service
86.31provider shall provide all recipients, including those in elderly housing with services
86.32under chapter 144D, with the address and telephone number of the office. Counties shall
86.33provide clients receiving a consumer support grant or a service allowance long-term care
86.34consultation services under section 256B.0911 or home and community-based services
87.1through a state or federally funded program with the name, address, and telephone number
87.2of the office. The posting or notice is subject to approval by the ombudsman.

87.3    Sec. 7. Minnesota Statutes 2006, section 256.9742, subdivision 4, is amended to read:
87.4    Subd. 4. Access to long-term care and acute care facilities and clients. The
87.5ombudsman or designee may:
87.6    (1) enter any long-term care facility without notice at any time;
87.7    (2) enter any acute care facility without notice during normal business hours;
87.8    (3) enter any acute care facility without notice at any time to interview a patient or
87.9observe services being provided to the patient as part of an investigation of a matter that is
87.10within the scope of the ombudsman's authority, but only if the ombudsman's or designee's
87.11presence does not intrude upon the privacy of another patient or interfere with routine
87.12hospital services provided to any patient in the facility;
87.13    (4) communicate privately and without restriction with any client in accordance
87.14with section 144.651, as long as the ombudsman has the client's consent for such
87.15communication;
87.16    (5) inspect records of a long-term care facility, home care service provider, or acute
87.17care facility that pertain to the care of the client according to sections section 144.335 and
87.18144.651; and
87.19    (6) with the consent of a client or client's legal guardian, the ombudsman or
87.20designated staff shall have access to review records pertaining to the care of the client
87.21according to sections section 144.335 and 144.651. If a client cannot consent and has no
87.22legal guardian, access to the records is authorized by this section.
87.23    A person who denies access to the ombudsman or designee in violation of this
87.24subdivision or aids, abets, invites, compels, or coerces another to do so is guilty of a
87.25misdemeanor.

87.26    Sec. 8. Minnesota Statutes 2006, section 256.9742, subdivision 6, is amended to read:
87.27    Subd. 6. Prohibition against discrimination or retaliation. (a) No entity shall take
87.28discriminatory, disciplinary, or retaliatory action against an employee or volunteer, or a
87.29patient, resident, or guardian or family member of a patient, resident, or guardian for filing
87.30in good faith a complaint with or providing information to the ombudsman or designee
87.31including volunteers. A person who violates this subdivision or who aids, abets, invites,
87.32compels, or coerces another to do so is guilty of a misdemeanor.
87.33    (b) There shall be a rebuttable presumption that any adverse action, as defined below,
87.34within 90 days of report, is discriminatory, disciplinary, or retaliatory. For the purpose
87.35of this clause, the term "adverse action" refers to action taken by the entity involved in a
88.1report against the person making the report or the person with respect to whom the report
88.2was made because of the report, and includes, but is not limited to:
88.3    (1) discharge or transfer from a facility;
88.4    (2) termination of service;
88.5    (3) restriction or prohibition of access to the facility or its residents;
88.6    (4) discharge from or termination of employment;
88.7    (5) demotion or reduction in remuneration for services; and
88.8    (6) any restriction of rights set forth in section 144.651 or, 144A.44, or 144A.751.

88.9    Sec. 9. Minnesota Statutes 2006, section 256.975, subdivision 7, is amended to read:
88.10    Subd. 7. Consumer information and assistance; senior linkage. (a) The
88.11Minnesota Board on Aging shall operate a statewide information and assistance service
88.12to aid older Minnesotans and their families in making informed choices about long-term
88.13care options and health care benefits. Language services to persons with limited English
88.14language skills may be made available. The service, known as Senior LinkAge Line, must
88.15be available during business hours through a statewide toll-free number and must also
88.16be available through the Internet.
88.17    (b) The service must assist older adults, caregivers, and providers in accessing
88.18information about choices in long-term care services that are purchased through private
88.19providers or available through public options. The service must:
88.20    (1) develop a comprehensive database that includes detailed listings in both
88.21consumer- and provider-oriented formats;
88.22    (2) make the database accessible on the Internet and through other telecommunication
88.23and media-related tools;
88.24    (3) link callers to interactive long-term care screening tools and make these tools
88.25available through the Internet by integrating the tools with the database;
88.26    (4) develop community education materials with a focus on planning for long-term
88.27care and evaluating independent living, housing, and service options;
88.28    (5) conduct an outreach campaign to assist older adults and their caregivers in
88.29finding information on the Internet and through other means of communication;
88.30    (6) implement a messaging system for overflow callers and respond to these callers
88.31by the next business day;
88.32    (7) link callers with county human services and other providers to receive more
88.33in-depth assistance and consultation related to long-term care options; and
88.34    (8) link callers with quality profiles for nursing facilities and other providers
88.35developed by the commissioner of health.; and
89.1    (9) incorporate information about housing with services and consumer rights
89.2within the MinnesotaHelp.info network long-term care database to facilitate consumer
89.3comparison of services and costs among housing with services establishments and with
89.4other in-home services and to support financial self-sufficiency as long as possible.
89.5Housing with services establishments and their arranged home care providers shall provide
89.6information to the commissioner of human services including delineation of charges for
89.7housing, meals, supportive services, adapted daily living services, and health-related
89.8services. The commissioner of human services and the commissioner of health shall
89.9align data elements required by section 144G.06, the Uniform Consumer Information
89.10Guide, and this section, to the extent possible. The commissioner of human services shall
89.11provide the data to the Minnesota Board on Aging for inclusion in the MinnesotaHelp.info
89.12network long-term care database.
89.13    (c) The Minnesota Board on Aging shall conduct an evaluation of the effectiveness
89.14of the statewide information and assistance, and submit this evaluation to the legislature
89.15by December 1, 2002. The evaluation must include an analysis of funding adequacy, gaps
89.16in service delivery, continuity in information between the service and identified linkages,
89.17and potential use of private funding to enhance the service.
89.18EFFECTIVE DATE.This section is effective the day following final enactment.

89.19    Sec. 10. Minnesota Statutes 2006, section 256B.056, subdivision 3, is amended to read:
89.20    Subd. 3. Asset limitations for aged, blind, or disabled individuals and families.
89.21    To be eligible for medical assistance, a person whose eligibility is based on blindness,
89.22disability, or age of 65 or more years must not individually own more than $3,000 $6,000
89.23in assets, or if a member of a household with two family members, husband and wife, or
89.24parent and child, the household must not own more than $6,000 $12,000 in assets, plus
89.25$200 $400 for each additional legal dependent. In addition to these maximum amounts,
89.26an eligible individual or family may accrue interest on these amounts, but they must be
89.27reduced to the maximum at the time of an eligibility redetermination. The accumulation
89.28of the clothing and personal needs allowance according to section 256B.35 must also be
89.29reduced to the maximum at the time of the eligibility redetermination. The value of assets
89.30that are not considered in determining eligibility for medical assistance is the value of
89.31those assets excluded under the supplemental security income program for aged, blind,
89.32and disabled persons, with the following exceptions:
89.33    (a) Household goods and personal effects are not considered.
89.34    (b) Capital and operating assets of a trade or business that the local agency
89.35determines are necessary to the person's ability to earn an income are not considered.
90.1    (c) Motor vehicles are excluded to the same extent excluded by the supplemental
90.2security income program.
90.3    (d) Assets designated as burial expenses are excluded to the same extent excluded by
90.4the supplemental security income program. Burial expenses funded by annuity contracts
90.5or life insurance policies must irrevocably designate the individual's estate as contingent
90.6beneficiary to the extent proceeds are not used for payment of selected burial expenses.
90.7    (e) Effective upon federal approval, for a person who no longer qualifies as an
90.8employed person with a disability due to loss of earnings, assets allowed while eligible
90.9for medical assistance under section 256B.057, subdivision 9, are not considered for 12
90.10months, beginning with the first month of ineligibility as an employed person with a
90.11disability, to the extent that the person's total assets remain within the allowed limits of
90.12section 256B.057, subdivision 9, paragraph (b).
90.13EFFECTIVE DATE.This section is effective July 1, 2007.

90.14    Sec. 11. Minnesota Statutes 2006, section 256B.056, subdivision 5c, is amended to
90.15read:
90.16    Subd. 5c. Excess income standard. (a) The excess income standard for families
90.17with children is the standard specified in subdivision 4.
90.18    (b) The excess income standard for a person whose eligibility is based on blindness,
90.19disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
90.20family size. Effective July 1, 2002, the excess income standard for this paragraph shall
90.21equal 75 percent of the federal poverty guidelines. Effective July 1, 2007, the excess
90.22income standard for this paragraph shall equal 85 percent of the federal poverty guidelines.
90.23The excess income standard for this paragraph shall be increased by five percentage points
90.24on July 1 of each of the next three years, so that the excess income standard shall equal
90.25100 percent of the federal poverty guidelines effective July 1, 2010.
90.26EFFECTIVE DATE.This section is effective July 1, 2007.

90.27    Sec. 12. Minnesota Statutes 2006, section 256B.0625, subdivision 18a, is amended to
90.28read:
90.29    Subd. 18a. Access to medical services. (a) Medical assistance reimbursement for
90.30meals for persons traveling to receive medical care may not exceed $5.50 for breakfast,
90.31$6.50 for lunch, or $8 for dinner.
90.32    (b) Medical assistance reimbursement for lodging for persons traveling to receive
90.33medical care may not exceed $50 per day unless prior authorized by the local agency.
90.34    (c) Medical assistance direct mileage reimbursement to the eligible person or the
90.35eligible person's driver may not exceed 20 cents per mile.
91.1    (d) Regardless of the number of employees that an enrolled health care provider
91.2may have, medical assistance covers sign and oral language interpreter services when
91.3provided by an enrolled health care provider during the course of providing a direct,
91.4person-to-person covered health care service to an enrolled recipient with limited English
91.5proficiency or who has a hearing loss and uses interpreting services.

91.6    Sec. 13. Minnesota Statutes 2006, section 256B.0625, is amended by adding a
91.7subdivision to read:
91.8    Subd. 49. Self-directed supports option. Upon federal approval, medical
91.9assistance covers the self-directed supports option as defined under section 256B.0657 and
91.10section 6087 of the Federal Deficit Reduction Act of 2005, Public Law 109-171.
91.11EFFECTIVE DATE.This section is effective upon federal approval of the state
91.12Medicaid plan amendment. The commissioner of human services shall inform the Office
91.13of the Revisor of Statutes when approval is obtained.

91.14    Sec. 14. [256B.0657] SELF-DIRECTED SUPPORTS OPTION.
91.15    Subdivision 1. Definition. "Self-directed supports option" means personal
91.16assistance, supports, items, and related services purchased under an approved budget
91.17plan and budget by a recipient.
91.18    Subd. 2. Eligibility. (a) The self-directed supports option is available to a person
91.19who:
91.20    (1) is a recipient of medical assistance as determined under sections 256B.055,
91.21256B.056, and 256B.057, subdivision 9;
91.22    (2) is eligible for personal care assistant services under section 256B.0655;
91.23    (3) lives in the person's own apartment or home, which is not owned, operated, or
91.24controlled by a provider of services not related by blood or marriage;
91.25    (4) has the ability to hire, fire, supervise, establish staff compensation for, and
91.26manage the individuals providing services, and to choose and obtain items, related
91.27services, and supports as described in the participant's plan. If the recipient is not able to
91.28carry out these functions but has a legal guardian or parent to carry them out, the guardian
91.29or parent may fulfill these functions on behalf of the recipient; and
91.30    (5) has not been excluded or disenrolled by the commissioner.
91.31    (b) The commissioner may disenroll or exclude recipients, including guardians and
91.32parents, under the following circumstances:
91.33    (1) recipients who have been restricted by the Primary Care Utilization Review
91.34Committee may be excluded for a specified time period; and
92.1    (2) recipients who exit the self-directed supports option during the recipient's
92.2service plan year shall not access the self-directed supports option for the remainder
92.3of that service plan year.
92.4    Subd. 3. Eligibility for other services. Selection of the self-directed supports
92.5option by a recipient shall not restrict access to other medically necessary care and
92.6services furnished under the state plan medical assistance benefit, including home care
92.7targeted case management, except that a person receiving home and community-based
92.8waiver services, a family support grant or a consumer support grant is not eligible for
92.9funding under the self-directed supports option.
92.10    Subd. 4. Assessment requirements. (a) The self-directed supports option
92.11assessment must meet the following requirements:
92.12    (1) it shall be conducted by the county public health nurse or a certified public
92.13health nurse under contract with the county;
92.14    (2) it shall be conducted face-to-face in the recipient's home initially, and at least
92.15annually thereafter; when there is a significant change in the recipient's condition; and
92.16when there is a change in the need for personal care assistant services. A recipient who is
92.17residing in a facility may be assessed for the self-directed support option for the purpose
92.18of returning to the community using this option; and
92.19    (3) it shall be completed using the format established by the commissioner.
92.20    (b) The results of the assessment and recommendations shall be communicated to
92.21the commissioner and the recipient by the county public health nurse or certified public
92.22health nurse under contract with the county.
92.23    Subd. 5. Self-directed supports option plan requirements. (a) The plan for the
92.24self-directed supports option must meet the following requirements:
92.25    (1) the plan must be completed using a person-centered process that:
92.26    (i) builds upon the recipient's capacity to engage in activities that promote
92.27community life;
92.28    (ii) respects the recipient's preferences, choices, and abilities;
92.29    (iii) involves families, friends, and professionals in the planning or delivery of
92.30services or supports as desired or required by the recipient; and
92.31    (iv) addresses the need for personal care assistant services identified in the recipient's
92.32self-directed supports option assessment;
92.33    (2) the plan shall be developed by the recipient or by the guardian of an adult
92.34recipient or by a parent or guardian of a minor child, with the assistance of an enrolled
92.35medical assistance home care targeted case manager provider who meets the requirements
93.1established for using a person-centered planning process and shall be reviewed at least
93.2annually upon reassessment or when there is a significant change in the recipient's
93.3condition; and
93.4    (3) the plan must include the total budget amount available divided into monthly
93.5amounts that cover the number of months of personal care assistant services authorization
93.6included in the budget. The amount used each month may vary, but additional funds shall
93.7not be provided above the annual personal care assistant services authorized amount
93.8unless a change in condition is documented.
93.9    (b) The commissioner shall:
93.10    (1) establish the format and criteria for the plan as well as the requirements for
93.11providers who assist with plan development;
93.12    (2) review the assessment and plan and, within 30 days after receiving the
93.13assessment and plan, make a decision on approval of the plan;
93.14    (3) notify the recipient, parent, or guardian of approval or denial of the plan and
93.15provide notice of the right to appeal under section 256.045; and
93.16    (4) provide a copy of the plan to the fiscal support entity selected by the recipient.
93.17    Subd. 6. Services covered. (a) Services covered under the self-directed supports
93.18option include:
93.19    (1) personal care assistant services under section 256B.0655; and
93.20    (2) items, related services, and supports, including assistive technology, that increase
93.21independence or substitute for human assistance to the extent expenditures would
93.22otherwise be used for human assistance.
93.23    (b) Items, supports, and related services purchased under this option shall not be
93.24considered home care services for the purposes of section 144A.43.
93.25    Subd. 7. Noncovered services. Services or supports that are not eligible for
93.26payment under the self-directed supports option include:
93.27    (1) services, goods, or supports that do not benefit the recipient;
93.28    (2) any fees incurred by the recipient, such as Minnesota health care program fees
93.29and co-pays, legal fees, or costs related to advocate agencies;
93.30    (3) insurance, except for insurance costs related to employee coverage or fiscal
93.31support entity payments;
93.32    (4) room and board and personal items that are not related to the disability, except
93.33that medically prescribed specialized diet items may be covered if they reduce the need for
93.34human assistance;
93.35    (5) home modifications that add square footage;
94.1    (6) home modifications for a residence other than the primary residence of the
94.2recipient, or in the event of a minor with parents not living together, the primary residences
94.3of the parents;
94.4    (7) expenses for travel, lodging, or meals related to training the recipient, the parent
94.5or guardian of an adult recipient, or the parent or guardian of a minor child, or paid or
94.6unpaid caregivers that exceed $500 in a 12-month period;
94.7    (8) experimental treatment;
94.8    (9) any service or item covered by other medical assistance state plan services,
94.9including prescription and over-the-counter medications, compounds, and solutions and
94.10related fees, including premiums and co-payments;
94.11    (10) membership dues or costs, except when the service is necessary and appropriate
94.12to treat a physical condition or to improve or maintain the recipient's physical condition.
94.13The condition must be identified in the recipient's plan of care and monitored by a
94.14Minnesota health care program enrolled physician;
94.15    (11) vacation expenses other than the cost of direct services;
94.16    (12) vehicle maintenance or modifications not related to the disability;
94.17    (13) tickets and related costs to attend sporting or other recreational events; and
94.18    (14) costs related to Internet access, except when necessary for operation of assistive
94.19technology, to increase independence, or to substitute for human assistance.
94.20    Subd. 8. Self-directed budget requirements. The budget for the provision of the
94.21self-directed service option shall be equal to the greater of either:
94.22    (1) the annual amount of personal care assistant services under section 256B.0655
94.23that the recipient has used in the most recent 12-month period; or
94.24    (2) the amount determined using the consumer support grant methodology under
94.25section 256.476, subdivision 11, except that the budget amount shall include the federal
94.26and nonfederal share of the average service costs.
94.27    Subd. 9. Quality assurance and risk management. (a) The commissioner
94.28shall establish quality assurance and risk management measures for use in developing
94.29and implementing self-directed plans and budgets that (1) recognize the roles and
94.30responsibilities involved in obtaining services in a self-directed manner, and (2) assure
94.31the appropriateness of such plans and budgets based upon a recipient's resources and
94.32capabilities. These measures must include (i) background studies, and (ii) backup and
94.33emergency plans, including disaster planning.
94.34    (b) The commissioner shall provide ongoing technical assistance and resource and
94.35educational materials for families and recipients selecting the self-directed option.
95.1    (c) Performance assessments measures, such as of a recipient's satisfaction with the
95.2services and supports, and ongoing monitoring of health and well-being shall be identified
95.3in consultation with the stakeholder group.
95.4    Subd. 10. Fiscal support entity. (a) Each recipient shall choose a fiscal support
95.5entity provider certified by the commissioner to make payments for services, items,
95.6supports, and administrative costs related to managing a self-directed service plan
95.7authorized for payment in the approved plan and budget. Recipients shall also choose
95.8the payroll, agency with choice, or the fiscal conduit model of financial and service
95.9management.
95.10    (b) The fiscal support entity:
95.11    (1) may not limit or restrict the recipient's choice of service or support providers,
95.12including use of the payroll, agency with choice, or fiscal conduit model of financial
95.13and service management;
95.14    (2) must have a written agreement with the recipient or the recipient's representative
95.15that identifies the duties and responsibilities to be performed and the specific related
95.16charges;
95.17    (3) must provide the recipient and the home care targeted case manager with a
95.18monthly written summary of the self-directed supports option services that were billed,
95.19including charges from the fiscal support entity;
95.20    (4) must be knowledgeable of and comply with Internal Revenue Service
95.21requirements necessary to process employer and employee deductions, provide appropriate
95.22and timely submission of employer tax liabilities, and maintain documentation to support
95.23medical assistance claims;
95.24    (5) must have current and adequate liability insurance and bonding and sufficient
95.25cash flow and have on staff or under contract a certified public accountant or an individual
95.26with a baccalaureate degree in accounting; and
95.27    (6) must maintain records to track all self-directed supports option services
95.28expenditures, including time records of persons paid to provide supports and receipts for
95.29any goods purchased. The records must be maintained for a minimum of five years from
95.30the claim date and be available for audit or review upon request. Claims submitted by
95.31the fiscal support entity must correspond with services, amounts, and time periods as
95.32authorized in the recipient's self-directed supports option plan.
95.33    (c) The commissioner shall have authority to:
95.34    (1) set or negotiate rates with fiscal support entities;
95.35    (2) limit the number of fiscal support entities;
96.1    (3) identify a process to certify and recertify fiscal support entities and assure fiscal
96.2support entities are available to recipients throughout the state; and
96.3    (4) establish a uniform format and protocol to be used by eligible fiscal support
96.4entities.
96.5    Subd. 11. Stakeholder consultation. The commissioner shall consult with a
96.6statewide consumer-directed services stakeholder group, including representatives of
96.7all types of consumer-directed service users, advocacy organizations, counties, and
96.8consumer-directed service providers. The commissioner shall seek recommendations
96.9from this stakeholder group in developing:
96.10    (1) the self-directed plan format;
96.11    (2) requirements and guidelines for the person-centered plan assessment and
96.12planning process;
96.13    (3) implementation of the option and the quality assurance and risk management
96.14techniques; and
96.15    (4) standards and requirements, including rates for the personal support plan
96.16development provider and the fiscal support entity; policies; training; and implementation.
96.17The stakeholder group shall provide recommendations on the repeal of the personal care
96.18assistant choice option, transition issues, and whether the consumer support grant program
96.19under section 256.476 should be modified. The stakeholder group shall meet at least
96.20three times each year to provide advice on policy, implementation, and other aspects of
96.21consumer and self-directed services.
96.22EFFECTIVE DATE.Subdivisions 1 to 10 are effective upon federal approval of
96.23the state Medicaid plan amendment. The commissioner of human services shall inform
96.24the Office of the Revisor of Statutes when federal approval is obtained. Subdivision 11
96.25is effective July 1, 2007.

96.26    Sec. 15. Minnesota Statutes 2006, section 256B.0911, is amended by adding a
96.27subdivision to read:
96.28    Subd. 3c. Transition to housing with services. (a) Transitional consultation shall
96.29be offered to all prospective residents 65 years of age or older regardless of income, assets,
96.30or funding sources before housing with services establishments offering or providing
96.31assisted living execute a lease or contract with the prospective resident. The purpose of
96.32transitional long-term care consultation is to support persons with current or anticipated
96.33long-term care needs in making informed choices among options that include the most
96.34cost-effective and least restrictive settings, and to delay spenddown to eligibility for
97.1publicly funded programs by connecting people to alternative services in their homes
97.2before transition to housing with services.
97.3    (b) Transitional consultation services are provided as determined by the
97.4commissioner of human services in partnership with county long-term care consultation
97.5units, and the Area Agencies on Aging, and are a combination of telephone-based and
97.6in-person assistance provided under models developed by the commissioner. Transitional
97.7consultation must be provided within five working days of the request of the prospective
97.8resident as follows:
97.9    (1) the consultation must be provided by a qualified professional as determined by
97.10the commissioner;
97.11    (2) the consultation must include a review of the prospective resident's reasons for
97.12considering assisted living, the prospective resident's personal goals, a discussion of the
97.13prospective resident's immediate and projected long-term care needs, and alternative
97.14community services or assisted living settings that may meet the prospective resident's
97.15needs; and
97.16    (3) the prospective resident will be informed of the availability of long-term care
97.17consultation services described in subdivision 3a that are available at no charge to the
97.18prospective resident to assist the prospective resident in assessment and planning to meet
97.19the prospective resident's long-term care needs.
97.20EFFECTIVE DATE.This section is effective October 1, 2008.

97.21    Sec. 16. Minnesota Statutes 2006, section 256B.0911, subdivision 4b, is amended to
97.22read:
97.23    Subd. 4b. Exemptions and emergency admissions. (a) Exemptions from the
97.24federal screening requirements outlined in subdivision 4a, paragraphs (b) and (c), are
97.25limited to:
97.26    (1) a person who, having entered an acute care facility from a certified nursing
97.27facility, is returning to a certified nursing facility;
97.28    (2) a person transferring from one certified nursing facility in Minnesota to another
97.29certified nursing facility in Minnesota; and
97.30    (3) a person, 21 years of age or older, who satisfies the following criteria, as specified
97.31in Code of Federal Regulations, title 42, section 483.106(b)(2):
97.32    (i) the person is admitted to a nursing facility directly from a hospital after receiving
97.33acute inpatient care at the hospital;
97.34    (ii) the person requires nursing facility services for the same condition for which
97.35care was provided in the hospital; and
98.1    (iii) the attending physician has certified before the nursing facility admission that
98.2the person is likely to receive less than 30 days of nursing facility services.
98.3    (b) Persons who are exempt from preadmission screening for purposes of level of
98.4care determination include:
98.5    (1) persons described in paragraph (a);
98.6    (2) an individual who has a contractual right to have nursing facility care paid for
98.7indefinitely by the veterans' administration;
98.8    (3) an individual enrolled in a demonstration project under section 256B.69,
98.9subdivision 8
, at the time of application to a nursing facility; and
98.10    (4) an individual currently being served under the alternative care program or under
98.11a home and community-based services waiver authorized under section 1915(c) of the
98.12federal Social Security Act; and.
98.13    (5) individuals admitted to a certified nursing facility for a short-term stay, which
98.14is expected to be 14 days or less in duration based upon a physician's certification, and
98.15who have been assessed and approved for nursing facility admission within the previous
98.16six months. This exemption applies only if the consultation team member determines at
98.17the time of the initial assessment of the six-month period that it is appropriate to use the
98.18nursing facility for short-term stays and that there is an adequate plan of care for return to
98.19the home or community-based setting. If a stay exceeds 14 days, the individual must be
98.20referred no later than the first county working day following the 14th resident day for a
98.21screening, which must be completed within five working days of the referral. The payment
98.22limitations in subdivision 7 apply to an individual found at screening to not meet the level
98.23of care criteria for admission to a certified nursing facility.
98.24    (c) Persons admitted to a Medicaid-certified nursing facility from the community
98.25on an emergency basis as described in paragraph (d) or from an acute care facility on a
98.26nonworking day must be screened the first working day after admission.
98.27    (d) Emergency admission to a nursing facility prior to screening is permitted when
98.28all of the following conditions are met:
98.29    (1) a person is admitted from the community to a certified nursing or certified
98.30boarding care facility during county nonworking hours;
98.31    (2) a physician has determined that delaying admission until preadmission screening
98.32is completed would adversely affect the person's health and safety;
98.33    (3) there is a recent precipitating event that precludes the client from living safely in
98.34the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
98.35inability to continue to provide care;
99.1    (4) the attending physician has authorized the emergency placement and has
99.2documented the reason that the emergency placement is recommended; and
99.3    (5) the county is contacted on the first working day following the emergency
99.4admission.
99.5Transfer of a patient from an acute care hospital to a nursing facility is not considered
99.6an emergency except for a person who has received hospital services in the following
99.7situations: hospital admission for observation, care in an emergency room without hospital
99.8admission, or following hospital 24-hour bed care.
99.9    (e) A nursing facility must provide a written notice to persons who satisfy the criteria
99.10in paragraph (a), clause (3), information to all persons admitted regarding the person's
99.11right to request and receive long-term care consultation services as defined in subdivision
99.121a. The notice information must be provided prior to the person's discharge from the
99.13facility and in a format specified by the commissioner.

99.14    Sec. 17. Minnesota Statutes 2006, section 256B.0911, subdivision 6, is amended to
99.15read:
99.16    Subd. 6. Payment for long-term care consultation services. (a) The total payment
99.17for each county must be paid monthly by certified nursing facilities in the county. The
99.18monthly amount to be paid by each nursing facility for each fiscal year must be determined
99.19by dividing the county's annual allocation for long-term care consultation services by 12
99.20to determine the monthly payment and allocating the monthly payment to each nursing
99.21facility based on the number of licensed beds in the nursing facility. Payments to counties
99.22in which there is no certified nursing facility must be made by increasing the payment
99.23rate of the two facilities located nearest to the county seat.
99.24    (b) The commissioner shall include the total annual payment determined under
99.25paragraph (a) for each nursing facility reimbursed under section 256B.431 or 256B.434
99.26according to section 256B.431, subdivision 2b, paragraph (g), or 256B.435.
99.27    (c) In the event of the layaway, delicensure and decertification, or removal from
99.28layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
99.29the per diem payment amount in paragraph (b) and may adjust the monthly payment
99.30amount in paragraph (a). The effective date of an adjustment made under this paragraph
99.31shall be on or after the first day of the month following the effective date of the layaway,
99.32delicensure and decertification, or removal from layaway.
99.33    (d) Payments for long-term care consultation services are available to the county
99.34or counties to cover staff salaries and expenses to provide the services described in
99.35subdivision 1a. The county shall employ, or contract with other agencies to employ, within
99.36the limits of available funding, sufficient personnel to provide long-term care consultation
100.1services while meeting the state's long-term care outcomes and objectives as defined in
100.2section 256B.0917, subdivision 1. The county shall be accountable for meeting local
100.3objectives as approved by the commissioner in the biennial home and community-based
100.4services quality assurance plan on a form provided by the commissioner.
100.5    (e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
100.6screening costs under the medical assistance program may not be recovered from a facility.
100.7    (f) The commissioner of human services shall amend the Minnesota medical
100.8assistance plan to include reimbursement for the local consultation teams.
100.9    (g) The county may bill, as case management services, assessments, support
100.10planning, and follow-along provided to persons determined to be eligible for case
100.11management under Minnesota health care programs. No individual or family member
100.12shall be charged for an initial assessment or initial support plan development provided
100.13under subdivision 3a or 3b.

100.14    Sec. 18. Minnesota Statutes 2006, section 256B.0911, is amended by adding a
100.15subdivision to read:
100.16    Subd. 6a. Withholding. If any provider obligated to pay the long-term care
100.17consultation amount as described in subdivision 6 is more than two months delinquent in
100.18the timely payment of the monthly installment, the commissioner may withhold payments,
100.19penalties, and interest in accordance with the methods outlined in section 256.9657,
100.20subdivision 7a. Any amount withheld under this provision must be returned to the county
100.21to whom the delinquent payments were due.

100.22    Sec. 19. Minnesota Statutes 2006, section 256B.0911, subdivision 7, is amended to
100.23read:
100.24    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance
100.25reimbursement for nursing facilities shall be authorized for a medical assistance recipient
100.26only if a preadmission screening has been conducted prior to admission or the county has
100.27authorized an exemption. Medical assistance reimbursement for nursing facilities shall
100.28not be provided for any recipient who the local screener has determined does not meet the
100.29level of care criteria for nursing facility placement or, if indicated, has not had a level II
100.30OBRA evaluation as required under the federal Omnibus Budget Reconciliation Act of
100.311987 completed unless an admission for a recipient with mental illness is approved by the
100.32local mental health authority or an admission for a recipient with developmental disability
100.33is approved by the state developmental disability authority.
100.34    (b) The nursing facility must not bill a person who is not a medical assistance
100.35recipient for resident days that preceded the date of completion of screening activities as
101.1required under subdivisions 4a, 4b, and 4c. The nursing facility must include unreimbursed
101.2resident days in the nursing facility resident day totals reported to the commissioner.
101.3    (c) The commissioner shall make a request to the Centers for Medicare and Medicaid
101.4Services for a waiver allowing team approval of Medicaid payments for certified nursing
101.5facility care. An individual has a choice and makes the final decision between nursing
101.6facility placement and community placement after the screening team's recommendation,
101.7except as provided in subdivision 4a, paragraph (c).

101.8    Sec. 20. Minnesota Statutes 2006, section 256B.0913, subdivision 4, is amended to
101.9read:
101.10    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
101.11    (a) Funding for services under the alternative care program is available to persons who
101.12meet the following criteria:
101.13    (1) the person has been determined by a community assessment under section
101.14256B.0911 to be a person who would require the level of care provided in a nursing
101.15facility, but for the provision of services under the alternative care program;
101.16    (2) the person is age 65 or older;
101.17    (3) the person would be eligible for medical assistance within 135 days of admission
101.18to a nursing facility;
101.19    (4) the person is not ineligible for the payment of long-term care services by the
101.20medical assistance program due to an asset transfer penalty under section 256B.0595 or
101.21equity interest in the home exceeding $500,000 as stated in section 256B.056;
101.22    (5) the person needs services that are not funded through other state or federal
101.23funding;
101.24    (6) the monthly cost of the alternative care services funded by the program for
101.25this person does not exceed 75 percent of the monthly limit described under section
101.26256B.0915, subdivision 3a . This monthly limit does not prohibit the alternative care client
101.27from payment for additional services, but in no case may the cost of additional services
101.28purchased under this section exceed the difference between the client's monthly service
101.29limit defined under section 256B.0915, subdivision 3, and the alternative care program
101.30monthly service limit defined in this paragraph. If medical supplies and equipment or
101.31environmental modifications are or will be purchased for an alternative care services
101.32recipient, the costs may be prorated on a monthly basis for up to 12 consecutive months
101.33beginning with the month of purchase. If the monthly cost of a recipient's other alternative
101.34care services exceeds the monthly limit established in this paragraph, the annual cost of the
101.35alternative care services shall be determined. In this event, the annual cost of alternative
101.36care services shall not exceed 12 times the monthly limit described in this paragraph; and
102.1    (7) the person is making timely payments of the assessed monthly fee.
102.2A person is ineligible if payment of the fee is over 60 days past due, unless the person
102.3agrees to:
102.4    (i) the appointment of a representative payee;
102.5    (ii) automatic payment from a financial account;
102.6    (iii) the establishment of greater family involvement in the financial management of
102.7payments; or
102.8    (iv) another method acceptable to the county to ensure prompt fee payments.
102.9    The county shall extend the client's eligibility as necessary while making
102.10arrangements to facilitate payment of past-due amounts and future premium payments.
102.11Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
102.12reinstated for a period of 30 days.
102.13    (b) Alternative care funding under this subdivision is not available for a person
102.14who is a medical assistance recipient or who would be eligible for medical assistance
102.15without a spenddown or waiver obligation. A person whose initial application for medical
102.16assistance and the elderly waiver program is being processed may be served under the
102.17alternative care program for a period up to 60 days. If the individual is found to be eligible
102.18for medical assistance, medical assistance must be billed for services payable under the
102.19federally approved elderly waiver plan and delivered from the date the individual was
102.20found eligible for the federally approved elderly waiver plan. Notwithstanding this
102.21provision, alternative care funds may not be used to pay for any service the cost of which:
102.22(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation;
102.23or (iii) is used to pay a medical assistance income spenddown for a person who is eligible
102.24to participate in the federally approved elderly waiver program under the special income
102.25standard provision.
102.26    (c) Alternative care funding is not available for a person who resides in a licensed
102.27nursing home, certified boarding care home, hospital, or intermediate care facility, except
102.28for case management services which are provided in support of the discharge planning
102.29process for a nursing home resident or certified boarding care home resident to assist with
102.30a relocation process to a community-based setting.
102.31    (d) Alternative care funding is not available for a person whose income is greater
102.32than the maintenance needs allowance under section 256B.0915, subdivision 1d, but
102.33equal to or less than 120 percent of the federal poverty guideline effective July 1 in the
102.34year for which alternative care eligibility is determined, who would be eligible for the
102.35elderly waiver with a waiver obligation.

103.1    Sec. 21. Minnesota Statutes 2006, section 256B.0913, subdivision 5a, is amended to
103.2read:
103.3    Subd. 5a. Services; service definitions; service standards. (a) Unless specified in
103.4statute, the services, service definitions, and standards for alternative care services shall
103.5be the same as the services, service definitions, and standards specified in the federally
103.6approved elderly waiver plan, except for alternative care does not cover transitional
103.7support services, assisted living services, adult foster care services, and residential care
103.8services and benefits defined under section 256B.0625 that meet primary and acute
103.9health care needs.
103.10    (b) The county agency must ensure that the funds are not used to supplant or
103.11supplement services available through other public assistance or services programs.,
103.12including supplementation of client co-pays, deductibles, premiums, or other cost-sharing
103.13arrangements for health-related benefits and services or entitlement programs and services
103.14that are available to the person, but in which they have elected not to enroll. For a provider
103.15of supplies and equipment when the monthly cost of the supplies and equipment is less
103.16than $250, persons or agencies must be employed by or under a contract with the county
103.17agency or the public health nursing agency of the local board of health in order to receive
103.18funding under the alternative care program. Supplies and equipment may be purchased
103.19from a vendor not certified to participate in the Medicaid program if the cost for the
103.20item is less than that of a Medicaid vendor.
103.21    (c) Personal care services must meet the service standards defined in the federally
103.22approved elderly waiver plan, except that a county agency may contract with a client's
103.23relative who meets the relative hardship waiver requirements or a relative who meets the
103.24criteria and is also the responsible party under an individual service plan that ensures the
103.25client's health and safety and supervision of the personal care services by a qualified
103.26professional as defined in section 256B.0625, subdivision 19c. Relative hardship is
103.27established by the county when the client's care causes a relative caregiver to do any of the
103.28following: resign from a paying job, reduce work hours resulting in lost wages, obtain a
103.29leave of absence resulting in lost wages, incur substantial client-related expenses, provide
103.30services to address authorized, unstaffed direct care time, or meet special needs of the
103.31client unmet in the formal service plan.

103.32    Sec. 22. Minnesota Statutes 2006, section 256B.0915, is amended to read:
103.33256B.0915 MEDICAID WAIVER FOR ELDERLY SERVICES.
103.34    Subdivision 1. Authority. The commissioner is authorized to apply for a home
103.35and community-based services waiver for the elderly, authorized under section 1915(c)
103.36of the Social Security Act, in order to obtain federal financial participation to expand
104.1the availability of services for persons who are eligible for medical assistance. The
104.2commissioner may apply for additional waivers or pursue other federal financial
104.3participation which is advantageous to the state for funding home care services for the
104.4frail elderly who are eligible for medical assistance. The provision of waivered services
104.5to elderly and disabled medical assistance recipients must comply with the criteria for
104.6service definitions and provider standards approved in the waiver.
104.7    Subd. 1a. Elderly waiver case management services. (a) Elderly case management
104.8services under the home and community-based services waiver for elderly individuals are
104.9available from providers meeting qualification requirements and the standards specified
104.10in subdivision 1b. Eligible recipients may choose any qualified provider of elderly case
104.11management services.
104.12    Case management services assist individuals who receive waiver services in gaining
104.13access to needed waiver and other state plan services, as well as needed medical, social,
104.14educational, and other services regardless of the funding source for the services to which
104.15access is gained.
104.16    A case aide shall provide assistance to the case manager in carrying out
104.17administrative activities of the case management function. The case aide may not assume
104.18responsibilities that require professional judgment including assessments, reassessments,
104.19and care plan development. The case manager is responsible for providing oversight of
104.20the case aide.
104.21    Case managers shall be responsible for ongoing monitoring of the provision of
104.22services included in the individual's plan of care. Case managers shall initiate and oversee
104.23the process of assessment and reassessment of the individual's care and review plan of
104.24care at intervals specified in the federally approved waiver plan.
104.25    (b) The county of service or tribe must provide access to and arrange for case
104.26management services. County of service has the meaning given it in Minnesota Rules,
104.27part 9505.0015, subpart 11.
104.28    Subd. 1b. Provider qualifications and standards. The commissioner must
104.29enroll qualified providers of elderly case management services under the home
104.30and community-based waiver for the elderly under section 1915(c) of the Social
104.31Security Act. The enrollment process shall ensure the provider's ability to meet the
104.32qualification requirements and standards in this subdivision and other federal and state
104.33requirements of this service. An elderly case management provider is an enrolled medical
104.34assistance provider who is determined by the commissioner to have all of the following
104.35characteristics:
105.1    (1) the demonstrated capacity and experience to provide the components of
105.2case management to coordinate and link community resources needed by the eligible
105.3population;
105.4    (2) administrative capacity and experience in serving the target population for
105.5whom it will provide services and in ensuring quality of services under state and federal
105.6requirements;
105.7    (3) a financial management system that provides accurate documentation of services
105.8and costs under state and federal requirements;
105.9    (4) the capacity to document and maintain individual case records under state and
105.10federal requirements; and
105.11    (5) the county lead agency may allow a case manager employed by the county lead
105.12agency to delegate certain aspects of the case management activity to another individual
105.13employed by the county lead agency provided there is oversight of the individual by
105.14the case manager. The case manager may not delegate those aspects which require
105.15professional judgment including assessments, reassessments, and care plan development.
105.16Lead agencies include counties, health plans, and federally recognized tribes who
105.17authorize services under this section.
105.18    Subd. 1c. Case management activities under the state plan. The commissioner
105.19shall seek an amendment to the home and community-based services waiver for the
105.20elderly to implement the provisions of subdivisions 1a and 1b. If the commissioner
105.21is unable to secure the approval of the secretary of health and human services for the
105.22requested waiver amendment by December 31, 1993, the commissioner shall amend
105.23the medical assistance state plan to provide that case management provided under the
105.24home and community-based services waiver for the elderly is performed by counties
105.25as an administrative function for the proper and effective administration of the state
105.26medical assistance plan. The state shall reimburse counties for the nonfederal share of
105.27costs for case management performed as an administrative function under the home and
105.28community-based services waiver for the elderly.
105.29    Subd. 1d. Posteligibility treatment of income and resources for elderly waiver.
105.30    Notwithstanding the provisions of section 256B.056, the commissioner shall make the
105.31following amendment to the medical assistance elderly waiver program effective July 1,
105.321999, or upon federal approval, whichever is later.
105.33    A recipient's maintenance needs will be an amount equal to the Minnesota
105.34supplemental aid equivalent rate as defined in section 256I.03, subdivision 5, plus the
105.35medical assistance personal needs allowance as defined in section 256B.35, subdivision
105.361
, paragraph (a), when applying posteligibility treatment of income rules to the gross
106.1income of elderly waiver recipients, except for individuals whose income is in excess of
106.2the special income standard according to Code of Federal Regulations, title 42, section
106.3435.236 . Recipient maintenance needs shall be adjusted under this provision each July 1.
106.4    Subd. 2. Spousal impoverishment policies. The commissioner shall seek to amend
106.5the federal waiver and the medical assistance state plan to allow apply:
106.6    (1) the spousal impoverishment criteria as authorized under United States Code, title
106.742, section 1396r-5, and as implemented in sections 256B.0575, 256B.058, and 256B.059,
106.8except that the amendment shall seek to add to;
106.9    (2) the personal needs allowance permitted in section 256B.0575,; and
106.10    (3) an amount equivalent to the group residential housing rate as set by section
106.11256I.03, subdivision 5 , and according to the approved federal waiver and medical
106.12assistance state plan.
106.13    Subd. 3. Limits of cases. The number of medical assistance waiver recipients that
106.14a county lead agency may serve must be allocated according to the number of medical
106.15assistance waiver cases open on July 1 of each fiscal year. Additional recipients may be
106.16served with the approval of the commissioner.
106.17    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of waivered
106.18services to an individual elderly waiver client shall be the weighted average monthly
106.19nursing facility rate of the case mix resident class to which the elderly waiver client would
106.20be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's
106.21maintenance needs allowance as described in subdivision 1d, paragraph (a), until the first
106.22day of the state fiscal year in which the resident assessment system as described in section
106.23256B.437 for nursing home rate determination is implemented. Effective on the first day
106.24of the state fiscal year in which the resident assessment system as described in section
106.25256B.437 for nursing home rate determination is implemented and the first day of each
106.26subsequent state fiscal year, the monthly limit for the cost of waivered services to an
106.27individual elderly waiver client shall be the rate of the case mix resident class to which the
106.28waiver client would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,
106.29in effect on the last day of the previous state fiscal year, adjusted by the greater of any
106.30legislatively adopted home and community-based services percentage rate increase or the
106.31average statewide percentage increase in nursing facility payment rates.
106.32    (b) If extended medical supplies and equipment or environmental modifications are
106.33or will be purchased for an elderly waiver client, the costs may be prorated for up to
106.3412 consecutive months beginning with the month of purchase. If the monthly cost of a
106.35recipient's waivered services exceeds the monthly limit established in paragraph (a), the
107.1annual cost of all waivered services shall be determined. In this event, the annual cost of
107.2all waivered services shall not exceed 12 times the monthly limit of waivered services as
107.3described in paragraph (a).
107.4    Subd. 3b. Cost limits for elderly waiver applicants who reside in a nursing
107.5facility. (a) For a person who is a nursing facility resident at the time of requesting a
107.6determination of eligibility for elderly waivered services, a monthly conversion limit for
107.7the cost of elderly waivered services may be requested. The monthly conversion limit for
107.8the cost of elderly waiver services shall be the resident class assigned under Minnesota
107.9Rules, parts 9549.0050 to 9549.0059, for that resident in the nursing facility where
107.10the resident currently resides until July 1 of the state fiscal year in which the resident
107.11assessment system as described in section 256B.437 for nursing home rate determination
107.12is implemented. Effective on July 1 of the state fiscal year in which the resident
107.13assessment system as described in section 256B.437 for nursing home rate determination
107.14is implemented, the monthly conversion limit for the cost of elderly waiver services
107.15shall be the per diem nursing facility rate as determined by the resident assessment
107.16system as described in section 256B.437 for that resident in the nursing facility where
107.17the resident currently resides multiplied by 365 and divided by 12, less the recipient's
107.18maintenance needs allowance as described in subdivision 1d. The initially approved
107.19conversion rate may be adjusted by the greater of any subsequent legislatively adopted
107.20home and community-based services percentage rate increase or the average statewide
107.21percentage increase in nursing facility payment rates. The limit under this subdivision
107.22only applies to persons discharged from a nursing facility after a minimum 30-day stay
107.23and found eligible for waivered services on or after July 1, 1997. For conversions from the
107.24nursing home to the elderly waiver with consumer directed community support services,
107.25the conversion rate limit is equal to the nursing facility rate reduced by a percentage equal
107.26to the percentage difference between the consumer directed services budget limit that
107.27would be assigned according to the federally approved waiver plan and the corresponding
107.28community case mix cap, but not to exceed 50 percent.
107.29    (b) The following costs must be included in determining the total monthly costs
107.30for the waiver client:
107.31    (1) cost of all waivered services, including extended medical supplies and equipment
107.32and environmental modifications and adaptations; and
107.33    (2) cost of skilled nursing, home health aide, and personal care services reimbursable
107.34by medical assistance.
107.35    Subd. 3c. Service approval and contracting provisions. (a) Medical assistance
107.36funding for skilled nursing services, private duty nursing, home health aide, and personal
108.1care services for waiver recipients must be approved by the case manager and included in
108.2the individual care plan.
108.3    (b) A county lead agency is not required to contract with a provider of supplies and
108.4equipment if the monthly cost of the supplies and equipment is less than $250.
108.5    Subd. 3d. Adult foster care rate. The adult foster care rate shall be considered
108.6a difficulty of care payment and shall not include room and board. The adult foster
108.7care service rate shall be negotiated between the county lead agency and the foster care
108.8provider. The elderly waiver payment for the foster care service in combination with
108.9the payment for all other elderly waiver services, including case management, must not
108.10exceed the limit specified in subdivision 3a, paragraph (a).
108.11    Subd. 3e. Assisted living Customized living service rate. (a) Payment for assisted
108.12living service customize living services shall be a monthly rate negotiated and authorized
108.13by the county agency based on an individualized service plan for each resident and may
108.14not cover direct rent or food costs. lead agency within the parameters established by
108.15the commissioner. The payment agreement must delineate the services that have been
108.16customized for each recipient and specify the amount of each service to be provided. The
108.17lead agency shall ensure that there is a documented need for all services authorized.
108.18Customized living services must not include rent or raw food costs. The negotiated
108.19payment rate must be based on services to be provided. Negotiated rates must not exceed
108.20payment rates for comparable elderly waiver or medical assistance services and must
108.21reflect economies of scale.
108.22    (b) The individualized monthly negotiated payment for assisted living customized
108.23living services as described in section 256B.0913, subdivisions 5d to 5f, and residential
108.24care services as described in section 256B.0913, subdivision 5c, shall not exceed the
108.25nonfederal share, in effect on July 1 of the state fiscal year for which the rate limit
108.26is being calculated, of the greater of either the statewide or any of the geographic
108.27groups' weighted average monthly nursing facility rate of the case mix resident class
108.28to which the elderly waiver eligible client would be assigned under Minnesota Rules,
108.29parts 9549.0050 to 9549.0059, less the maintenance needs allowance as described in
108.30subdivision 1d, paragraph (a), until the July 1 of the state fiscal year in which the resident
108.31assessment system as described in section 256B.437 for nursing home rate determination
108.32is implemented. Effective on July 1 of the state fiscal year in which the resident
108.33assessment system as described in section 256B.437 for nursing home rate determination
108.34is implemented and July 1 of each subsequent state fiscal year, the individualized monthly
108.35negotiated payment for the services described in this clause shall not exceed the limit
108.36described in this clause which was in effect on June 30 of the previous state fiscal year
109.1and which has been adjusted by the greater of any legislatively adopted home and
109.2community-based services cost-of-living percentage increase or any legislatively adopted
109.3statewide percent rate increase for nursing facilities.
109.4    (c) The individualized monthly negotiated payment for assisted Customized living
109.5services described in section 144A.4605 and are delivered by a provider licensed by the
109.6Department of Health as a class A or class F home care provider or an assisted living
109.7home care provider and provided in a building that is registered as a housing with services
109.8establishment under chapter 144D and that provides 24-hour supervision in combination
109.9with the payment for other elderly waiver services, including case management, must not
109.10exceed the limit specified in subdivision 3a.
109.11    Subd. 3f. Individual service rates; expenditure forecasts. (a) The county lead
109.12agency shall negotiate individual service rates with vendors and may authorize payment
109.13for actual costs up to the county's lead agency's current approved rate. Persons or agencies
109.14must be employed by or under a contract with the county lead agency or the public health
109.15nursing agency of the local board of health in order to receive funding under the elderly
109.16waiver program, except as a provider of supplies and equipment when the monthly cost of
109.17the supplies and equipment is less than $250.
109.18    (b) Reimbursement for the medical assistance recipients under the approved waiver
109.19shall be made from the medical assistance account through the invoice processing
109.20procedures of the department's Medicaid Management Information System (MMIS),
109.21only with the approval of the client's case manager. The budget for the state share of the
109.22Medicaid expenditures shall be forecasted with the medical assistance budget, and shall
109.23be consistent with the approved waiver.
109.24    Subd. 3g. Service rate limits; state assumption of costs. (a) To improve access
109.25to community services and eliminate payment disparities between the alternative care
109.26program and the elderly waiver, the commissioner shall establish statewide maximum
109.27service rate limits and eliminate county-specific lead agency-specific service rate limits.
109.28    (b) Effective July 1, 2001, for service rate limits, except those described or defined in
109.29subdivisions 3d and 3e, the rate limit for each service shall be the greater of the alternative
109.30care statewide maximum rate or the elderly waiver statewide maximum rate.
109.31    (c) Counties Lead agencies may negotiate individual service rates with vendors for
109.32actual costs up to the statewide maximum service rate limit.
109.33    Subd. 3h. Service rate limits; 24-hour customized living services. The payment
109.34rates for 24-hour customized living services is a monthly rate negotiated and authorized by
109.35the lead agency within the parameters established by the commissioner of human services.
110.1The payment agreement must delineate the services that have been customized for each
110.2recipient and specify the amount of each service to be provided. The lead agency shall
110.3ensure that there is a documented need for all services authorized. The lead agency shall
110.4not authorize 24-hour customized living services unless there is a documented need for
110.524-hour supervision. For purposes of this section, "24-hour supervision" means that the
110.6recipient requires assistance due to needs related to one or more of the following:
110.7    (1) intermittent assistance with toileting or transferring;
110.8    (2) cognitive or behavioral issues;
110.9    (3) a medical condition that requires clinical monitoring; or
110.10    (4) other conditions or needs as defined by the commissioner of human services.
110.11The lead agency shall ensure that the frequency and mode of supervision of the recipient
110.12and the qualifications of staff providing supervision are described and meet the needs
110.13of the recipient. Customized living services must not include rent or raw food costs.
110.14The negotiated payment rate for 24-hour customized living services must be based on
110.15services to be provided. Negotiated rates must not exceed payment rates for comparable
110.16elderly waiver or medical assistance services and must reflect economies of scale. The
110.17individually negotiated 24-hour customized living payments, in combination with the
110.18payment for other elderly waiver services, including case management, must not exceed
110.19the recipient's community budget cap specified in subdivision 3a.
110.20    Subd. 4. Termination notice. The case manager must give the individual a ten-day
110.21written notice of any denial, reduction, or termination of waivered services.
110.22    Subd. 5. Assessments and reassessments for waiver clients. Each client shall
110.23receive an initial assessment of strengths, informal supports, and need for services in
110.24accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
110.25client served under the elderly waiver must be conducted at least every 12 months and
110.26at other times when the case manager determines that there has been significant change
110.27in the client's functioning. This may include instances where the client is discharged
110.28from the hospital.
110.29    Subd. 6. Implementation of care plan. Each elderly waiver client shall be provided
110.30a copy of a written care plan that meets the requirements outlined in section 256B.0913,
110.31subdivision 8
. The care plan must be implemented by the county administering waivered
110.32services of service when it is different than the county of financial responsibility. The
110.33county of service administering waivered services must notify the county of financial
110.34responsibility of the approved care plan.
111.1    Subd. 7. Prepaid elderly waiver services. An individual for whom a prepaid health
111.2plan is liable for nursing home services or elderly waiver services according to section
111.3256B.69, subdivision 6a , is not eligible to also receive county-administered elderly waiver
111.4services under this section.
111.5    Subd. 8. Services and supports. (a) Services and supports shall meet the
111.6requirements set out in United States Code, title 42, section 1396n.
111.7    (b) Services and supports shall promote consumer choice and be arranged and
111.8provided consistent with individualized, written care plans.
111.9    (c) The state of Minnesota, county, managed care organization, or tribal government
111.10under contract to administer the elderly waiver shall not be liable for damages, injuries,
111.11or liabilities sustained through the purchase of direct supports or goods by the person,
111.12the person's family, or the authorized representatives with funds received through
111.13consumer-directed community support services under the federally approved waiver plan.
111.14Liabilities include, but are not limited to, workers' compensation liability, the Federal
111.15Insurance Contributions Act (FICA), or the Federal Unemployment Tax Act (FUTA).
111.16    Subd. 9. Tribal management of elderly waiver. Notwithstanding contrary
111.17provisions of this section, or those in other state laws or rules, the commissioner may
111.18develop a model for tribal management of the elderly waiver program and implement this
111.19model through a contract between the state and any of the state's federally recognized tribal
111.20governments. The model shall include the provision of tribal waiver case management,
111.21assessment for personal care assistance, and administrative requirements otherwise carried
111.22out by counties lead agencies but shall not include tribal financial eligibility determination
111.23for medical assistance.
111.24EFFECTIVE DATE.Subdivision 3h is effective the day following final enactment.

111.25    Sec. 23. Minnesota Statutes 2006, section 256B.0917, subdivision 8, is amended to
111.26read:
111.27    Subd. 8. Living-at-home/block nurse program grant. (a) The organization
111.28awarded the contract under subdivision 7, shall develop and administer a grant program
111.29to establish or expand up to 33 51 community-based organizations that will implement
111.30living-at-home/block nurse programs that are designed to enable senior citizens to live as
111.31independently as possible in their homes and in their communities. At least one-half of
111.32the programs must be in counties outside the seven-county metropolitan area. Nonprofit
111.33organizations and units of local government are eligible to apply for grants to establish
111.34the community organizations that will implement living-at-home/block nurse programs.
111.35In awarding grants, the organization awarded the contract under subdivision 7 shall give
112.1preference to nonprofit organizations and units of local government from communities
112.2that:
112.3    (1) have high nursing home occupancy rates;
112.4    (2) have a shortage of health care professionals;
112.5    (3) are located in counties adjacent to, or are located in, counties with existing
112.6living-at-home/block nurse programs; and
112.7    (4) meet other criteria established by LAH/BN, Inc., in consultation with the
112.8commissioner.
112.9    (b) Grant applicants must also meet the following criteria:
112.10    (1) the local community demonstrates a readiness to establish a community model
112.11of care, including the formation of a board of directors, advisory committee, or similar
112.12group, of which at least two-thirds is comprised of community citizens interested in
112.13community-based care for older persons;
112.14    (2) the program has sponsorship by a credible, representative organization within
112.15the community;
112.16    (3) the program has defined specific geographic boundaries and defined its
112.17organization, staffing and coordination/delivery of services;
112.18    (4) the program demonstrates a team approach to coordination and care, ensuring
112.19that the older adult participants, their families, the formal and informal providers are all
112.20part of the effort to plan and provide services; and
112.21    (5) the program provides assurances that all community resources and funding will
112.22be coordinated and that other funding sources will be maximized, including a person's
112.23own resources.
112.24    (c) Grant applicants must provide a minimum of five percent of total estimated
112.25development costs from local community funding. Grants shall be awarded for four-year
112.26periods, and the base amount shall not exceed $80,000 $100,000 per applicant for the grant
112.27period. The organization under contract may increase the grant amount for applicants from
112.28communities that have socioeconomic characteristics that indicate a higher level of need
112.29for assistance. Subject to the availability of funding, grants and grant renewals awarded or
112.30entered into on or after July 1, 1997, shall be renewed by LAH/BN, Inc. every four years,
112.31unless LAH/BN, Inc. determines that the grant recipient has not satisfactorily operated the
112.32living-at-home/block nurse program in compliance with the requirements of paragraphs
112.33(b) and (d). Grants provided to living-at-home/block nurse programs under this paragraph
112.34may be used for both program development and the delivery of services.
113.1    (d) Each living-at-home/block nurse program shall be designed by representatives of
113.2the communities being served to ensure that the program addresses the specific needs of
113.3the community residents. The programs must be designed to:
113.4    (1) incorporate the basic community, organizational, and service delivery principles
113.5of the living-at-home/block nurse program model;
113.6    (2) provide senior citizens with registered nurse directed assessment, provision and
113.7coordination of health and personal care services on a sliding fee basis as an alternative
113.8to expensive nursing home care;
113.9    (3) provide information, support services, homemaking services, counseling, and
113.10training for the client and family caregivers;
113.11    (4) encourage the development and use of respite care, caregiver support, and
113.12in-home support programs, such as adult foster care and in-home adult day care;
113.13    (5) encourage neighborhood residents and local organizations to collaborate in
113.14meeting the needs of senior citizens in their communities;
113.15    (6) recruit, train, and direct the use of volunteers to provide informal services and
113.16other appropriate support to senior citizens and their caregivers; and
113.17    (7) provide coordination and management of formal and informal services to senior
113.18citizens and their families using less expensive alternatives.

113.19    Sec. 24. Minnesota Statutes 2006, section 256B.431, subdivision 2e, is amended to
113.20read:
113.21    Subd. 2e. Contracts for services for ventilator-dependent persons. (a)
113.22The commissioner may negotiate with a nursing facility eligible to receive medical
113.23assistance payments to provide services to a ventilator-dependent person identified by the
113.24commissioner according to criteria developed by the commissioner, including:
113.25    (1) nursing facility care has been recommended for the person by a preadmission
113.26screening team;
113.27    (2) the person has been hospitalized and no longer requires inpatient acute care
113.28hospital services; and
113.29    (3) the commissioner has determined that necessary services for the person cannot
113.30be provided under existing nursing facility rates.
113.31    The commissioner may negotiate an adjustment to the operating cost payment
113.32rate for a nursing facility with a resident who is ventilator-dependent, for that resident.
113.33The negotiated adjustment must reflect only the actual additional cost of meeting the
113.34specialized care needs of a ventilator-dependent person identified by the commissioner
113.35for whom necessary services cannot be provided under existing nursing facility rates and
113.36which are not otherwise covered under Minnesota Rules, parts 9549.0010 to 9549.0080 or
114.19505.0170 to 9505.0475. For persons who are initially admitted to a nursing facility before
114.2July 1, 2001, and have their payment rate under this subdivision negotiated after July 1,
114.32001, the negotiated payment rate must not exceed 200 percent of the highest multiple
114.4bedroom payment rate for the facility, as initially established by the commissioner for the
114.5rate year for case mix classification K; or, upon implementation of the RUG's-based case
114.6mix system, 200 percent of the highest RUG's rate. For persons initially admitted to a
114.7nursing facility on or after July 1, 2001, the negotiated payment rate must not exceed 300
114.8percent of the facility's multiple bedroom payment rate for case mix classification K; or,
114.9upon implementation of the RUG's-based case mix system, 300 percent of the highest
114.10RUG's rate. The negotiated adjustment shall not affect the payment rate charged to private
114.11paying residents under the provisions of section 256B.48, subdivision 1.
114.12    (b) Effective July 1, 2007, or upon opening a unit of at least ten beds dedicated to
114.13care of ventilator-dependent persons in partnership with Mayo Health Systems, whichever
114.14is later, the operating payment rates for residents determined eligible under paragraph (a)
114.15of a nursing facility in Waseca County that on February 1, 2007, was licensed for 70 beds
114.16and reimbursed under this section, section 256B.434, or section 256B.441, shall be 300
114.17percent of the facility's highest RUG rate.

114.18    Sec. 25. Minnesota Statutes 2006, section 256B.434, is amended by adding a
114.19subdivision to read:
114.20    Subd. 4i. Nursing facility rate increase effective October 1, 2007; Hennepin
114.21County. For the rate year beginning October 1, 2007, the commissioner shall provide to
114.22a nursing facility in Hennepin County licensed for 268 beds as of February 1, 2007, an
114.23increase in the property payment rate of $6.52 per resident per day. The increase under
114.24this subdivision must be added following the determination under this chapter of the
114.25payment rate for the rate year beginning October 1, 2007, and must be included in the
114.26facility's total payment rate for purposes of determining future rates under this section or
114.27any other section.

114.28    Sec. 26. Minnesota Statutes 2006, section 256B.434, is amended by adding a
114.29subdivision to read:
114.30    Subd. 4j. Rate increase for facilities in Chisago County. Effective October
114.311, 2007, operating payment rates of all nursing facilities in Chisago County that are
114.32reimbursed under this section or section 256B.441 shall be increased to be equal, for
114.33a RUG's rate with a weight of 1.00, to the geographic group III median rate for the
114.34same RUG's weight. The percentage of the operating payment rate for each facility to
114.35be case-mix adjusted shall be equal to the percentage that is case-mix adjusted in that
114.36facility's September 30, 2007, operating payment rate. This subdivision applies only if it
115.1results in a rate increase. Increases provided by this subdivision shall be added to the rate
115.2determined under any new reimbursement system established under section 256B.441.

115.3    Sec. 27. Minnesota Statutes 2006, section 256B.434, is amended by adding a
115.4subdivision to read:
115.5    Subd. 4k. Nursing facility rate increase effective January 1, 2008; Hennepin
115.6County. Effective January 1, 2008, a nursing facility in Hennepin County licensed for
115.7137 beds as of February 1, 2007, shall receive an increase of $2.81 in each case mix
115.8payment rate to offset property tax payments due as a result of the facility's conversion
115.9from nonprofit to for-profit status. The increase under this subdivision must be added
115.10following the determination under this chapter of the payment rate for the rate year
115.11beginning October 1, 2007, and must be included in the facility's total payment rate for the
115.12purposes of determining future rates under this section or any other section.

115.13    Sec. 28. Minnesota Statutes 2006, section 256B.434, is amended by adding a
115.14subdivision to read:
115.15    Subd. 4l. Property rate adjustment; Kanabec County. The commissioner
115.16shall allow a property rate adjustment for a facility located in Kanabec County that
115.17was approved for a moratorium exception project in 2001, but experienced a delay and
115.18additional costs associated with the project, and completed the project in 2005. The
115.19property payment rate for the rate years beginning October 1, 2007, and ending September
115.2030, 2009, must be $22.73 per resident day. For subsequent years, the property rate of
115.21$22.73 per resident day shall be adjusted as provided in subdivision 4, paragraph (c), as
115.22long as the facility has a contract under this section.

115.23    Sec. 29. Minnesota Statutes 2006, section 256B.434, is amended by adding a
115.24subdivision to read:
115.25    Subd. 4m. Rate increase for facilities in Rice County. Effective July 1, 2007,
115.26operating payment rates of nursing facilities in Rice County located within two miles
115.27of Scott County or Dakota County that are reimbursed under this section or section
115.28256B.441 must be increased to be equal, for a RUG's rate with a weight of 1.00, to the
115.29geographic group III median rate for the same RUG's weight. The percentage of the
115.30operating payment rate for each facility to be case-mix adjusted must be equal to the
115.31percentage that is case-mix adjusted in that facility's June 30, 2006, operating payment
115.32rate. This subdivision applies only if it results in a rate increase.

115.33    Sec. 30. Minnesota Statutes 2006, section 256B.434, is amended by adding a
115.34subdivision to read:
116.1    Subd. 19. Rate increases for October 1, 2007, and October 1, 2008. (a) For the
116.2rate years beginning October 1, 2007, and October 1, 2008, the commissioner shall make
116.3available to each nursing facility reimbursed under this section an adjustment equal to five
116.4percent of the total operating payment rate.
116.5    (b) Seventy-five percent of the money resulting from the rate adjustment under
116.6paragraph (a) must be used to increase wages and benefits and pay associated costs
116.7for all employees, except management fees, the administrator, and central office staff.
116.8Seventy-five percent of the money received by a facility as a result of the rate adjustment
116.9provided in paragraph (a) must be used only for wage and benefit increases and payment
116.10of associated costs, implemented on or after the effective date of the rate increase each
116.11year, and must not be used for increases implemented prior to that date.
116.12    (c) Nursing facilities may apply for the portion of the rate adjustment under
116.13paragraph (a) for employee wages and benefits and associated costs. The application
116.14must be made to the commissioner and contain a plan by which the nursing facility
116.15will distribute the funds according to paragraph (b). For nursing facilities in which the
116.16employees are represented by an exclusive bargaining representative, an agreement
116.17negotiated and agreed to by the employer and the exclusive bargaining representative
116.18constitutes the plan. The commissioner shall not review and shall not require changes
116.19to the portion or portions of the plan covered by collective bargaining agreements. A
116.20negotiated agreement may constitute the plan only if the agreement is finalized after the
116.21date of enactment of all increases for the rate year and signed by both parties prior to
116.22submission to the commissioner. The commissioner shall review the plan to ensure that
116.23the rate adjustments are used as provided in paragraph (b). To be eligible, a facility must
116.24submit its distribution plan by March 31, 2008, and March 31, 2009, respectively. The
116.25commissioner may approve distribution plans on or before June 30, 2008, and June 30,
116.262009, respectively. If a facility's distribution plan is effective after the first day of the
116.27applicable rate period that the funds are available, the rate adjustments are effective the
116.28same date as the facility's plan.
116.29    (d) A copy of the approved distribution plan must be made available to all employees
116.30by giving each employee a copy or by posting a copy in an area of the nursing facility
116.31to which all employees have access. If an employee does not receive the wage and
116.32benefit adjustment described in the facility's approved plan and is unable to resolve the
116.33problem with the facility's management or through the employee's union representative,
116.34the employee may contact the commissioner at an address or telephone number provided
116.35by the commissioner and included in the approved plan.

117.1    Sec. 31. Minnesota Statutes 2006, section 256B.434, is amended by adding a
117.2subdivision to read:
117.3    Subd. 20. Payment of Public Employees Retirement Association costs. Nursing
117.4facilities that participate in the Public Employees Retirement Association (PERA) shall
117.5have the component of their payment rate associated with the costs of PERA determined
117.6for each rate year. Effective for rate years beginning on and after October 1, 2007, the
117.7commissioner shall determine the portion of the payment rate in effect on September 30
117.8each year and shall subtract that amount from the payment rate to be effective on the
117.9following October 1. The portion that shall be deemed to be included in the September 30,
117.102007, rate that is associated with PERA costs shall be the allowed costs in the facility's
117.11base for determining rates under this section, divided by the resident days reported for that
117.12year. The commissioner shall add to the payment rate to be effective on October 1 each
117.13year an amount equal to the reported costs associated with PERA, for the year ended on
117.14the most recent September 30 for which data is available, divided by total resident days
117.15for that year, as reported by the facility and audited under section 256B.441.

117.16    Sec. 32. Minnesota Statutes 2006, section 256B.437, is amended by adding a
117.17subdivision to read:
117.18    Subd. 11. Big Stone County rate adjustment. Notwithstanding the time period
117.19specified in subdivision 3, the commissioner may approve a planned closure rate
117.20adjustment in Big Stone County for an eight-bed facility in Clinton for reassignment to a
117.2150-bed facility in Graceville. The adjustment shall be calculated according to subdivision
117.226.

117.23    Sec. 33. Minnesota Statutes 2006, section 256B.439, subdivision 1, is amended to read:
117.24    Subdivision 1. Development and implementation of quality profiles. (a) The
117.25commissioner of human services, in cooperation with the commissioner of health, shall
117.26develop and implement a quality profile system for nursing facilities and, beginning not
117.27later than July 1, 2004, other providers of long-term care services, except when the quality
117.28profile system would duplicate requirements under section 256B.5011, 256B.5012, or
117.29256B.5013 . Beginning July 1, 2008, the commissioners shall include quality profiles of
117.30nursing homes that are not medical assistance certified in the Minnesota Nursing Home
117.31Report Card. The nonmedical assistance certified nursing homes may provide to the
117.32commissioners information necessary to conduct consumer satisfaction surveys and to
117.33determine other quality measures. The system must be developed and implemented to the
117.34extent possible without the collection of significant amounts of new data. To the extent
117.35possible, the system must incorporate or be coordinated with information on quality
118.1maintained by area agencies on aging, long-term care trade associations, and other entities.
118.2The system must be designed to provide information on quality to:
118.3    (1) consumers and their families to facilitate informed choices of service providers;
118.4    (2) providers to enable them to measure the results of their quality improvement
118.5efforts and compare quality achievements with other service providers; and
118.6    (3) public and private purchasers of long-term care services to enable them to
118.7purchase high-quality care.
118.8    (b) The system must be developed in consultation with the long-term care task force,
118.9area agencies on aging, and representatives of consumers, providers, and labor unions.
118.10Within the limits of available appropriations, the commissioners may employ consultants
118.11to assist with this project.

118.12    Sec. 34. Minnesota Statutes 2006, section 256B.5012, is amended by adding a
118.13subdivision to read:
118.14    Subd. 7. ICF/MR rate increases October 1, 2007, and October 1, 2008. (a) For
118.15the rate periods beginning October 1, 2007, and October 1, 2008, the commissioner shall
118.16make available to each facility reimbursed under this section an adjustment to the total
118.17operating payment rate of three percent.
118.18    (b) Seventy-five percent of the money resulting from the rate adjustment under
118.19paragraph (a) must be used to increase wages and benefits and pay associated costs for
118.20employees, except for administrative and central office employees. Seventy-five percent
118.21of the money received by a facility as a result of the rate adjustment provided in paragraph
118.22(a) must be used only for wage, benefit, and staff increases implemented on or after
118.23the effective date of the rate increase each year, and must not be used for increases
118.24implemented prior to that date. The wage adjustment eligible employees may receive may
118.25vary based on merit, seniority, or other factors determined by the provider.
118.26    (c) For each facility, the commissioner shall make available an adjustment, based
118.27on occupied beds, using the percentage specified in paragraph (a) multiplied by the total
118.28payment rate, including variable rate but excluding the property-related payment rate, in
118.29effect on the preceding day. The total payment rate must include the adjustment provided
118.30in section 256B.501, subdivision 12.
118.31    (d) A facility whose payment rates are governed by closure agreements, receivership
118.32agreements, or Minnesota Rules, part 9553.0075, is not eligible for an adjustment
118.33otherwise granted under this subdivision.
118.34    (e) A facility may apply for the portion of the payment rate adjustment provided
118.35under paragraph (a) for employee wages and benefits and associated costs. The application
118.36must be made to the commissioner and contain a plan by which the facility will distribute
119.1the funds according to paragraph (b). For facilities in which the employees are represented
119.2by an exclusive bargaining representative, an agreement negotiated and agreed to by
119.3the employer and the exclusive bargaining representative constitutes the plan. The
119.4commissioner shall not review, and shall not require changes, to the portion or portions
119.5of the plan covered by collective bargaining agreements. A negotiated agreement may
119.6constitute the plan only if the agreement is finalized after the date of enactment of all rate
119.7increases for the rate year. The commissioner shall review the plan to ensure that the
119.8payment rate adjustment per diem is used as provided in this subdivision. To be eligible, a
119.9facility must submit its plan by March 31, 2008, and December 31, 2008, respectively.
119.10If a facility's plan is effective for its employees after the first day of the applicable rate
119.11period that the funds are available, the payment rate adjustment per diem is effective
119.12the same date as its plan.
119.13    (f) A copy of the approved distribution plan must be made available to all employees
119.14by giving each employee a copy or by posting it in an area of the facility to which all
119.15employees have access. If an employee does not receive the wage and benefit adjustment
119.16described in the facility's approved plan and is unable to resolve the problem with the
119.17facility's management or through the employee's union representative, the employee
119.18may contact the commissioner at an address or telephone number provided by the
119.19commissioner and included in the approved plan.

119.20    Sec. 35. Minnesota Statutes 2006, section 256B.69, subdivision 23, is amended to read:
119.21    Subd. 23. Alternative services; elderly and disabled persons. (a) The
119.22commissioner may implement demonstration projects to create alternative integrated
119.23delivery systems for acute and long-term care services to elderly persons and persons
119.24with disabilities as defined in section 256B.77, subdivision 7a, that provide increased
119.25coordination, improve access to quality services, and mitigate future cost increases.
119.26The commissioner may seek federal authority to combine Medicare and Medicaid
119.27capitation payments for the purpose of such demonstrations and may contract with
119.28Medicare-approved special needs plans to provide Medicaid services. Medicare funds and
119.29services shall be administered according to the terms and conditions of the federal contract
119.30and demonstration provisions. For the purpose of administering medical assistance funds,
119.31demonstrations under this subdivision are subject to subdivisions 1 to 22. The provisions
119.32of Minnesota Rules, parts 9500.1450 to 9500.1464, apply to these demonstrations,
119.33with the exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, subpart 1,
119.34items B and C, which do not apply to persons enrolling in demonstrations under this
119.35section. An initial open enrollment period may be provided. Persons who disenroll from
119.36demonstrations under this subdivision remain subject to Minnesota Rules, parts 9500.1450
120.1to 9500.1464. When a person is enrolled in a health plan under these demonstrations and
120.2the health plan's participation is subsequently terminated for any reason, the person shall
120.3be provided an opportunity to select a new health plan and shall have the right to change
120.4health plans within the first 60 days of enrollment in the second health plan. Persons
120.5required to participate in health plans under this section who fail to make a choice of
120.6health plan shall not be randomly assigned to health plans under these demonstrations.
120.7Notwithstanding section 256L.12, subdivision 5, and Minnesota Rules, part 9505.5220,
120.8subpart 1, item A, if adopted, for the purpose of demonstrations under this subdivision,
120.9the commissioner may contract with managed care organizations, including counties, to
120.10serve only elderly persons eligible for medical assistance, elderly and disabled persons, or
120.11disabled persons only. For persons with a primary diagnosis of developmental disability,
120.12serious and persistent mental illness, or serious emotional disturbance, the commissioner
120.13must ensure that the county authority has approved the demonstration and contracting
120.14design. Enrollment in these projects for persons with disabilities shall be voluntary. The
120.15commissioner shall not implement any demonstration project under this subdivision for
120.16persons with a primary diagnosis of developmental disabilities, serious and persistent
120.17mental illness, or serious emotional disturbance, without approval of the county board of
120.18the county in which the demonstration is being implemented.
120.19    (b) Notwithstanding chapter 245B, sections 252.40 to 252.46, 256B.092, 256B.501
120.20to 256B.5015, and Minnesota Rules, parts 9525.0004 to 9525.0036, 9525.1200 to
120.219525.1330 , 9525.1580, and 9525.1800 to 9525.1930, the commissioner may implement
120.22under this section projects for persons with developmental disabilities. The commissioner
120.23may capitate payments for ICF/MR services, waivered services for developmental
120.24disabilities, including case management services, day training and habilitation and
120.25alternative active treatment services, and other services as approved by the state and by
120.26the federal government. Case management and active treatment must be individualized
120.27and developed in accordance with a person-centered plan. Costs under these projects may
120.28not exceed costs that would have been incurred under fee-for-service. Beginning July 1,
120.292003, and until two four years after the pilot project implementation date, subcontractor
120.30participation in the long-term care developmental disability pilot is limited to a nonprofit
120.31long-term care system providing ICF/MR services, home and community-based waiver
120.32services, and in-home services to no more than 120 consumers with developmental
120.33disabilities in Carver, Hennepin, and Scott Counties. The commissioner shall report to the
120.34legislature prior to expansion of the developmental disability pilot project. This paragraph
120.35expires two four years after the implementation date of the pilot project.
121.1    (c) Before implementation of a demonstration project for disabled persons, the
121.2commissioner must provide information to appropriate committees of the house of
121.3representatives and senate and must involve representatives of affected disability groups
121.4in the design of the demonstration projects.
121.5    (d) A nursing facility reimbursed under the alternative reimbursement methodology
121.6in section 256B.434 may, in collaboration with a hospital, clinic, or other health care entity
121.7provide services under paragraph (a). The commissioner shall amend the state plan and
121.8seek any federal waivers necessary to implement this paragraph.
121.9    (e) The commissioner, in consultation with the commissioners of commerce and
121.10health, may approve and implement programs for all-inclusive care for the elderly (PACE)
121.11according to federal laws and regulations governing that program and state laws or rules
121.12applicable to participating providers. The process for approval of these programs shall
121.13begin only after the commissioner receives grant money in an amount sufficient to cover
121.14the state share of the administrative and actuarial costs to implement the programs during
121.15state fiscal years 2006 and 2007. Grant amounts for this purpose shall be deposited in an
121.16account in the special revenue fund and are appropriated to the commissioner to be used
121.17solely for the purpose of PACE administrative and actuarial costs. A PACE provider is
121.18not required to be licensed or certified as a health plan company as defined in section
121.1962Q.01, subdivision 4 . Persons age 55 and older who have been screened by the county
121.20and found to be eligible for services under the elderly waiver or community alternatives
121.21for disabled individuals or who are already eligible for Medicaid but meet level of
121.22care criteria for receipt of waiver services may choose to enroll in the PACE program.
121.23Medicare and Medicaid services will be provided according to this subdivision and
121.24federal Medicare and Medicaid requirements governing PACE providers and programs.
121.25PACE enrollees will receive Medicaid home and community-based services through the
121.26PACE provider as an alternative to services for which they would otherwise be eligible
121.27through home and community-based waiver programs and Medicaid State Plan Services.
121.28The commissioner shall establish Medicaid rates for PACE providers that do not exceed
121.29costs that would have been incurred under fee-for-service or other relevant managed care
121.30programs operated by the state.
121.31    (f) The commissioner shall seek federal approval to expand the Minnesota disability
121.32health options (MnDHO) program established under this subdivision in stages, first to
121.33regional population centers outside the seven-county metro area and then to all areas
121.34of the state. Until January 1, 2008, expansion for MnDHO projects that include home
121.35and community-based services is limited to the two projects and service areas in effect
121.36on March 1, 2006. Enrollment in integrated MnDHO programs that include home and
122.1community-based services shall remain voluntary. Costs for home and community-based
122.2services included under MnDHO must not exceed costs that would have been incurred
122.3under the fee-for-service program. In developing program specifications for expansion of
122.4integrated programs, the commissioner shall involve and consult the state-level stakeholder
122.5group established in subdivision 28, paragraph (d), including consultation on whether and
122.6how to include home and community-based waiver programs. Plans for further expansion
122.7of MnDHO projects shall be presented to the chairs of the house and senate committees
122.8with jurisdiction over health and human services policy and finance by February 1, 2007.
122.9    (g) Notwithstanding section 256B.0261, health plans providing services under this
122.10section are responsible for home care targeted case management and relocation targeted
122.11case management. Services must be provided according to the terms of the waivers and
122.12contracts approved by the federal government.

122.13    Sec. 36. [256C.261] SERVICES FOR DEAF-BLIND PERSONS.
122.14     (a) The commissioner of human services shall combine the existing biennial base
122.15level funding for deaf-blind services into a single grant program. At least 35 percent
122.16of the total funding is awarded for services and other supports to deaf-blind children
122.17and their families and at least 25 percent is awarded for services and other supports to
122.18deaf-blind adults.
122.19    The commissioner shall award grants for the purposes of:
122.20    (1) providing services and supports to individuals who are deaf-blind; and
122.21    (2) developing and providing training to counties and the network of senior citizen
122.22service providers. The purpose of the training grants is to teach counties how to use
122.23existing programs that capture federal financial participation to meet the needs of eligible
122.24deaf-blind persons and to build capacity of senior service programs to meet the needs of
122.25seniors with a dual sensory hearing and vision loss.
122.26    (b) The commissioner may make grants:
122.27    (1) for services and training provided by organizations; and
122.28    (2) to develop and administer consumer-directed services.
122.29    (c) Any entity that is able to satisfy the grant criteria is eligible to receive a grant
122.30under paragraph (a).
122.31    (d) Deaf-blind service providers are not required to, but may, provide intervenor
122.32services as part of the service package provided with grant funds under this section.

122.33    Sec. 37. Minnesota Statutes 2006, section 256D.03, subdivision 4, is amended to read:
122.34    Subd. 4. General assistance medical care; services. (a)(i) For a person who is
122.35eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
122.36care covers, except as provided in paragraph (c):
123.1    (1) inpatient hospital services;
123.2    (2) outpatient hospital services;
123.3    (3) services provided by Medicare certified rehabilitation agencies;
123.4    (4) prescription drugs and other products recommended through the process
123.5established in section 256B.0625, subdivision 13;
123.6    (5) equipment necessary to administer insulin and diagnostic supplies and equipment
123.7for diabetics to monitor blood sugar level;
123.8    (6) eyeglasses and eye examinations provided by a physician or optometrist;
123.9    (7) hearing aids;
123.10    (8) prosthetic devices;
123.11    (9) laboratory and X-ray services;
123.12    (10) physician's services;
123.13    (11) medical transportation except special transportation;
123.14    (12) chiropractic services as covered under the medical assistance program;
123.15    (13) podiatric services;
123.16    (14) dental services as covered under the medical assistance program;
123.17    (15) outpatient services provided by a mental health center or clinic that is under
123.18contract with the county board and is established under section 245.62;
123.19    (16) day treatment services for mental illness provided under contract with the
123.20county board;
123.21    (17) prescribed medications for persons who have been diagnosed as mentally ill as
123.22necessary to prevent more restrictive institutionalization;
123.23    (18) psychological services, medical supplies and equipment, and Medicare
123.24premiums, coinsurance and deductible payments;
123.25    (19) medical equipment not specifically listed in this paragraph when the use of
123.26the equipment will prevent the need for costlier services that are reimbursable under
123.27this subdivision;
123.28    (20) services performed by a certified pediatric nurse practitioner, a certified family
123.29nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
123.30nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
123.31practitioner in independent practice, if (1) the service is otherwise covered under this
123.32chapter as a physician service, (2) the service provided on an inpatient basis is not included
123.33as part of the cost for inpatient services included in the operating payment rate, and (3) the
123.34service is within the scope of practice of the nurse practitioner's license as a registered
123.35nurse, as defined in section 148.171;
124.1    (21) services of a certified public health nurse or a registered nurse practicing in
124.2a public health nursing clinic that is a department of, or that operates under the direct
124.3authority of, a unit of government, if the service is within the scope of practice of the
124.4public health nurse's license as a registered nurse, as defined in section 148.171;
124.5    (22) telemedicine consultations, to the extent they are covered under section
124.6256B.0625, subdivision 3b ; and
124.7    (23) mental health telemedicine and psychiatric consultation as covered under
124.8section 256B.0625, subdivisions 46 and 48.; and
124.9    (24) care coordination and patient education services provided by a community
124.10health worker according to section 256B.0625, subdivision 49.
124.11    (ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
124.12paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
124.13to inpatient hospital services, including physician services provided during the inpatient
124.14hospital stay. A $1,000 deductible is required for each inpatient hospitalization.
124.15    (b) Effective August 1, 2005, sex reassignment surgery is not covered under this
124.16subdivision.
124.17    (c) In order to contain costs, the commissioner of human services shall select
124.18vendors of medical care who can provide the most economical care consistent with high
124.19medical standards and shall where possible contract with organizations on a prepaid
124.20capitation basis to provide these services. The commissioner shall consider proposals by
124.21counties and vendors for prepaid health plans, competitive bidding programs, block grants,
124.22or other vendor payment mechanisms designed to provide services in an economical
124.23manner or to control utilization, with safeguards to ensure that necessary services are
124.24provided. Before implementing prepaid programs in counties with a county operated or
124.25affiliated public teaching hospital or a hospital or clinic operated by the University of
124.26Minnesota, the commissioner shall consider the risks the prepaid program creates for the
124.27hospital and allow the county or hospital the opportunity to participate in the program in a
124.28manner that reflects the risk of adverse selection and the nature of the patients served by
124.29the hospital, provided the terms of participation in the program are competitive with the
124.30terms of other participants considering the nature of the population served. Payment for
124.31services provided pursuant to this subdivision shall be as provided to medical assistance
124.32vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
124.33payments made during fiscal year 1990 and later years, the commissioner shall consult
124.34with an independent actuary in establishing prepayment rates, but shall retain final control
124.35over the rate methodology.
125.1    (d) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
125.2co-payments for services provided on or after October 1, 2003:
125.3    (1) $25 for eyeglasses;
125.4    (2) $25 for nonemergency visits to a hospital-based emergency room;
125.5    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
125.6subject to a $12 per month maximum for prescription drug co-payments. No co-payments
125.7shall apply to antipsychotic drugs when used for the treatment of mental illness; and
125.8    (4) 50 percent coinsurance on restorative dental services.
125.9    (e) Co-payments shall be limited to one per day per provider for nonpreventive visits,
125.10eyeglasses, and nonemergency visits to a hospital-based emergency room. Recipients of
125.11general assistance medical care are responsible for all co-payments in this subdivision.
125.12The general assistance medical care reimbursement to the provider shall be reduced by
125.13the amount of the co-payment, except that reimbursement for prescription drugs shall not
125.14be reduced once a recipient has reached the $12 per month maximum for prescription
125.15drug co-payments. The provider collects the co-payment from the recipient. Providers
125.16may not deny services to recipients who are unable to pay the co-payment, except as
125.17provided in paragraph (f).
125.18    (f) If it is the routine business practice of a provider to refuse service to an individual
125.19with uncollected debt, the provider may include uncollected co-payments under this
125.20section. A provider must give advance notice to a recipient with uncollected debt before
125.21services can be denied.
125.22    (g) Any county may, from its own resources, provide medical payments for which
125.23state payments are not made.
125.24    (h) Chemical dependency services that are reimbursed under chapter 254B must not
125.25be reimbursed under general assistance medical care.
125.26    (i) The maximum payment for new vendors enrolled in the general assistance
125.27medical care program after the base year shall be determined from the average usual and
125.28customary charge of the same vendor type enrolled in the base year.
125.29    (j) The conditions of payment for services under this subdivision are the same as the
125.30conditions specified in rules adopted under chapter 256B governing the medical assistance
125.31program, unless otherwise provided by statute or rule.
125.32    (k) Inpatient and outpatient payments shall be reduced by five percent, effective July
125.331, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003,
125.34and incorporated by reference in paragraph (i).
125.35    (l) Payments for all other health services except inpatient, outpatient, and pharmacy
125.36services shall be reduced by five percent, effective July 1, 2003.
126.1    (m) Payments to managed care plans shall be reduced by five percent for services
126.2provided on or after October 1, 2003.
126.3    (n) A hospital receiving a reduced payment as a result of this section may apply the
126.4unpaid balance toward satisfaction of the hospital's bad debts.
126.5    (o) Fee-for-service payments for nonpreventive visits shall be reduced by $3
126.6for services provided on or after January 1, 2006. For purposes of this subdivision, a
126.7visit means an episode of service which is required because of a recipient's symptoms,
126.8diagnosis, or established illness, and which is delivered in an ambulatory setting by
126.9a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
126.10audiologist, optician, or optometrist.
126.11    (p) Payments to managed care plans shall not be increased as a result of the removal
126.12of the $3 nonpreventive visit co-payment effective January 1, 2006.
126.13EFFECTIVE DATE.This section is effective July 1, 2007.

126.14    Sec. 38. Minnesota Statutes 2006, section 256D.44, subdivision 2, is amended to read:
126.15    Subd. 2. Standard of assistance for persons eligible for medical assistance
126.16waivers or at risk of placement in a group residential housing facility. The state
126.17standard of assistance for a person (1) who is eligible for a medical assistance home
126.18and community-based services waiver or a person, (2) who has been determined by the
126.19local agency to meet the plan requirements for placement in a group residential housing
126.20facility under section 256I.04, subdivision 1a, or (3) who is eligible for a shelter needy
126.21payment under subdivision 5, paragraph (f), is the standard established in subdivision 3,
126.22paragraph (a) or (b).

126.23    Sec. 39. Minnesota Statutes 2006, section 256D.44, subdivision 5, is amended to read:
126.24    Subd. 5. Special needs. In addition to the state standards of assistance established in
126.25subdivisions 1 to 4, payments are allowed for the following special needs of recipients of
126.26Minnesota supplemental aid who are not residents of a nursing home, a regional treatment
126.27center, or a group residential housing facility.
126.28    (a) The county agency shall pay a monthly allowance for medically prescribed
126.29diets if the cost of those additional dietary needs cannot be met through some other
126.30maintenance benefit. The need for special diets or dietary items must be prescribed by
126.31a licensed physician. Costs for special diets shall be determined as percentages of the
126.32allotment for a one-person household under the thrifty food plan as defined by the United
126.33States Department of Agriculture. The types of diets and the percentages of the thrifty
126.34food plan that are covered are as follows:
126.35    (1) high protein diet, at least 80 grams daily, 25 percent of thrifty food plan;
127.1    (2) controlled protein diet, 40 to 60 grams and requires special products, 100 percent
127.2of thrifty food plan;
127.3    (3) controlled protein diet, less than 40 grams and requires special products, 125
127.4percent of thrifty food plan;
127.5    (4) low cholesterol diet, 25 percent of thrifty food plan;
127.6    (5) high residue diet, 20 percent of thrifty food plan;
127.7    (6) pregnancy and lactation diet, 35 percent of thrifty food plan;
127.8    (7) gluten-free diet, 25 percent of thrifty food plan;
127.9    (8) lactose-free diet, 25 percent of thrifty food plan;
127.10    (9) antidumping diet, 15 percent of thrifty food plan;
127.11    (10) hypoglycemic diet, 15 percent of thrifty food plan; or
127.12    (11) ketogenic diet, 25 percent of thrifty food plan.
127.13    (b) Payment for nonrecurring special needs must be allowed for necessary home
127.14repairs or necessary repairs or replacement of household furniture and appliances using
127.15the payment standard of the AFDC program in effect on July 16, 1996, for these expenses,
127.16as long as other funding sources are not available.
127.17    (c) A fee for guardian or conservator service is allowed at a reasonable rate
127.18negotiated by the county or approved by the court. This rate shall not exceed five percent
127.19of the assistance unit's gross monthly income up to a maximum of $100 per month. If the
127.20guardian or conservator is a member of the county agency staff, no fee is allowed.
127.21    (d) The county agency shall continue to pay a monthly allowance of $68 for
127.22restaurant meals for a person who was receiving a restaurant meal allowance on June 1,
127.231990, and who eats two or more meals in a restaurant daily. The allowance must continue
127.24until the person has not received Minnesota supplemental aid for one full calendar month
127.25or until the person's living arrangement changes and the person no longer meets the criteria
127.26for the restaurant meal allowance, whichever occurs first.
127.27    (e) A fee of ten percent of the recipient's gross income or $25, whichever is less,
127.28is allowed for representative payee services provided by an agency that meets the
127.29requirements under SSI regulations to charge a fee for representative payee services. This
127.30special need is available to all recipients of Minnesota supplemental aid regardless of
127.31their living arrangement.
127.32    (f) Notwithstanding the language in this subdivision, an amount equal to the
127.33maximum allotment authorized by the federal Food Stamp Program for a single individual
127.34which is in effect on the first day of January July of the previous each year will be added to
127.35the standards of assistance established in subdivisions 1 to 4 for individuals adults under
127.36the age of 65 who qualify as shelter needy and are: (1) relocating from an institution, or
128.1an adult mental health residential treatment program under section 256B.0622, and who
128.2are shelter needy; (2) self-directed supports option participants defined under section
128.3256B.0657 if enacted in the 2007 legislative session; or (3) home and community-based
128.4waiver recipients living in their own rented, leased, or owned apartment or home not
128.5owned, operated, or controlled by a provider of service not related by blood or marriage.
128.6Notwithstanding subdivision 3, paragraph (c), an individual eligible for the shelter needy
128.7benefit under subdivision 5, paragraph (f), is considered a household of one. An eligible
128.8individual who receives this benefit prior to age 65 may continue to receive the benefit
128.9after the age of 65.
128.10    (g)(1) Persons eligible for shelter needy funding under paragraph (f), who are not
128.11receiving medial assistance home and community-based waiver services, are eligible for
128.12a state-funded transitional supports allowance under section 256B.49, subdivision 16,
128.13paragraph (e), to establish their own residence not owned, operated, or controlled by a
128.14provider of service not related by blood or marriage.
128.15    (2) "Shelter needy" means that the assistance unit incurs monthly shelter costs that
128.16exceed 40 percent of the assistance unit's gross income before the application of this
128.17special needs standard. "Gross income" for the purposes of this section is the applicant's or
128.18recipient's income as defined in section 256D.35, subdivision 10, or the standard specified
128.19in subdivision 3, paragraph (a) or (b), whichever is greater. A recipient of a federal or
128.20state housing subsidy, that limits shelter costs to a percentage of gross income, shall not be
128.21considered shelter needy for purposes of this paragraph.

128.22    Sec. 40. Minnesota Statutes 2006, section 256I.04, subdivision 3, is amended to read:
128.23    Subd. 3. Moratorium on the development of group residential housing beds. (a)
128.24County agencies shall not enter into agreements for new group residential housing beds
128.25with total rates in excess of the MSA equivalent rate except: (1) for group residential
128.26housing establishments licensed under Minnesota Rules, parts 9525.0215 to 9525.0355,
128.27provided the facility is needed to meet the census reduction targets for persons with
128.28developmental disabilities at regional treatment centers; (2) to ensure compliance with
128.29the federal Omnibus Budget Reconciliation Act alternative disposition plan requirements
128.30for inappropriately placed persons with developmental disabilities or mental illness;
128.31(3) up to 80 beds in a single, specialized facility located in Hennepin County that will
128.32provide housing for chronic inebriates who are repetitive users of detoxification centers
128.33and are refused placement in emergency shelters because of their state of intoxication,
128.34and planning for the specialized facility must have been initiated before July 1, 1991, in
128.35anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
128.36subdivision 20a
, paragraph (b); (4) notwithstanding the provisions of subdivision 2a, for
129.1up to 190 supportive housing units in Anoka, Dakota, Hennepin, or Ramsey County
129.2for homeless adults with a mental illness, a history of substance abuse, or human
129.3immunodeficiency virus or acquired immunodeficiency syndrome. For purposes of this
129.4section, "homeless adult" means a person who is living on the street or in a shelter or
129.5discharged from a regional treatment center, community hospital, or residential treatment
129.6program and has no appropriate housing available and lacks the resources and support
129.7necessary to access appropriate housing. At least 70 percent of the supportive housing
129.8units must serve homeless adults with mental illness, substance abuse problems, or human
129.9immunodeficiency virus or acquired immunodeficiency syndrome who are about to be
129.10or, within the previous six months, has been discharged from a regional treatment center,
129.11or a state-contracted psychiatric bed in a community hospital, or a residential mental
129.12health or chemical dependency treatment program. If a person meets the requirements of
129.13subdivision 1, paragraph (a), and receives a federal or state housing subsidy, the group
129.14residential housing rate for that person is limited to the supplementary rate under section
129.15256I.05, subdivision 1a , and is determined by subtracting the amount of the person's
129.16countable income that exceeds the MSA equivalent rate from the group residential housing
129.17supplementary rate. A resident in a demonstration project site who no longer participates
129.18in the demonstration program shall retain eligibility for a group residential housing
129.19payment in an amount determined under section 256I.06, subdivision 8, using the MSA
129.20equivalent rate. Service funding under section 256I.05, subdivision 1a, will end June 30,
129.211997, if federal matching funds are available and the services can be provided through a
129.22managed care entity. If federal matching funds are not available, then service funding will
129.23continue under section 256I.05, subdivision 1a; or (6) (5) for group residential housing
129.24beds in settings meeting the requirements of subdivision 2a, clauses (1) and (3), which
129.25are used exclusively for recipients receiving home and community-based waiver services
129.26under sections 256B.0915, 256B.092, subdivision 5, 256B.093, and 256B.49, and who
129.27resided in a nursing facility for the six months immediately prior to the month of entry
129.28into the group residential housing setting. The group residential housing rate for these
129.29beds must be set so that the monthly group residential housing payment for an individual
129.30occupying the bed when combined with the nonfederal share of services delivered under
129.31the waiver for that person does not exceed the nonfederal share of the monthly medical
129.32assistance payment made for the person to the nursing facility in which the person resided
129.33prior to entry into the group residential housing establishment. The rate may not exceed
129.34the MSA equivalent rate plus $426.37 for any case.; or (6) for an additional two beds,
129.35resulting in a total of 32 beds, for a facility located in Hennepin County providing services
129.36for recovering and chemically dependent men that has had a group residential housing
130.1contract with the county and has been licensed as a board and lodge facility with special
130.2services since 1980; (7) for a group residential housing provider located in Stearns County
130.3that operates a 40-bed facility, that received financing through the Minnesota Housing
130.4Finance Agency Ending Long-Term Homelessness Initiative and serves chemically
130.5dependent clientele, providing 24-hour-a-day supervision; (8) for a group residential
130.6housing provider located in Crow Wing County that serves a chemically dependent
130.7clientele, providing 24-hour-a-day supervision and limiting a resident's maximum length
130.8of stay to 13 months out of a consecutive 24-month period; (9) for a 60-bed facility in
130.9St. Louis County which opened in January 2006 that will serve chemically dependent
130.10persons operated by a group residential housing provider that currently operates a 304-bed
130.11facility in Minneapolis; and (10) for a group residential housing provider that operates two
130.12ten-bed facilities, one located in Hennepin County and one located in Ramsey County,
130.13which provide community support and serve the mental health needs of individuals who
130.14have chronically lived unsheltered, providing 24-hour-a-day supervision.
130.15    (b) A county agency may enter into a group residential housing agreement for beds
130.16with rates in excess of the MSA equivalent rate in addition to those currently covered
130.17under a group residential housing agreement if the additional beds are only a replacement
130.18of beds with rates in excess of the MSA equivalent rate which have been made available
130.19due to closure of a setting, a change of licensure or certification which removes the beds
130.20from group residential housing payment, or as a result of the downsizing of a group
130.21residential housing setting. The transfer of available beds from one county to another can
130.22only occur by the agreement of both counties.

130.23    Sec. 41. Minnesota Statutes 2006, section 256I.05, is amended by adding a subdivision
130.24to read:
130.25    Subd. 1h. Supplementary rate for certain facilities serving chemically
130.26dependent males. Notwithstanding subdivisions 1a and 1c, beginning July 1, 2007, a
130.27county agency shall negotiate a supplementary rate in addition to the rate specified in
130.28subdivision 1, not to exceed $737.87 per month, including any legislatively authorized
130.29inflationary adjustments, for a group residential housing provider that:
130.30    (1) is located in Ramsey County and has had a group residential housing contract
130.31with the county since 1982 and has been licensed as a board and lodge facility with special
130.32services since 1979; and
130.33    (2) serves recovering and chemically dependent males, providing 24-hour-a-day
130.34supervision.

130.35    Sec. 42. Minnesota Statutes 2006, section 256I.05, is amended by adding a subdivision
130.36to read:
131.1    Subd. 1i. Supplementary rate for certain facilities; Hennepin County.
131.2    Notwithstanding the provisions of subdivisions 1a and 1c, a county agency shall negotiate
131.3a supplementary rate in addition to the rate specified in subdivision 1, not to exceed $700
131.4per month, including any legislatively authorized inflationary adjustments, for a facility
131.5located in Hennepin County with a capacity of up to 48 beds that has been licensed since
131.61978 as a board and lodging facility and that until August 1, 2007, operated as a licensed
131.7chemical dependency treatment program.
131.8EFFECTIVE DATE.This section is effective the day following final enactment.

131.9    Sec. 43. Minnesota Statutes 2006, section 256I.05, is amended by adding a subdivision
131.10to read:
131.11    Subd. 1j. Supplementary rate for certain facilities; St. Louis County. (a)
131.12Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 2007, a
131.13county agency shall negotiate a supplementary rate in addition to the rate specified in
131.14subdivision 1, not to exceed $700 per month, including any legislatively authorized
131.15inflationary adjustments, for a 60-bed facility in St. Louis County which opened in
131.16January 2006 that will serve chemically dependent persons operated by a group residential
131.17housing provider that currently operates a 304-bed facility in Minneapolis.
131.18    (b) The supplementary rate in paragraph (a) applies to the 48 beds which do not
131.19already receive a supplementary rate.

131.20    Sec. 44. Minnesota Statutes 2006, section 256I.05, is amended by adding a subdivision
131.21to read:
131.22    Subd. 1k. Supplementary rate for certain facilities; Crow Wing County.
131.23    Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 2007, a
131.24county agency shall negotiate a supplementary rate in addition to the rate specified in
131.25subdivision 1, not to exceed $700 per month, including any legislatively authorized
131.26inflationary adjustments, for a new 65-bed facility in Crow Wing County that will serve
131.27chemically dependent persons operated by a group residential housing provider that
131.28currently operates a 304-bed facility in Minneapolis and a 44-bed facility in Duluth which
131.29opened in January of 2006.

131.30    Sec. 45. Minnesota Statutes 2006, section 256I.05, is amended by adding a subdivision
131.31to read:
131.32    Subd. 1l. Supplementary rate for certain facilities; Stearns County.
131.33    Notwithstanding the provisions of this section, beginning July 1, 2007, a county agency
131.34shall negotiate a supplementary service rate in addition to the rate specified in subdivision
131.351, not to exceed $700 per month, including any legislatively authorized inflationary
132.1adjustments, for a group residential housing provider located in Stearns County that
132.2operates a 40-bed facility, that received financing through the Minnesota Housing Finance
132.3Agency Ending Long-Term Homelessness Initiative and serves chemically dependent
132.4clientele, providing 24-hour-a-day supervision.

132.5    Sec. 46. Minnesota Statutes 2006, section 256I.05, is amended by adding a subdivision
132.6to read:
132.7    Subd. 1m. Supplementary rate for certain facilities; St. Louis County.
132.8    Notwithstanding the provisions of this section, beginning July 1, 2007, a county agency
132.9shall negotiate a supplementary service rate in addition to the rate specified in subdivision
132.101, not to exceed $700 per month, including any legislatively authorized inflationary
132.11adjustments, for a group residential housing provider located in St. Louis County that
132.12operates a 30-bed facility, that received financing through the Minnesota Housing Finance
132.13Agency Ending Long-Term Homelessness Initiative and serves chemically dependent
132.14clientele, providing 24-hour-a-day supervision.

132.15    Sec. 47. Minnesota Statutes 2006, section 256I.05, is amended by adding a subdivision
132.16to read:
132.17    Subd. 1n. Supplemental rate for certain facilities; Hennepin and Ramsey
132.18Counties. Notwithstanding the provisions of this section, beginning July 1, 2007, a county
132.19agency shall negotiate a supplemental service rate in addition to the rate specified in
132.20subdivision 1, not to exceed $715.78 per month, including any legislatively authorized
132.21inflationary adjustments, for a group residential housing provider that operates two
132.22ten-bed facilities, one located in Hennepin County and one located in Ramsey County,
132.23which provide community support and serve the mental health needs of individuals who
132.24have chronically lived unsheltered, providing 24-hour-a-day supervision.

132.25    Sec. 48. Laws 2006, chapter 282, article 20, section 37, is amended to read:
132.26    Sec. 37. REPAYMENT DELAY.
132.27    A Fillmore County that overspent its allowed amounts in calendar year 2004 or 2005
132.28under the waivered services program for persons with developmental disabilities shall
132.29not be required to pay back the amount of overspending until May 31, 2007 in calendar
132.30year 2004 or 2005 under the waivered services program for persons with developmental
132.31disabilities.
132.32EFFECTIVE DATE.This section is effective the day following final enactment.

132.33    Sec. 49. LICENSURE; SERVICES FOR YOUTH WITH DISABILITIES.
132.34    (a) Notwithstanding the requirements of Minnesota Statutes, chapter 245A, upon the
132.35recommendation of a county agency, the commissioner of human services shall grant a
133.1license with any necessary variances to a nonresidential program for youth which provides
133.2services to youth with disabilities under age 21 during nonschool hours established
133.3to ensure health and safety, prevent out-of-home placement, and increase community
133.4inclusion of youth with disabilities. The nonresidential youth program is subject to the
133.5conditions of any variances granted and with consumer rights under Minnesota Statutes,
133.6section 245B.04, consumer protection standards under Minnesota Statutes, section
133.7245B.05, service standards under Minnesota Statutes, section 245B.06, management
133.8standards under Minnesota Statutes, section 245B.07, and fire marshal inspections under
133.9Minnesota Statutes, section 245A.151, until the commissioner develops other licensure
133.10requirements for this type of program.
133.11    (b) By February 1, 2008, the commissioner shall recommend amendments to
133.12licensure requirements in Minnesota Statutes, chapter 245A, to allow licensure of
133.13appropriate services for school-age youth with disabilities under age 21 who need
133.14supervision and services to develop skills necessary to maintain personal safety and
133.15increase their independence, productivity, and participation in their communities during
133.16nonschool hours. As part of developing the recommendations, the commissioner shall
133.17survey county agencies to determine how the needs of youth with disabilities under age 21
133.18who require supervision and support services are being met and the funding sources used.
133.19The recommendations must be provided to the house and senate chairs of the committees
133.20with jurisdiction over licensing of programs for youth with disabilities.

133.21    Sec. 50. INDEPENDENT LIVING.
133.22    An individual who has lived in one of the facilities under Minnesota Statutes,
133.23section 256I.05, subdivision 1h, who is being transitioned to independent living as
133.24part of the program plan continues to be eligible for group residential housing and the
133.25supplemental service rate negotiated with the county under Minnesota Statutes, section
133.26256I.05, subdivision 1h.

133.27    Sec. 51. ASSISTIVE TECHNOLOGY STUDY AND REPORT.
133.28    Subdivision 1. Study. (a) During the biennium ending June 30, 2009, the Council
133.29on Disability shall facilitate a statewide study of the assistive technology needs of
133.30people with disabling conditions, and seniors. As part of the study, the council shall
133.31identify community-based service providers, state agencies, and other entities involved in
133.32providing assistive technology supports. The study shall also examine the creation of an
133.33assistive technology pretax savings account to allow disabled persons to set aside pretax
133.34and unearned income to purchase assistive technology devices, equipment, and services.
133.35    (b) The council shall provide oversight and direction to the Minnesota Regions
133.36Assistive Technology Collaborative during the biennium ending June 30, 2009.
134.1    Subd. 2. Report. The council shall present to the chairs of the house and senate
134.2committees having jurisdiction over human services, by January 1, 2009, a report of the
134.3findings of the study, including proposed legislation creating a statewide comprehensive
134.4plan to meet the assistive technology needs of people with disabling conditions and
134.5seniors. The statewide plan must include steps to coordinate and streamline assistive
134.6technology services and the creation of an assistive technology pretax savings account.

134.7    Sec. 52. HOUSING WITH SERVICES AND HOME CARE PROVIDERS
134.8STUDY; REPORT.
134.9    The commissioner of human services shall conduct a study of housing with
134.10services establishments and their arranged home care providers to assess the impact that
134.11residents' spending down to eligibility for public programs has on public expenditures.
134.12The preliminary results of this study shall be reported to the house and senate committees
134.13with jurisdiction over health and human services policy and finance issues by February
134.1415, 2008, with a final report completed by December 15, 2008. Housing with services
134.15establishments and home care providers shall provide information upon request of the
134.16commissioner in order to achieve study outcomes, including:
134.17    (1) length of stay of residents in the housing with services establishment;
134.18    (2) housing and services provided and related charges, payments, and payment
134.19sources;
134.20    (3) housing and services included in base rates charged to all residents;
134.21    (4) reasons for termination of services;
134.22    (5) reasons for termination of leases;
134.23    (6) copies of contracts, agreements, and leases;
134.24    (7) resident demographics; and
134.25    (8) other information as requested by the commissioner.
134.26EFFECTIVE DATE.This section is effective the day following final enactment.

134.27    Sec. 53. COMMUNITY SERVICES PROVIDER RATE INCREASES.
134.28    (a) The commissioner of human services shall increase reimbursement rates or rate
134.29limits, as applicable, by three percent for the rate period beginning October 1, 2007, and
134.30the rate period beginning October 1, 2008, effective for services rendered on or after
134.31those dates.
134.32    (b) The three percent annual rate increase described in this section must be provided
134.33to:
134.34    (1) home and community-based waivered services for persons with developmental
134.35disabilities or related conditions under Minnesota Statutes, section 256B.501;
135.1    (2) home and community-based waivered services for the elderly under Minnesota
135.2Statutes, section 256B.0915;
135.3    (3) waivered services under community alternatives for disabled individuals under
135.4Minnesota Statutes, section 256B.49;
135.5    (4) community alternative care waivered services under Minnesota Statutes, section
135.6256B.49;
135.7    (5) traumatic brain injury waivered services under Minnesota Statutes, section
135.8256B.49;
135.9    (6) nursing services and home health services under Minnesota Statutes, section
135.10256B.0625, subdivision 6a;
135.11    (7) personal care services and nursing supervision of personal care services under
135.12Minnesota Statutes, section 256B.0625, subdivision 19a;
135.13    (8) private duty nursing services under Minnesota Statutes, section 256B.0625,
135.14subdivision 7;
135.15    (9) day training and habilitation services for adults with developmental disabilities
135.16or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
135.17additional cost of rate adjustments on day training and habilitation service, provided as a
135.18social service under Minnesota Statutes, section 256M.60;
135.19    (10) alternative care services under Minnesota Statutes, section 256B.0913;
135.20    (11) adult residential program grants under Minnesota Statutes, section 245.73;
135.21    (12) adult and children's mental health grants under Minnesota Rules, parts
135.229535.1700 to 9535.1760;
135.23    (13) the group residential housing supplementary service rate under Minnesota
135.24Statutes, section 256I.05, subdivision 1a;
135.25    (14) adult mental health integrated fund grants under Minnesota Statutes, section
135.26245.4661;
135.27    (15) semi-independent living services (SILS) under Minnesota Statutes, section
135.28252.275, including SILS funding under county social services grants formerly funded
135.29under Minnesota Statutes, chapter 256I;
135.30    (16) community support services for deaf and hard-of-hearing adults with mental
135.31illness who use or wish to use sign language as their primary means of communication
135.32under Minnesota Statutes, section 256.01, subdivision 2;
135.33    (17) living skills training programs for persons with intractable epilepsy who need
135.34assistance in the transition to independent living under Laws 1988, chapter 689;
135.35    (18) physical therapy services under Minnesota Statutes, sections 256B.0625,
135.36subdivision 8, and 256D.03, subdivision 4;
136.1    (19) occupational therapy services under Minnesota Statutes, sections 256B.0625,
136.2subdivision 8a, and 256D.03, subdivision 4;
136.3    (20) speech-language therapy services under Minnesota Statutes, section 256D.03,
136.4subdivision 4, and Minnesota Rules, part 9505.0390;
136.5    (21) respiratory therapy services under Minnesota Statutes, section 256D.03,
136.6subdivision 4, and Minnesota Rules, part 9505.0295;
136.7    (22) aging grants under Minnesota Statutes, sections 256.975 to 256.977, 256B.0917,
136.8and 256B.0928;
136.9    (23) deaf and hard-of-hearing grants under Minnesota Statutes, sections 256C.233;
136.10256C.25; Laws 1985, chapter 9, article 1; and Laws 1997, First Special Session chapter
136.115, section 20;
136.12    (24) children's therapeutic services and supports under Minnesota Statutes, section
136.13256B.0943;
136.14    (25) tier I chemical health services under Minnesota Statutes, chapter 254B;
136.15    (26) consumer support grants under Minnesota Statutes, section 256.476;
136.16    (27) family support grants under Minnesota Statutes, section 252.32;
136.17    (28) case management services to persons with HIV or AIDS under Minnesota
136.18Statutes, section 256.01, subdivision 19; and
136.19    (29) adult rehabilitative mental health services under Minnesota Statutes, section
136.20256B.0623.
136.21    (c) Providers that receive a rate increase under this section shall use 75 percent of
136.22the additional revenue to increase wages and benefits and pay associated costs for all
136.23employees, except for management fees, the administrator, and central office staff.
136.24    (d) For public employees, the increase for wages and benefits for certain staff is
136.25available and pay rates must be increased only to the extent that they comply with laws
136.26governing public employees' collective bargaining. Money received by a provider for pay
136.27increases under this section may be used only for increases implemented on or after the
136.28first day of the rate period in which the increase is available and must not be used for
136.29increases implemented prior to that date.
136.30    (e) A copy of the provider's plan for complying with paragraph (c) must be made
136.31available to all employees by giving each employee a copy or by posting a copy in an area
136.32of the provider's operation to which all employees have access. If an employee does not
136.33receive the adjustment, if any, described in the plan and is unable to resolve the problem
136.34with the provider, the employee may contact the employee's union representative. If the
136.35employee is not covered by a collective bargaining agreement, the employee may contact
137.1the commissioner at a telephone number provided by the commissioner and included in
137.2the provider's plan.
137.3    (f) The commissioner and each county agency shall take steps necessary to
137.4implement the increases required by this section on the dates specified, and the increases
137.5must be effective on the dates specified, regardless of the client's service authorization date
137.6and notwithstanding the terms of any provider contract, service agreement, or schedule
137.7that limits when a county may increase payment rates.

137.8    Sec. 54. REPEALER.
137.9(a) Minnesota Statutes 2006, section 256.9743, is repealed.
137.10(b) Minnesota Rules, part 9505.0335, is repealed.

137.11ARTICLE 5
137.12MENTAL HEALTH

137.13    Section 1. Minnesota Statutes 2006, section 245.462, subdivision 20, is amended to
137.14read:
137.15    Subd. 20. Mental illness. (a) "Mental illness" means an organic disorder of the
137.16brain or a clinically significant disorder of thought, mood, perception, orientation,
137.17memory, or behavior that is listed in the clinical manual of the International Classification
137.18of Diseases (ICD-9-CM), current edition, code range 290.0 to 302.99 or 306.0 to 316.0
137.19or the corresponding code in the American Psychiatric Association's Diagnostic and
137.20Statistical Manual of Mental Disorders (DSM-MD), current edition, Axes I, II, or III, and
137.21that seriously limits a person's capacity to function in primary aspects of daily living such
137.22as personal relations, living arrangements, work, and recreation.
137.23    (b) An "adult with acute mental illness" means an adult who has a mental illness that
137.24is serious enough to require prompt intervention.
137.25    (c) For purposes of case management and community support services, a "person
137.26with serious and persistent mental illness" means an adult who has a mental illness and
137.27meets at least one of the following criteria:
137.28    (1) the adult has undergone two or more episodes of inpatient care for a mental
137.29illness within the preceding 24 months;
137.30    (2) the adult has experienced a continuous psychiatric hospitalization or residential
137.31treatment exceeding six months' duration within the preceding 12 months;
137.32    (3) the adult has been treated by a crisis team two or more times within the preceding
137.3324 months;
137.34    (4) the adult:
137.35    (i) has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline
137.36personality disorder;
138.1    (ii) indicates a significant impairment in functioning; and
138.2    (iii) has a written opinion from a mental health professional, in the last three years,
138.3stating that the adult is reasonably likely to have future episodes requiring inpatient or
138.4residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
138.5management or community support services are provided;
138.6    (4) (5) the adult has, in the last three years, been committed by a court as a person
138.7who is mentally ill under chapter 253B, or the adult's commitment has been stayed or
138.8continued; or
138.9    (5) (6) the adult (i) was eligible under clauses (1) to (4) (5), but the specified time
138.10period has expired or the adult was eligible as a child under section 245.4871, subdivision
138.116
; and (ii) has a written opinion from a mental health professional, in the last three years,
138.12stating that the adult is reasonably likely to have future episodes requiring inpatient or
138.13residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
138.14management or community support services are provided.

138.15    Sec. 2. Minnesota Statutes 2006, section 245.98, subdivision 2, is amended to read:
138.16    Subd. 2. Program. The commissioner of human services shall establish a program
138.17for the treatment of compulsive gamblers. The commissioner may contract with an
138.18entity with expertise regarding the treatment of compulsive gambling to operate the
138.19program. The program may include the establishment of a statewide toll-free number,
138.20resource library, public education programs; regional in-service training programs and
138.21conferences for health care professionals, educators, treatment providers, employee
138.22assistance programs, and criminal justice representatives; and the establishment of
138.23certification standards for programs and service providers. The commissioner may enter
138.24into agreements with other entities and may employ or contract with consultants to
138.25facilitate the provision of these services or the training of individuals to qualify them to
138.26provide these services. The program may also include inpatient and outpatient treatment
138.27and rehabilitation services and for residents in a temporary or permanent residential
138.28setting for mental health or chemical dependency, and individuals in jails or correctional
138.29facilities. The program may also include research studies. The research studies must
138.30include baseline and prevalence studies for adolescents and adults to identify those at the
138.31highest risk. The program must be approved by the commissioner before it is established.

138.32    Sec. 3. Minnesota Statutes 2006, section 245.98, subdivision 5, is amended to read:
138.33    Subd. 5. Standards. The commissioner shall create standards for treatment and
138.34provider qualifications for the treatment component of the compulsive gambling program.
138.35The commissioner, in coordination with the commissioner of corrections, shall create
139.1standards for the assessment and treatment of compulsive gamblers in programs operated
139.2by the commissioner of corrections.

139.3    Sec. 4. [245A.175] MENTAL HEALTH TRAINING REQUIREMENT.
139.4    Prior to placement of a child in a foster care home, the child foster care provider, if
139.5required to be licensed, must complete two hours of training that addresses the causes,
139.6symptoms, and key warning signs of mental health disorders; cultural considerations; and
139.7effective approaches for dealing with a child's behaviors. At least one hour of the annual
139.812-hour training requirement for foster parents must be on children's mental health issues
139.9and treatment. Training curriculum shall be approved by the commissioner of human
139.10services.

139.11    Sec. 5. Minnesota Statutes 2006, section 256B.0623, subdivision 8, is amended to read:
139.12    Subd. 8. Diagnostic assessment. Providers of adult rehabilitative mental
139.13health services must complete a diagnostic assessment as defined in section 245.462,
139.14subdivision 9
, within five days after the recipient's second visit or within 30 days after
139.15intake, whichever occurs first. A diagnostic assessment must be reimbursed at the
139.16same rate as an assessment under section 256B.0655, subdivision 8. In cases where a
139.17diagnostic assessment is available that reflects the recipient's current status, and has been
139.18completed within 180 days preceding admission, an update must be completed. An
139.19update shall include a written summary by a mental health professional of the recipient's
139.20current mental health status and service needs. If the recipient's mental health status
139.21has changed significantly since the adult's most recent diagnostic assessment, a new
139.22diagnostic assessment is required. For initial implementation of adult rehabilitative mental
139.23health services, until June 30, 2005, a diagnostic assessment that reflects the recipient's
139.24current status and has been completed within the past three years preceding admission
139.25is acceptable.

139.26    Sec. 6. Minnesota Statutes 2006, section 256B.69, subdivision 5g, is amended to read:
139.27    Subd. 5g. Payment for covered services. For services rendered on or after January
139.281, 2003, the total payment made to managed care plans for providing covered services
139.29under the medical assistance and general assistance medical care programs is reduced by
139.30.5 percent from their current statutory rates. This provision excludes payments for nursing
139.31home services, home and community-based waivers, and payments to demonstration
139.32projects for persons with disabilities, and mental health services added as covered benefits
139.33after December 31, 2007.

139.34    Sec. 7. Minnesota Statutes 2006, section 256B.69, subdivision 5h, is amended to read:
140.1    Subd. 5h. Payment reduction. In addition to the reduction in subdivision 5g,
140.2the total payment made to managed care plans under the medical assistance program is
140.3reduced 1.0 percent for services provided on or after October 1, 2003, and an additional
140.41.0 percent for services provided on or after January 1, 2004. This provision excludes
140.5payments for nursing home services, home and community-based waivers, and payments
140.6to demonstration projects for persons with disabilities, and mental health services added as
140.7covered benefits after December 1, 2007.

140.8    Sec. 8. Minnesota Statutes 2006, section 256L.03, subdivision 1, is amended to read:
140.9    Subdivision 1. Covered health services. For individuals under section 256L.04,
140.10subdivision 7
, with income no greater than 75 percent of the federal poverty guidelines
140.11or for families with children under section 256L.04, subdivision 1, all subdivisions of
140.12this section apply. "Covered health services" means the health services reimbursed
140.13under chapter 256B, with the exception of inpatient hospital services, special education
140.14services, private duty nursing services, adult dental care services other than services
140.15covered under section 256B.0625, subdivision 9, orthodontic services, nonemergency
140.16medical transportation services, personal care assistant and case management services,
140.17nursing home or intermediate care facilities services, inpatient mental health services,
140.18and chemical dependency services. Outpatient mental health services covered under the
140.19MinnesotaCare program are limited to diagnostic assessments, psychological testing,
140.20explanation of findings, mental health telemedicine, psychiatric consultation, medication
140.21management by a physician, day treatment, partial hospitalization, and individual, family,
140.22and group psychotherapy.
140.23    No public funds shall be used for coverage of abortion under MinnesotaCare
140.24except where the life of the female would be endangered or substantial and irreversible
140.25impairment of a major bodily function would result if the fetus were carried to term; or
140.26where the pregnancy is the result of rape or incest.
140.27    Covered health services shall be expanded as provided in this section.
140.28EFFECTIVE DATE.This section is effective January 1, 2008, except coverage for
140.29mental health case management under subdivision 1 is effective January 1, 2009.

140.30    Sec. 9. Minnesota Statutes 2006, section 256L.03, subdivision 5, is amended to read:
140.31    Subd. 5. Co-payments and coinsurance. (a) Except as provided in paragraphs (b)
140.32and (c), the MinnesotaCare benefit plan shall include the following co-payments and
140.33coinsurance requirements for all enrollees:
141.1    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
141.2subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
141.3$3,000 per family;
141.4    (2) $3 per prescription for adult enrollees;
141.5    (3) $25 for eyeglasses for adult enrollees;
141.6    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
141.7episode of service which is required because of a recipient's symptoms, diagnosis, or
141.8established illness, and which is delivered in an ambulatory setting by a physician or
141.9physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
141.10audiologist, optician, or optometrist; and
141.11    (5) $6 for nonemergency visits to a hospital-based emergency room.
141.12    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
141.13children under the age of 21 in households with family income equal to or less than 175
141.14percent of the federal poverty guidelines. Paragraph (a), clause (1), does not apply to
141.15parents and relative caretakers of children under the age of 21 in households with family
141.16income greater than 175 percent of the federal poverty guidelines for inpatient hospital
141.17admissions occurring on or after January 1, 2001.
141.18    (c) Paragraph (a), clauses (1) to (4), do not apply to pregnant women and children
141.19under the age of 21.
141.20    (d) Paragraph (a), clause (4), does not apply to mental health services.
141.21    (e) Adult enrollees with family gross income that exceeds 175 percent of the
141.22federal poverty guidelines and who are not pregnant shall be financially responsible for
141.23the coinsurance amount, if applicable, and amounts which exceed the $10,000 inpatient
141.24hospital benefit limit.
141.25    (e) (f) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
141.26or changes from one prepaid health plan to another during a calendar year, any charges
141.27submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
141.28expenses incurred by the enrollee for inpatient services, that were submitted or incurred
141.29prior to enrollment, or prior to the change in health plans, shall be disregarded.

141.30    Sec. 10. Minnesota Statutes 2006, section 256L.035, is amended to read:
141.31256L.035 LIMITED BENEFITS COVERAGE FOR CERTAIN SINGLE
141.32ADULTS AND HOUSEHOLDS WITHOUT CHILDREN.
141.33    (a) "Covered health services" for individuals under section 256L.04, subdivision
141.347
, with income above 75 percent, but not exceeding 175 percent, of the federal poverty
141.35guideline means:
142.1    (1) inpatient hospitalization benefits with a ten percent co-payment up to $1,000 and
142.2subject to an annual limitation of $10,000;
142.3    (2) physician services provided during an inpatient stay; and
142.4    (3) physician services not provided during an inpatient stay; outpatient hospital
142.5services; freestanding ambulatory surgical center services; chiropractic services; lab and
142.6diagnostic services; diabetic supplies and equipment; mental health services as covered
142.7under chapter 256B; and prescription drugs; subject to the following co-payments:
142.8    (i) $50 co-pay per emergency room visit;
142.9    (ii) $3 co-pay per prescription drug; and
142.10    (iii) $5 co-pay per nonpreventive visit; except this co-pay does not apply to mental
142.11health services or community mental health services.
142.12The services covered under this section may be provided by a physician, physician
142.13ancillary, chiropractor, psychologist, or licensed independent clinical social worker, or
142.14other mental health providers covered under chapter 256B if the services are within the
142.15scope of practice of that health care professional.
142.16    For purposes of this section, "a visit" means an episode of service which is required
142.17because of a recipient's symptoms, diagnosis, or established illness, and which is delivered
142.18in an ambulatory setting by any health care provider identified in this paragraph.
142.19    Enrollees are responsible for all co-payments in this section.
142.20    (b) Reimbursement to the providers shall be reduced by the amount of the
142.21co-payment, except that reimbursement for prescription drugs shall not be reduced once a
142.22recipient has reached the $20 per month maximum for prescription drug co-payments.
142.23The provider collects the co-payment from the recipient. Providers may not deny services
142.24to recipients who are unable to pay the co-payment, except as provided in paragraph (c).
142.25    (c) If it is the routine business practice of a provider to refuse service to an individual
142.26with uncollected debt, the provider may include uncollected co-payments under this
142.27section. A provider must give advance notice to a recipient with uncollected debt before
142.28services can be denied.

142.29    Sec. 11. Minnesota Statutes 2006, section 256L.12, subdivision 9a, is amended to read:
142.30    Subd. 9a. Rate setting; ratable reduction. For services rendered on or after
142.31October 1, 2003, the total payment made to managed care plans under the MinnesotaCare
142.32program is reduced 1.0 percent. This provision excludes payments for mental health
142.33services added as covered benefits after December 31, 2007.

142.34    Sec. 12. Minnesota Statutes 2006, section 609.115, subdivision 9, is amended to read:
142.35    Subd. 9. Compulsive gambling assessment required. (a) If a person is convicted
142.36of theft under section 609.52, embezzlement of public funds under section 609.54, or
143.1forgery under section 609.625, 609.63, or 609.631, the probation officer shall determine in
143.2the report prepared under subdivision 1 whether or not compulsive gambling contributed
143.3to the commission of the offense. If so, the report shall contain the results of a compulsive
143.4gambling assessment conducted in accordance with this subdivision. The probation officer
143.5shall make an appointment for the offender to undergo the assessment if so indicated.
143.6    (b) The compulsive gambling assessment report must include a recommended level
143.7of treatment for the offender if the assessor concludes that the offender is in need of
143.8compulsive gambling treatment. The assessment must be conducted by an assessor
143.9qualified under section 245.98, subdivision 2a, to perform these assessments or to
143.10provide compulsive gambling treatment. An assessor providing a compulsive gambling
143.11assessment may not have any direct or shared financial interest or referral relationship
143.12resulting in shared financial gain with a treatment provider. If an independent assessor is
143.13not available, the probation officer may use the services of an assessor with a financial
143.14interest or referral relationship as authorized under rules adopted by the commissioner
143.15of human services under section 245.98, subdivision 2a.
143.16    (c) The commissioner of human services shall reimburse the assessor for the
143.17costs associated with a compulsive gambling assessment at a rate established by the
143.18commissioner up to a maximum of $100 for each assessment. To the extent practicable, the
143.19commissioner shall standardize reimbursement rates for assessments. The commissioner
143.20shall reimburse these costs after receiving written verification from the probation officer
143.21that the assessment was performed and found acceptable.

143.22    Sec. 13. TRAUMA-FOCUSED EVIDENCE-BASED PRACTICES TO
143.23CHILDREN.
143.24    Organizations that are certified to provide children's therapeutic services and
143.25supports under Minnesota Statutes, section 256B.0943, are eligible to apply for a grant.
143.26Grants are to be used to provide trauma-focused evidence-based practices to children
143.27who are living in a battered women's shelter, homeless shelter, transitional housing, or
143.28supported housing. Children served must have been exposed to or witnessed domestic
143.29violence, have been exposed to or witnessed community violence, or be a refugee. Priority
143.30shall be given to organizations that demonstrate collaboration with battered women's
143.31shelters, homeless shelters, or providers of transitional housing or supported housing. The
143.32commissioner shall specify which constitutes evidence-based practice. Organizations shall
143.33use all available funding streams.

143.34    Sec. 14. DUAL DIAGNOSIS; DEMONSTRATION PROJECT.
144.1    (a) The commissioner of human services shall fund demonstration projects for high
144.2risk adults with serious mental illness and co-occurring substance abuse problems. The
144.3projects must include, but not be limited to, the following:
144.4    (1) housing services, including rent or housing subsidies, housing with clinical
144.5staff, or housing support;
144.6    (2) assertive outreach services; and
144.7    (3) intensive direct therapeutic, rehabilitative, and care management services
144.8oriented to harm reduction.
144.9    (b) The commissioner shall work with providers to ensure proper licensure or
144.10certification to meet medical assistance or third-party payor reimbursement requirements.

144.11    Sec. 15. MINNESOTA FAMILY INVESTMENT PROGRAM AND CHILDREN'S
144.12MENTAL HEALTH PILOT PROJECT.
144.13    Subdivision 1. Pilot project authorized. The commissioner of human services
144.14shall fund a two-year pilot project to measure the impact of children's identified mental
144.15health needs, including social and emotional needs, on Minnesota family investment
144.16program (MFIP) participants' ability to obtain and retain employment. The project shall
144.17also measure the impact on work activity of MFIP participants' needs to address their
144.18children's identified mental health needs.
144.19    Subd. 2. Provider and agency proposals. (a) Interested MFIP providers and
144.20agencies shall:
144.21    (1) submit proposals defining how they will identify participants whose children
144.22have mental health needs that hinder the employment process;
144.23    (2) connect families with appropriate developmental, social, and emotional
144.24screenings and services; and
144.25    (3) incorporate those services into the participant's employment plan.
144.26Each proposal under this paragraph must include an evaluation component.
144.27    (b) Interested MFIP providers and agencies shall develop a protocol to inform MFIP
144.28participants of the following:
144.29    (1) the availability of developmental, social, and emotional screening tools for
144.30children and youth;
144.31    (2) the purpose of the screenings;
144.32    (3) how the information will be used to assist the participants in identifying and
144.33addressing potential barriers to employment; and
144.34    (4) that their employment plan may be modified based on the screening results.
145.1    Subd. 3. Program components. (a) MFIP providers shall obtain the participant's
145.2written consent for participation in the pilot project, including consent for developmental,
145.3social, and emotional screening.
145.4    (b) MFIP providers shall coordinate with county social service agencies and health
145.5plans to assist recipients in arranging referrals indicated by the screening results.
145.6    (c) Tools used for developmental, social, and emotional screenings shall be approved
145.7by the commissioner of human services.
145.8    Subd. 4. Program evaluation. The commissioner of human services shall conduct
145.9an evaluation of the pilot project to determine:
145.10    (1) the number of participants who took part in the screening;
145.11    (2) the number of children who were screened and what screening tools were used;
145.12    (3) the number of children who were identified in the screening who needed referral
145.13or follow-up services;
145.14    (4) the number of children who received services, what agency provided the services,
145.15and what type of services were provided;
145.16    (5) the number of employment plans that were adjusted to include the activities
145.17recommended in the screenings;
145.18    (6) the changes in work participation rates;
145.19    (7) the changes in earned income;
145.20    (8) the changes in sanction rates; and
145.21    (9) the participants' report of program effectiveness.
145.22    Subd. 5. Work activity. Participant involvement in screenings and subsequent
145.23referral and follow-up services shall count as work activity under Minnesota Statutes,
145.24section 256J.49, subdivision 13.

145.25    Sec. 16. SOCIAL AND ECONOMIC COSTS OF GAMBLING.
145.26    Subdivision 1. Report. The commissioner of human services, in consultation with
145.27the state affiliate of the National Council on Problem Gambling, stakeholders, and licensed
145.28vendors, shall prepare a report that provides a process and funding mechanism to study the
145.29issues in subdivisions 2 and 3. The commissioner, in consultation with the state affiliate
145.30of the National Council on Problem Gambling, stakeholders, and licensed vendors, shall
145.31include in the report potential financial commitments made by stakeholders and others in
145.32order to fund the study. The report is due to the legislative committees having jurisdiction
145.33over compulsive gambling issues by December 1, 2007.
145.34    Subd. 2. Issues to be addressed. The study must address:
146.1    (1) state, local, and tribal government policies and practices in Minnesota to legalize
146.2or prohibit gambling;
146.3    (2) the relationship between gambling and crime in Minnesota, including: (i) the
146.4relationship between gambling and overall crime rates; (ii) the relationship between
146.5gambling and crimes rates for specific crimes, such as forgery, domestic abuse, child
146.6neglect and abuse, alcohol and drug offenses, and youth crime; and (iii) enforcement
146.7and regulation practices that are intended to address the relationship between gambling
146.8and levels of crime;
146.9    (3) the relationship between expanded gambling and increased rates of problem
146.10gambling in Minnesota, including the impact of pathological or problem gambling on
146.11individuals, families, businesses, social institutions, and the economy;
146.12    (4) the social impact of gambling on individuals, families, businesses, and social
146.13institutions in Minnesota, including an analysis of the relationship between gambling and
146.14depression, abuse, divorce, homelessness, suicide, and bankruptcy;
146.15    (5) the economic impact of gambling on state, local, and tribal economies in
146.16Minnesota; and
146.17    (6) any other issues deemed necessary in assessing the social and economic impact
146.18of gambling in Minnesota.
146.19    Subd. 3. Quantification of social and economic impact. The study shall quantify
146.20the social and economic impact on both (1) state, local, and tribal governments in
146.21Minnesota, and (2) Minnesota's communities and social institutions, including individuals,
146.22families, and businesses within those communities and institutions.

146.23    Sec. 17. REPEALER.
146.24Minnesota Rules, part 9585.0030, is repealed.

146.25ARTICLE 6
146.26DEPARTMENT OF HEALTH

146.27    Section 1. Minnesota Statutes 2006, section 62Q.80, is amended by adding a
146.28subdivision to read:
146.29    Subd. 1a. Demonstration project. The commissioner of health shall award a
146.30demonstration project grant to a community-based health care initiative to develop and
146.31operate a community-based health care coverage program to operate within Carlton,
146.32Cook, Lake, and St. Louis Counties. The demonstration project shall extend for five years
146.33and must comply with all the requirements of this section.

146.34    Sec. 2. Minnesota Statutes 2006, section 62Q.80, subdivision 3, is amended to read:
147.1    Subd. 3. Approval. (a) Prior to the operation of a community-based health care
147.2coverage program, a community-based health initiative shall submit to the commissioner
147.3of health for approval the community-based health care coverage program developed by
147.4the initiative. The commissioner shall only approve a program that has been awarded
147.5a community access program grant from the United States Department of Health and
147.6Human Services. The commissioner shall ensure that the program meets the federal grant
147.7requirements and any requirements described in this section and is actuarially sound based
147.8on a review of appropriate records and methods utilized by the community-based health
147.9initiative in establishing premium rates for the community-based health care coverage
147.10program.
147.11    (b) Prior to approval, the commissioner shall also ensure that:
147.12    (1) the benefits offered comply with subdivision 8 and that there are adequate
147.13numbers of health care providers participating in the community-based health network to
147.14deliver the benefits offered under the program;
147.15    (2) the activities of the program are limited to activities that are exempt under this
147.16section or otherwise from regulation by the commissioner of commerce;
147.17    (3) the complaint resolution process meets the requirements of subdivision 10; and
147.18    (4) the data privacy policies and procedures comply with state and federal law.

147.19    Sec. 3. Minnesota Statutes 2006, section 62Q.80, subdivision 4, is amended to read:
147.20    Subd. 4. Establishment. (a) The initiative shall establish and operate upon approval
147.21by the commissioner of health a community-based health care coverage program. The
147.22operational structure established by the initiative shall include, but is not limited to:
147.23    (1) establishing a process for enrolling eligible individuals and their dependents;
147.24    (2) collecting and coordinating premiums from enrollees and employers of enrollees;
147.25    (3) providing payment to participating providers;
147.26    (4) establishing a benefit set according to subdivision 8 and establishing premium
147.27rates and cost-sharing requirements;
147.28    (5) creating incentives to encourage primary care and wellness services; and
147.29    (6) initiating disease management services, as appropriate.
147.30    (b) The payments collected under paragraph (a), clause (2), may be used to capture
147.31available federal funds.

147.32    Sec. 4. Minnesota Statutes 2006, section 62Q.80, subdivision 13, is amended to read:
147.33    Subd. 13. Report. (a) The initiative shall submit quarterly status reports to the
147.34commissioner of health on January 15, April 15, July 15, and October 15 of each year,
147.35with the first report due January 15, 2007 2008. The status report shall include:
148.1    (1) the financial status of the program, including the premium rates, cost per member
148.2per month, claims paid out, premiums received, and administrative expenses;
148.3    (2) a description of the health care benefits offered and the services utilized;
148.4    (3) the number of employers participating, the number of employees and dependents
148.5covered under the program, and the number of health care providers participating;
148.6    (4) a description of the health outcomes to be achieved by the program and a status
148.7report on the performance measurements to be used and collected; and
148.8    (5) any other information requested by the commissioner of health or commerce or
148.9the legislature.
148.10    (b) The initiative shall contract with an independent entity to conduct an evaluation
148.11of the program to be submitted to the commissioners of health and commerce and the
148.12legislature by January 15, 2009 2010. The evaluation shall include:
148.13    (1) an analysis of the health outcomes established by the initiative and the
148.14performance measurements to determine whether the outcomes are being achieved;
148.15    (2) an analysis of the financial status of the program, including the claims to
148.16premiums loss ratio and utilization and cost experience;
148.17    (3) the demographics of the enrollees, including their age, gender, family income,
148.18and the number of dependents;
148.19    (4) the number of employers and employees who have been denied access to the
148.20program and the basis for the denial;
148.21    (5) specific analysis on enrollees who have aggregate medical claims totaling over
148.22$5,000 per year, including data on the enrollee's main diagnosis and whether all the
148.23medical claims were covered by the program;
148.24    (6) number of enrollees referred to state public assistance programs;
148.25    (7) a comparison of employer-subsidized health coverage provided in a comparable
148.26geographic area to the designated community-based geographic area served by the
148.27program, including, to the extent available:
148.28    (i) the difference in the number of employers with 50 or fewer employees offering
148.29employer-subsidized health coverage;
148.30    (ii) the difference in uncompensated care being provided in each area; and
148.31    (iii) a comparison of health care outcomes and measurements established by the
148.32initiative; and
148.33    (8) any other information requested by the commissioner of health or commerce.

148.34    Sec. 5. Minnesota Statutes 2006, section 62Q.80, subdivision 14, is amended to read:
148.35    Subd. 14. Sunset. This section expires December 31, 2011 2012.

148.36    Sec. 6. [144.291] MINNESOTA HEALTH RECORDS ACT.
149.1    Subdivision 1. Short title. Sections 144.291 to 144.298 may be cited as the
149.2Minnesota Health Records Act.
149.3    Subd. 2. Definitions. For the purposes of sections 144.291 to 144.298, the following
149.4terms have the meanings given.
149.5    (a) Affiliate. "Affiliate" has the meaning given in section 144.6521, subdivision 3,
149.6paragraph (b).
149.7    (b) Group purchaser. "Group purchaser" has the meaning given in section 62J.03,
149.8subdivision 6.
149.9    (c) Health record. "Health record" means any information, whether oral or recorded
149.10in any form or medium, that relates to the past, present, or future physical or mental health
149.11or condition of a patient; the provision of health care to a patient; or the past, present, or
149.12future payment for the provision of health care to a patient.
149.13    (d) Identifying information. "Identifying information" means the patient's name,
149.14address, date of birth, gender, parent's or guardian's name regardless of the age of the
149.15patient, and other nonclinical data which can be used to uniquely identify a patient.
149.16    (e) Individually identifiable form. "Individually identifiable form" means a form in
149.17which the patient is or can be identified as the subject of the health records.
149.18    (f) Medical emergency. "Medical emergency" means medically necessary care
149.19which is immediately needed to preserve life, prevent serious impairment to bodily
149.20functions, organs, or parts, or prevent placing the physical or mental health of the patient
149.21in serious jeopardy.
149.22    (g) Patient. "Patient" means a natural person who has received health care services
149.23from a provider for treatment or examination of a medical, psychiatric, or mental
149.24condition, the surviving spouse and parents of a deceased patient, or a person the patient
149.25appoints in writing as a representative, including a health care agent acting according to
149.26chapter 145C, unless the authority of the agent has been limited by the principal in the
149.27principal's health care directive. Except for minors who have received health care services
149.28under sections 144.341 to 144.347, in the case of a minor, patient includes a parent or
149.29guardian, or a person acting as a parent or guardian in the absence of a parent or guardian.
149.30    (h) Provider. "Provider" means:
149.31    (1) any person who furnishes health care services and is regulated to furnish the
149.32services under chapter 147, 147A, 147B, 147C, 147D, 148, 148B, 148C, 148D, 150A,
149.33151, 153, or 153A;
149.34    (2) a home care provider licensed under section 144A.46;
149.35    (3) a health care facility licensed under this chapter or chapter 144A;
149.36    (4) a physician assistant registered under chapter 147A; and
150.1    (5) an unlicensed mental health practitioner regulated under sections 148B.60 to
150.2148B.71.
150.3    (i) Record locator service. "Record locator service" means an electronic index of
150.4patient identifying information that directs providers in a health information exchange to
150.5the location of patient health records held by providers and group purchasers.
150.6    (j) Related health care entity. "Related health care entity" means an affiliate of
150.7the provider releasing the health records.

150.8    Sec. 7. [144.292] PATIENT RIGHTS.
150.9    Subdivision 1. Scope. Patients have the rights specified in this section regarding the
150.10treatment the patient receives and the patient's health record.
150.11    Subd. 2. Patient access. Upon request, a provider shall supply to a patient complete
150.12and current information possessed by that provider concerning any diagnosis, treatment,
150.13and prognosis of the patient in terms and language the patient can reasonably be expected
150.14to understand.
150.15    Subd. 3. Additional patient rights. A patient's right specified in this section and
150.16sections 144.293 to 144.298 are in addition to the rights specified in sections 144.651 and
150.17144.652 and any other provision of law relating to the access of a patient to the patient's
150.18health records.
150.19    Subd. 4. Notice of rights; information on release. A provider shall provide to
150.20patients, in a clear and conspicuous manner, a written notice concerning practices and
150.21rights with respect to access to health records. The notice must include an explanation of:
150.22    (1) disclosures of health records that may be made without the written consent of the
150.23patient, including the type of records and to whom the records may be disclosed; and
150.24    (2) the right of the patient to have access to and obtain copies of the patient's health
150.25records and other information about the patient that is maintained by the provider.
150.26    The notice requirements of this subdivision are satisfied if the notice is included with
150.27the notice and copy of the patient and resident bill of rights under section 144.652 or if it
150.28is displayed prominently in the provider's place of business. The commissioner of health
150.29shall develop the notice required in this subdivision and publish it in the State Register.
150.30    Subd. 5. Copies of health records to patients. Except as provided in section
150.31144.296, upon a patient's written request, a provider, at a reasonable cost to the patient,
150.32shall promptly furnish to the patient:
150.33    (1) copies of the patient's health record, including but not limited to laboratory
150.34reports, x-rays, prescriptions, and other technical information used in assessing the
150.35patient's health conditions; or
151.1    (2) the pertinent portion of the record relating to a condition specified by the patient.
151.2    With the consent of the patient, the provider may instead furnish only a summary
151.3of the record. The provider may exclude from the health record written speculations
151.4about the patient's health condition, except that all information necessary for the patient's
151.5informed consent must be provided.
151.6    Subd. 6. Cost. (a) When a patient requests a copy of the patient's record for
151.7purposes of reviewing current medical care, the provider must not charge a fee.
151.8    (b) When a provider or its representative makes copies of patient records upon a
151.9patient's request under this section, the provider or its representative may charge the
151.10patient or the patient's representative no more than 75 cents per page, plus $10 for time
151.11spent retrieving and copying the records, unless other law or a rule or contract provide for
151.12a lower maximum charge. This limitation does not apply to x-rays. The provider may
151.13charge a patient no more than the actual cost of reproducing x-rays, plus no more than
151.14$10 for the time spent retrieving and copying the x-rays.
151.15    (c) The respective maximum charges of 75 cents per page and $10 for time provided
151.16in this subdivision are in effect for calendar year 1992 and may be adjusted annually each
151.17calendar year as provided in this subdivision. The permissible maximum charges shall
151.18change each year by an amount that reflects the change, as compared to the previous year,
151.19in the Consumer Price Index for all Urban Consumers, Minneapolis-St. Paul (CPI-U),
151.20published by the Department of Labor.
151.21    (d) A provider or its representative must not charge a fee to provide copies of records
151.22requested by a patient or the patient's authorized representative if the request for copies
151.23of records is for purposes of appealing a denial of Social Security disability income or
151.24Social Security disability benefits under title II or title XVI of the Social Security Act. For
151.25the purpose of further appeals, a patient may receive no more than two medical record
151.26updates without charge, but only for medical record information previously not provided.
151.27For purposes of this paragraph, a patient's authorized representative does not include units
151.28of state government engaged in the adjudication of Social Security disability claims.
151.29    Subd. 7. Withholding health records from patient. (a) If a provider reasonably
151.30determines that the information is detrimental to the physical or mental health of the
151.31patient, or is likely to cause the patient to inflict self harm, or to harm another, the provider
151.32may withhold the information from the patient and may supply the information to an
151.33appropriate third party or to another provider. The other provider or third party may
151.34release the information to the patient.
152.1    (b) A provider shall release information upon written request unless, prior to the
152.2request, a provider has designated and described a specific basis for withholding the
152.3information as authorized by paragraph (a).

152.4    Sec. 8. [144.293] RELEASE OR DISCLOSURE OF HEALTH RECORDS.
152.5    Subdivision 1. Release or disclosure of health records. Health records can be
152.6released or disclosed as specified in subdivisions 2 to 9 and sections 144.294 and 144.295.
152.7    Subd. 2. Patient consent to release of records. A provider, or a person who
152.8receives health records from a provider, may not release a patient's health records to a
152.9person without:
152.10    (1) a signed and dated consent from the patient or the patient's legally authorized
152.11representative authorizing the release;
152.12    (2) specific authorization in law; or
152.13    (3) a representation from a provider that the provider holds a consent from the
152.14patient.
152.15    Subd. 3. Release from one provider to another. A patient's health record,
152.16including, but not limited to, laboratory reports, x-rays, prescriptions, and other technical
152.17information used in assessing the patient's condition, or the pertinent portion of the record
152.18relating to a specific condition, or a summary of the record, shall promptly be furnished to
152.19another provider upon the written request of the patient. The written request shall specify
152.20the name of the provider to whom the health record is to be furnished. The provider who
152.21furnishes the health record or summary may retain a copy of the materials furnished. The
152.22patient shall be responsible for the reasonable costs of furnishing the information.
152.23    Subd. 4. Duration of consent. Except as provided in this section, a consent is
152.24valid for one year or for a lesser period specified in the consent or for a different period
152.25provided by law.
152.26    Subd. 5. Exceptions to consent requirement. This section does not prohibit the
152.27release of health records:
152.28    (1) for a medical emergency when the provider is unable to obtain the patient's
152.29consent due to the patient's condition or the nature of the medical emergency;
152.30    (2) to other providers within related health care entities when necessary for the
152.31current treatment of the patient; or
152.32    (3) to a health care facility licensed by this chapter, chapter 144A, or to the same
152.33types of health care facilities licensed by this chapter and chapter 144A that are licensed
152.34in another state when a patient:
152.35    (i) is returning to the health care facility and unable to provide consent; or
153.1    (ii) who resides in the health care facility, has services provided by an outside
153.2resource under Code of Federal Regulations, title 42, section 483.75(h), and is unable
153.3to provide consent.
153.4    Subd. 6. Consent does not expire. Notwithstanding subdivision 4, if a patient
153.5explicitly gives informed consent to the release of health records for the purposes and
153.6restrictions in clauses (1) and (2), the consent does not expire after one year for:
153.7    (1) the release of health records to a provider who is being advised or consulted with
153.8in connection with the releasing provider's current treatment of the patient;
153.9    (2) the release of health records to an accident and health insurer, health service plan
153.10corporation, health maintenance organization, or third-party administrator for purposes of
153.11payment of claims, fraud investigation, or quality of care review and studies, provided that:
153.12    (i) the use or release of the records complies with sections 72A.49 to 72A.505;
153.13    (ii) further use or release of the records in individually identifiable form to a person
153.14other than the patient without the patient's consent is prohibited; and
153.15    (iii) the recipient establishes adequate safeguards to protect the records from
153.16unauthorized disclosure, including a procedure for removal or destruction of information
153.17that identifies the patient.
153.18    Subd. 7. Exception to consent. Subdivision 2 does not apply to the release of health
153.19records to the commissioner of health or the Health Data Institute under chapter 62J,
153.20provided that the commissioner encrypts the patient identifier upon receipt of the data.
153.21    Subd. 8. Record locator service. (a) A provider or group purchaser may send
153.22patient identifying information and information about the location of the patient's health
153.23records to a record locator service without consent from the patient. Except in the case of
153.24a medical emergency, a provider participating in a health information exchange using a
153.25record locator service cannot access patient identifying information and information
153.26about the location of the patient's health records until the patient has provided consent.
153.27The Minnesota Department of Health may not access the record locator service or receive
153.28data from the record locator service. Only a provider may access patient identifying
153.29information in a record locator service. The consent does not expire and may be revoked
153.30by the patient at any time by providing written notice of the revocation to the provider.
153.31    (b) A health information exchange maintaining a record locator service or an entity
153.32maintaining a record locator service for a health information exchange must maintain an
153.33audit log of providers accessing information in a record locator service that minimally
153.34contains information on:
153.35    (1) the identity of the provider accessing the information;
154.1    (2) the identity of the patient whose information was accessed by the provider; and
154.2    (3) the date the information was accessed.
154.3    (c) No group purchaser may in any way require a provider to participate in any
154.4record locator service as a condition of payment or participation.
154.5    (d) A record locator service must provide a mechanism for patients to opt out of
154.6including their identifying information and information about the location of their health
154.7records in a record locator service. At a minimum, any consent form that permits a
154.8provider to access a record locator service must include a check-box option that allows a
154.9patient to completely opt out of the record locator service which shall be clearly displayed
154.10to the patient. A provider participating in a health information exchange with a record
154.11locator service who receives a patient's request to completely opt out of the record locator
154.12service or to not have a specific provider contact in the record locator service shall be
154.13responsible for removing the patient's information from the record locator service.
154.14    Subd. 9. Documentation of release. (a) In cases where a provider releases health
154.15records without patient consent as authorized by law, the release must be documented in
154.16the patient's health record. In the case of a release under section 144.294, subdivision 2, the
154.17documentation must include the date and circumstances under which the release was made,
154.18the person or agency to whom the release was made, and the records that were released.
154.19    (b) When a health record is released using a representation from a provider that
154.20holds a consent from the patient, the releasing provider shall document:
154.21    (1) the provider requesting the health records;
154.22    (2) the identity of the patient;
154.23    (3) the health records requested; and
154.24    (4) the date the health records were requested.

154.25    Sec. 9. [144.294] RECORDS RELATING TO MENTAL HEALTH.
154.26    Subdivision 1. Provider inquiry. Upon the written request of a spouse, parent,
154.27child, or sibling of a patient being evaluated for or diagnosed with mental illness, a
154.28provider shall inquire of a patient whether the patient wishes to authorize a specific
154.29individual to receive information regarding the patient's current and proposed course of
154.30treatment. If the patient so authorizes, the provider shall communicate to the designated
154.31individual the patient's current and proposed course of treatment. Section 144.293,
154.32subdivisions 2 and 4, apply to consents given under this subdivision.
154.33    Subd. 2. Disclosure to law enforcement agency. Notwithstanding section 144.293,
154.34subdivisions 2 and 4, a provider must disclose health records relating to a patient's mental
155.1health to a law enforcement agency if the law enforcement agency provides the name
155.2of the patient and communicates that the:
155.3    (1) patient is currently involved in an emergency interaction with the law
155.4enforcement agency; and
155.5    (2) disclosure of the records is necessary to protect the health or safety of the patient
155.6or of another person.
155.7    The scope of disclosure under this subdivision is limited to the minimum necessary
155.8for law enforcement to respond to the emergency. A law enforcement agency that obtains
155.9health records under this subdivision shall maintain a record of the requestor, the provider
155.10of the information, and the patient's name. Health records obtained by a law enforcement
155.11agency under this subdivision are private data on individuals as defined in section 13.02,
155.12subdivision 12, and must not be used by law enforcement for any other purpose.
155.13    Subd. 3. Records release for family and caretaker; mental health care. (a)
155.14Notwithstanding section 144.293, a provider providing mental health care and treatment
155.15may disclose health record information described in paragraph (b) about a patient to a
155.16family member of the patient or other person who requests the information if:
155.17    (1) the request for information is in writing;
155.18    (2) the family member or other person lives with, provides care for, or is directly
155.19involved in monitoring the treatment of the patient;
155.20    (3) the involvement under clause (2) is verified by the patient's mental health care
155.21provider, the patient's attending physician, or a person other than the person requesting the
155.22information, and is documented in the patient's medical record;
155.23    (4) before the disclosure, the patient is informed in writing of the request, the name
155.24of the person requesting the information, the reason for the request, and the specific
155.25information being requested;
155.26    (5) the patient agrees to the disclosure, does not object to the disclosure, or is
155.27unable to consent or object, and the patient's decision or inability to make a decision is
155.28documented in the patient's medical record; and
155.29    (6) the disclosure is necessary to assist in the provision of care or monitoring of the
155.30patient's treatment.
155.31    (b) The information disclosed under this paragraph is limited to diagnosis, admission
155.32to or discharge from treatment, the name and dosage of the medications prescribed, side
155.33effects of the medication, consequences of failure of the patient to take the prescribed
155.34medication, and a summary of the discharge plan.
155.35    (c) If a provider reasonably determines that providing information under this
155.36subdivision would be detrimental to the physical or mental health of the patient or is
156.1likely to cause the patient to inflict self harm or to harm another, the provider must not
156.2disclose the information.
156.3    (d) This subdivision does not apply to disclosures for a medical emergency or
156.4to family members as authorized or required under subdivision 1 or section 144.293,
156.5subdivision 5, clause (1).

156.6    Sec. 10. [144.295] DISCLOSURE OF HEALTH RECORDS FOR EXTERNAL
156.7RESEARCH.
156.8    Subdivision 1. Methods of release. (a) Notwithstanding section 144.293,
156.9subdivisions 2 and 4, health records may be released to an external researcher solely for
156.10purposes of medical or scientific research only as follows:
156.11    (1) health records generated before January 1, 1997, may be released if the patient
156.12has not objected or does not elect to object after that date;
156.13    (2) for health records generated on or after January 1, 1997, the provider must:
156.14    (i) disclose in writing to patients currently being treated by the provider that health
156.15records, regardless of when generated, may be released and that the patient may object, in
156.16which case the records will not be released; and
156.17    (ii) use reasonable efforts to obtain the patient's written general authorization that
156.18describes the release of records in item (i), which does not expire but may be revoked or
156.19limited in writing at any time by the patient or the patient's authorized representative;
156.20    (3) the provider must advise the patient of the rights specified in clause (4); and
156.21    (4) the provider must, at the request of the patient, provide information on how the
156.22patient may contact an external researcher to whom the health record was released and
156.23the date it was released.
156.24    (b) Authorization may be established if an authorization is mailed at least two
156.25times to the patient's last known address with a postage prepaid return envelope and a
156.26conspicuous notice that the patient's medical records may be released if the patient does
156.27not object, and at least 60 days have expired since the second notice was sent.
156.28    Subd. 2. Duties of researcher. In making a release for research purposes, the
156.29provider shall make a reasonable effort to determine that:
156.30    (1) the use or disclosure does not violate any limitations under which the record
156.31was collected;
156.32    (2) the use or disclosure in individually identifiable form is necessary to accomplish
156.33the research or statistical purpose for which the use or disclosure is to be made;
156.34    (3) the recipient has established and maintains adequate safeguards to protect the
156.35records from unauthorized disclosure, including a procedure for removal or destruction of
156.36information that identifies the patient; and
157.1    (4) further use or release of the records in individually identifiable form to a person
157.2other than the patient without the patient's consent is prohibited.

157.3    Sec. 11. [144.296] COPIES OF VIDEOTAPES.
157.4    A provider may not release a copy of a videotape of a child victim or alleged victim
157.5of physical or sexual abuse without a court order under section 13.03, subdivision 6, or
157.6as provided in section 611A.90. This section does not limit the right of a patient to view
157.7the videotape.

157.8    Sec. 12. [144.297] INDEPENDENT MEDICAL EXAMINATION.
157.9    This section applies to the subject and provider of an independent medical
157.10examination requested by or paid for by a third party. Notwithstanding section 144.293, a
157.11provider may release health records created as part of an independent medical examination
157.12to the third party who requested or paid for the examination.

157.13    Sec. 13. [144.298] PENALTIES.
157.14    Subdivision 1. Licensing action. A violation of sections 144.291 to 144.298 may
157.15be grounds for disciplinary action against a provider by the appropriate licensing board
157.16or agency.
157.17    Subd. 2. Allocation of liability. In adjudicating a dispute involving the disclosure
157.18of patient health records, a court shall use the criteria in this subdivision in determining
157.19how liability will be allocated.
157.20    (a) When requesting health records using consent, a person warrants that the consent:
157.21    (1) contains no information known to the person to be false; and
157.22    (2) accurately states the patient's desire to have health records disclosed or that there
157.23is specific authorization in law.
157.24    (b) When requesting health records using consent or the representation authorized in
157.25section 144.293, subdivision 2, a provider warrants that the request:
157.26    (1) contains no information known to the provider to be false;
157.27    (2) accurately states the patient's desire to have health records disclosed or that
157.28there is specific authorization in law; and
157.29    (3) does not exceed any limits imposed by the patient in the consent.
157.30    (c) When disclosing health records, a person releasing health records warrants that
157.31the person:
157.32    (1) has complied with the requirements of this section regarding disclosure of
157.33health records;
157.34    (2) knows of no information related to the request that is false; and
158.1    (3) has complied with the limits set by the patient in the consent or as described
158.2in the representation of consent.
158.3    (d) A court of this state presumes that:
158.4    (1) a request made by a person that complies with the provisions of this section is
158.5valid and represents the wishes of the patient;
158.6    (2) the information listed in a consent or representation of consent is accurate;
158.7    (3) the recipient of a consent or representation of consent has no knowledge or
158.8notice that the person making the request breached a duty to the patient or does not
158.9rightfully have a consent;
158.10    (4) the signature on the consent or representation of consent is not forged;
158.11    (5) the consent or representation of consent was not obtained under false pretenses;
158.12and
158.13    (6) the consent or representation of consent was not altered without the patient's
158.14permission.
158.15    (e) No person or provider may disclaim or contractually limit the application of this
158.16section, or obtain indemnity for its effects, if the disclaimer, limitation, or indemnity
158.17restricts liability for misrepresentation against persons reasonably relying on the consent,
158.18representation of consent, or disclosure.
158.19    (f) A court of this state shall give effect to liability allocations between the parties
158.20provided by contract that does not allocate liability to the detriment of the patient and the
158.21allocation is consistent with the requirements of sections 144.291 to 144.298.
158.22    (g) A patient is eligible to receive compensatory damages plus costs and reasonable
158.23attorney fees if there is a negligent or intentional violation of sections 144.293 to 144.295.
158.24    Subd. 3. Liability for a record locator service. A patient is eligible to receive
158.25compensatory damages plus costs and reasonable attorney fees if a health information
158.26exchange maintaining a record locator service, or an entity maintaining a record locator
158.27service for a health information exchange, negligently or intentionally violates the
158.28provisions of section 144.293, subdivision 8.

158.29    Sec. 14. Minnesota Statutes 2006, section 144.3345, subdivision 2, is amended to read:
158.30    Subd. 2. Grants authorized. (a) The commissioner of health shall award grants
158.31to eligible community e-health collaborative projects and to individual organizations
158.32as specified in paragraph (b) to improve the implementation and use of interoperable
158.33electronic health records including but not limited to the following projects:
158.34    (1) collaborative efforts to host and support fully functional interoperable electronic
158.35health records in multiple care settings;
158.36    (2) electronic medication history and electronic patient registration information;
159.1    (3) electronic personal health records for persons with chronic diseases and for
159.2prevention services;
159.3    (4) rural and underserved community models for electronic prescribing; and
159.4    (5) enabling local public health systems to rapidly and electronically exchange
159.5information needed to participate in community e-health collaboratives or for public
159.6health emergency preparedness and response.
159.7    Grant funds may not be used for construction of health care or other buildings or
159.8facilities.
159.9    (b) The commissioner shall award grants to community clinics as defined under
159.10section 145.9268, subdivision 1, federally qualified health centers, community mental
159.11health centers, community dental clinics that primarily serve low-income and uninsured
159.12persons, and nonprofit organizations that provide public health home nursing services to
159.13uninsured patients, for the purposes listed in paragraph (a). An organization must not
159.14be required to be part of a community e-health collaborative in order to receive a grant
159.15under this paragraph.

159.16    Sec. 15. Minnesota Statutes 2006, section 144.651, subdivision 26, is amended to read:
159.17    Subd. 26. Right to associate. (a) Residents may meet with and receive visitors
159.18and participate in activities of commercial, religious, political, as defined in section
159.19203B.11 and community groups without interference at their discretion if the activities
159.20do not infringe on the right to privacy of other residents or are not programmatically
159.21contraindicated. This includes:
159.22    (1) the right to join with other individuals within and outside the facility to work for
159.23improvements in long-term care;
159.24    (2) the right to visitation by an individual the patient has appointed as the patient's
159.25health care agent under chapter 145C;
159.26    (3) the right to visitation and health care decision making by an individual designated
159.27by the patient under paragraph (c).
159.28    (b) Upon admission to a facility where federal law prohibits unauthorized disclosure
159.29of patient or resident identifying information to callers and visitors, the patient or
159.30resident, or the legal guardian or conservator of the patient or resident, shall be given the
159.31opportunity to authorize disclosure of the patient's or resident's presence in the facility
159.32to callers and visitors who may seek to communicate with the patient or resident. To the
159.33extent possible, the legal guardian or conservator of a patient or resident shall consider the
159.34opinions of the patient or resident regarding the disclosure of the patient's or resident's
159.35presence in the facility.
160.1    (c) Upon admission to a facility, the patient or resident, or the legal guardian
160.2or conservator of the patient or resident, must be given the opportunity to designate
160.3a person who is not related who will have the status of the patient's next of kin with
160.4respect to visitation and making a health care decision. A designation must be included
160.5in the patient's health record. With respect to making a health care decision, a health
160.6care directive or appointment of a health care agent under chapter 145C prevails over a
160.7designation made under this paragraph. The unrelated person may also be identified as
160.8such by the patient or by the patient's family.

160.9    Sec. 16. Minnesota Statutes 2006, section 145C.05, is amended to read:
160.10145C.05 SUGGESTED FORM; PROVISIONS THAT MAY BE INCLUDED.
160.11    Subdivision 1. Content. A health care directive executed pursuant to this chapter
160.12may, but need not, be in the form contained in section 145C.16.
160.13    Subd. 2. Provisions that may be included. (a) A health care directive may include
160.14provisions consistent with this chapter, including, but not limited to:
160.15    (1) the designation of one or more alternate health care agents to act if the named
160.16health care agent is not reasonably available to serve;
160.17    (2) directions to joint health care agents regarding the process or standards by which
160.18the health care agents are to reach a health care decision for the principal, and a statement
160.19whether joint health care agents may act independently of one another;
160.20    (3) limitations, if any, on the right of the health care agent or any alternate health
160.21care agents to receive, review, obtain copies of, and consent to the disclosure of the
160.22principal's medical records or to visit the principal when the principal is a patient in a
160.23health care facility;
160.24    (4) limitations, if any, on the nomination of the health care agent as guardian for
160.25purposes of sections 524.5-202, 524.5-211, 524.5-302, and 524.5-303;
160.26    (5) a document of gift for the purpose of making an anatomical gift, as set forth in
160.27sections 525.921 to 525.9224, or an amendment to, revocation of, or refusal to make
160.28an anatomical gift;
160.29    (6) a declaration regarding intrusive mental health treatment under section 253B.03,
160.30subdivision 6d
, or a statement that the health care agent is authorized to give consent for
160.31the principal under section 253B.04, subdivision 1a;
160.32    (7) a funeral directive as provided in section 149A.80, subdivision 2;
160.33    (8) limitations, if any, to the effect of dissolution or annulment of marriage or
160.34termination of domestic partnership on the appointment of a health care agent under
160.35section 145C.09, subdivision 2;
161.1    (9) specific reasons why a principal wants a health care provider or an employee
161.2of a health care provider attending the principal to be eligible to act as the principal's
161.3health care agent;
161.4    (10) health care instructions by a woman of child bearing age regarding how she
161.5would like her pregnancy, if any, to affect health care decisions made on her behalf; and
161.6    (11) health care instructions regarding artificially administered nutrition or hydration.
161.7    (b) A health care directive may include a statement of the circumstances under
161.8which the directive becomes effective other than upon the judgment of the principal's
161.9attending physician in the following situations:
161.10    (1) a principal who in good faith generally selects and depends upon spiritual means
161.11or prayer for the treatment or care of disease or remedial care and does not have an
161.12attending physician, may include a statement appointing an individual who may determine
161.13the principal's decision-making capacity; and
161.14    (2) a principal who in good faith does not generally select a physician or a health
161.15care facility for the principal's health care needs may include a statement appointing an
161.16individual who may determine the principal's decision-making capacity, provided that if
161.17the need to determine the principal's capacity arises when the principal is receiving care
161.18under the direction of an attending physician in a health care facility, the determination
161.19must be made by an attending physician after consultation with the appointed individual.
161.20    If a person appointed under clause (1) or (2) is not reasonably available and the
161.21principal is receiving care under the direction of an attending physician in a health care
161.22facility, an attending physician shall determine the principal's decision-making capacity.
161.23    (c) A health care directive may authorize a health care agent to make health care
161.24decisions for a principal even though the principal retains decision-making capacity.

161.25    Sec. 17. Minnesota Statutes 2006, section 145C.07, is amended by adding a
161.26subdivision to read:
161.27    Subd. 5. Visitation. A health care agent may visit the principal when the
161.28principal is a patient in a health care facility regardless of whether the principal retains
161.29decision-making capacity, unless:
161.30    (1) the principal has otherwise specified in the health care directive;
161.31    (2) a principal who retains decision-making capacity indicates otherwise; or
161.32    (3) a health care provider reasonably determines that the principal must be isolated
161.33from all visitors or that the presence of the health care agent would endanger the health or
161.34safety of the principal, other patients, or the facility in which the care is being provided.

161.35    Sec. 18. HEALTH PROMOTION PROGRAM.
162.1    The State Community Health Services Advisory Committee established in
162.2Minnesota Statutes, section 145A.10, subdivision 10, shall develop a plan to fund and
162.3implement an ongoing comprehensive health promotion program that can effect change
162.4more effectively and at lower cost at a community level rather than through individual
162.5counseling and change promotion. The program shall use proven public health strategies
162.6to promote healthy lifestyles and behaviors in order to establish a sustainable, long-term
162.7approach to reducing preventable disability, chronic health conditions, and disease. The
162.8focus shall be on community based initiatives that address childhood and adult obesity,
162.9tobacco and substance abuse, improved activity levels among senior citizens, and other
162.10lifestyle issues that impact health and healthcare costs. Because of its population health
162.11focus, funding shall be related to the size of the population to be served. The plan shall be
162.12completed by September 15, 2007, and shared with the Legislative Health Care Access
162.13Commission.

162.14    Sec. 19. INJUNCTIVE RELIEF REPORT.
162.15    The commissioner of health shall present to the 2008 legislature, by December 15,
162.162007, recommendations to fund the cost of bringing actions for injunctive relief under
162.17Minnesota Statutes, section 144G.02, subdivision 2, paragraph (b).

162.18    Sec. 20. FUNDING FOR MEDICAL HOME MODELS.
162.19    The commissioner of health shall award a grant to a multiclinic quality improvement
162.20collaborative that receives funding through a federal maternal and child health bureau
162.21grant, to allow the collaborative to expand services provided under a medical home model
162.22to children with special health care needs, and to increase the number of children served
162.23by the collaborative.

162.24    Sec. 21. REVISOR'S INSTRUCTION.
162.25    In Minnesota Statutes and Minnesota Rules, the revisor shall change the references
162.26in column A with the references in column B.
162.27
Column A
Column B
162.28
section 144.335
sections 144.291 to 144.298
162.29
section 144.335, subdivision 1
section 144.291, subdivision 2
162.30
162.31
section 144.335, subdivision 1, paragraph
(b)
section 144.291, subdivision 2, paragraph
(h)
162.32
162.33
section 144.335, subdivision 2, paragraphs
(a) and (b)
section 144.292, subdivisions 2 and 5
162.34
section 144.335, subdivision 2
section 144.292
162.35
section 144.335, subdivision 3a
section 144.294, subdivision 2
162.36
162.37
section 144.335, subdivision 3a, paragraph
(d)
section 144.295
163.1
163.2
section 144.335, subdivision 3a, paragraph
(f)
section 144.294
163.3
section 144.335, subdivision 3b
section 144.293, subdivision 7

163.4    Sec. 22. REPEALER.
163.5Minnesota Statutes 2006, section 144.335, is repealed.

163.6ARTICLE 7
163.7MISCELLANEOUS

163.8    Section 1. [62Q.40] LANGUAGE INTERPRETER SERVICES.
163.9    A health plan must cover sign language interpreter services provided to deaf and
163.10hard-of-hearing enrollees and language interpreter services provided to enrollees with
163.11limited English proficiency in order to facilitate the provision of health care services by a
163.12provider or health care facility. For purposes of this section, "provider" has the meaning
163.13given in section 62J.03, subdivision 8; and "health plan" includes coverage excluded under
163.14section 62A.011, subdivision 3, clauses (6), (7), (9), and (10). Interpreter services may be
163.15provided in person, by telephone, or by video conference. The health plan shall reimburse
163.16either the party providing interpreter services directly for the costs of language interpreter
163.17services provided to the enrollee or the provider or health care facility arranging for
163.18the provision of interpreter services. Providers and health care facilities that employ
163.19interpreters may bill and shall be reimbursed directly by health plan companies for such
163.20services. Except where health plan companies are already reimbursing a party providing or
163.21a provider or health care facility arranging for interpreter services, required reimbursement
163.22by health plan companies for interpreter services shall be phased in over a three-year
163.23period beginning July 1, 2008, with one-third of the cost reimbursed the first year,
163.24two-thirds of the cost reimbursed the second year, and full reimbursement the third year. A
163.25health plan company shall provide to enrollees, upon request, the policies and procedures
163.26for addressing the needs of deaf and hard-of-hearing enrollees and enrollees with limited
163.27English proficiency. All entities providing interpreter services must disclose their methods
163.28for ensuring competency upon request of any health plan company, provider, or consumer.
163.29EFFECTIVE DATE.This section is effective July 1, 2008, and applies to plans
163.30issued or renewed to provide coverage to Minnesota residents on or after that date unless
163.31the legislature enacts alternative funding sources based on the recommendations of the
163.32commissioner.

163.33    Sec. 2. [72A.329] DIRECT LIABILITY OF INSURER.
163.34    Any bond or policy of insurance covering liability to others for negligence makes
163.35the insurer liable, up to the amounts stated in the bond or policy, to the persons entitled to
164.1recover against the insured for the death of any person or for injury to persons or property,
164.2irrespective of whether the liability is presently established or is contingent and to become
164.3fixed or certain by final judgment against the insured.
164.4EFFECTIVE DATE.This section is effective August 1, 2007, and applies to bonds
164.5or policies of insurance issued, renewed, or in place on or after that date.

164.6    Sec. 3. Minnesota Statutes 2006, section 148.235, is amended by adding a subdivision
164.7to read:
164.8    Subd. 11. Dispensing by protocol. A registered nurse in a family planning agency
164.9as defined in Minnesota Rules, part 9505.0280, subpart 3, may dispense oral contraceptives
164.10prescribed by a licensed practitioner as defined in section 151.01, subdivision 23, pursuant
164.11to a dispensing protocol established by the agency's medical director or under the direction
164.12of a physician. The dispensing protocol must address the requirements of sections 151.01,
164.13subdivision 30, and 151.212, subdivision 1.

164.14    Sec. 4. Minnesota Statutes 2006, section 151.37, subdivision 2, is amended to read:
164.15    Subd. 2. Prescribing and filing. (a) A licensed practitioner in the course of
164.16professional practice only, may prescribe, administer, and dispense a legend drug, and may
164.17cause the same to be administered by a nurse, a physician assistant, or medical student or
164.18resident under the practitioner's direction and supervision, and may cause a person who
164.19is an appropriately certified, registered, or licensed health care professional to prescribe,
164.20dispense, and administer the same within the expressed legal scope of the person's practice
164.21as defined in Minnesota Statutes. A licensed practitioner may prescribe a legend drug,
164.22without reference to a specific patient, by directing a nurse, pursuant to section 148.235,
164.23subdivisions 8 and 9
, physician assistant, or medical student or resident to adhere to
164.24a particular practice guideline or protocol when treating patients whose condition falls
164.25within such guideline or protocol, and when such guideline or protocol specifies the
164.26circumstances under which the legend drug is to be prescribed and administered. An
164.27individual who verbally, electronically, or otherwise transmits a written, oral, or electronic
164.28order, as an agent of a prescriber, shall not be deemed to have prescribed the legend drug.
164.29This paragraph applies to a physician assistant only if the physician assistant meets the
164.30requirements of section 147A.18.
164.31    (b) A licensed practitioner that dispenses for profit a legend drug that is to be
164.32administered orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must
164.33file with the practitioner's licensing board a statement indicating that the practitioner
164.34dispenses legend drugs for profit, the general circumstances under which the practitioner
164.35dispenses for profit, and the types of legend drugs generally dispensed. It is unlawful to
165.1dispense legend drugs for profit after July 31, 1990, unless the statement has been filed
165.2with the appropriate licensing board. For purposes of this paragraph, "profit" means (1)
165.3any amount received by the practitioner in excess of the acquisition cost of a legend drug
165.4for legend drugs that are purchased in prepackaged form, or (2) any amount received
165.5by the practitioner in excess of the acquisition cost of a legend drug plus the cost of
165.6making the drug available if the legend drug requires compounding, packaging, or other
165.7treatment. The statement filed under this paragraph is public data under section 13.03.
165.8This paragraph does not apply to a licensed doctor of veterinary medicine or a registered
165.9pharmacist. Any person other than a licensed practitioner with the authority to prescribe,
165.10dispense, and administer a legend drug under paragraph (a) shall not dispense for profit.
165.11To dispense for profit does not include dispensing by a community health clinic when the
165.12profit from dispensing is used to meet operating expenses.
165.13    (c) A prescription or drug order for a legend drug is not valid unless it is issued
165.14for a legitimate medical purpose arising from a prescriber-patient relationship that
165.15includes a documented patient evaluation adequate to establish diagnoses and identify
165.16underlying conditions and contraindications to the treatment. Treatment, including issuing
165.17a prescription or drug order, based solely on an online questionnaire does not constitute a
165.18legitimate medical purpose.

165.19    Sec. 5. Minnesota Statutes 2006, section 245.4874, is amended to read:
165.20245.4874 DUTIES OF COUNTY BOARD.
165.21    (a) The county board must:
165.22    (1) develop a system of affordable and locally available children's mental health
165.23services according to sections 245.487 to 245.4887;
165.24    (2) establish a mechanism providing for interagency coordination as specified in
165.25section 245.4875, subdivision 6;
165.26    (3) consider the assessment of unmet needs in the county as reported by the local
165.27children's mental health advisory council under section 245.4875, subdivision 5, paragraph
165.28(b), clause (3). The county shall provide, upon request of the local children's mental health
165.29advisory council, readily available data to assist in the determination of unmet needs;
165.30    (4) assure that parents and providers in the county receive information about how to
165.31gain access to services provided according to sections 245.487 to 245.4887;
165.32    (5) coordinate the delivery of children's mental health services with services
165.33provided by social services, education, corrections, health, and vocational agencies to
165.34improve the availability of mental health services to children and the cost-effectiveness of
165.35their delivery;
166.1    (6) assure that mental health services delivered according to sections 245.487
166.2to 245.4887 are delivered expeditiously and are appropriate to the child's diagnostic
166.3assessment and individual treatment plan;
166.4    (7) provide the community with information about predictors and symptoms of
166.5emotional disturbances and how to access children's mental health services according to
166.6sections 245.4877 and 245.4878;
166.7    (8) provide for case management services to each child with severe emotional
166.8disturbance according to sections 245.486; 245.4871, subdivisions 3 and 4; and 245.4881,
166.9subdivisions 1, 3, and 5
;
166.10    (9) provide for screening of each child under section 245.4885 upon admission
166.11to a residential treatment facility, acute care hospital inpatient treatment, or informal
166.12admission to a regional treatment center;
166.13    (10) prudently administer grants and purchase-of-service contracts that the county
166.14board determines are necessary to fulfill its responsibilities under sections 245.487 to
166.15245.4887 ;
166.16    (11) assure that mental health professionals, mental health practitioners, and case
166.17managers employed by or under contract to the county to provide mental health services
166.18are qualified under section 245.4871;
166.19    (12) assure that children's mental health services are coordinated with adult mental
166.20health services specified in sections 245.461 to 245.486 so that a continuum of mental
166.21health services is available to serve persons with mental illness, regardless of the person's
166.22age;
166.23    (13) assure that culturally informed mental health consultants are used as necessary
166.24to assist the county board in assessing and providing appropriate treatment for children of
166.25cultural or racial minority heritage; and
166.26    (14) consistent with section 245.486, arrange for or provide a children's mental
166.27health screening to a child receiving child protective services or a child in out-of-home
166.28placement, a child for whom parental rights have been terminated, a child found to be
166.29delinquent, and a child found to have committed a juvenile petty offense for the third
166.30or subsequent time, unless a screening or diagnostic assessment has been performed
166.31within the previous 180 days, or the child is currently under the care of a mental health
166.32professional. The court or county agency must notify a parent or guardian whose
166.33parental rights have not been terminated of the potential mental health screening and the
166.34option to prevent the screening by notifying the court or county agency in writing. The
166.35screening shall be conducted with a screening instrument approved by the commissioner
166.36of human services according to criteria that are updated and issued annually to ensure
167.1that approved screening instruments are valid and useful for child welfare and juvenile
167.2justice populations, and shall be conducted by a mental health practitioner as defined in
167.3section 245.4871, subdivision 26, or a probation officer or local social services agency
167.4staff person who is trained in the use of the screening instrument. Training in the use of the
167.5instrument shall include training in the administration of the instrument, the interpretation
167.6of its validity given the child's current circumstances, the state and federal data practices
167.7laws and confidentiality standards, the parental consent requirement, and providing respect
167.8for families and cultural values. If the screen indicates a need for assessment, the child's
167.9family, or if the family lacks mental health insurance, the local social services agency,
167.10in consultation with the child's family, shall have conducted a diagnostic assessment,
167.11including a functional assessment, as defined in section 245.4871. The administration of
167.12the screening shall safeguard the privacy of children receiving the screening and their
167.13families and shall comply with the Minnesota Government Data Practices Act, chapter
167.1413, and the federal Health Insurance Portability and Accountability Act of 1996, Public
167.15Law 104-191. Screening results shall be considered private data and the commissioner
167.16shall not collect individual screening results.
167.17    (b) When the county board refers clients to providers of children's therapeutic
167.18services and supports under section 256B.0943, the county board must clearly identify
167.19the desired services components not covered under section 256B.0943 and identify the
167.20reimbursement source for those requested services, the method of payment, and the
167.21payment rate to the provider.

167.22    Sec. 6. Minnesota Statutes 2006, section 252.32, subdivision 3, is amended to read:
167.23    Subd. 3. Amount of support grant; use. Support grant amounts shall be
167.24determined by the county social service agency. Services and items purchased with a
167.25support grant must:
167.26    (1) be over and above the normal costs of caring for the dependent if the dependent
167.27did not have a disability;
167.28    (2) be directly attributable to the dependent's disabling condition; and
167.29    (3) enable the family to delay or prevent the out-of-home placement of the dependent.
167.30    The design and delivery of services and items purchased under this section must
167.31suit the dependent's chronological age and be provided in the least restrictive environment
167.32possible, consistent with the needs identified in the individual service plan.
167.33    Items and services purchased with support grants must be those for which there
167.34are no other public or private funds available to the family. Fees assessed to parents
167.35for health or human services that are funded by federal, state, or county dollars are not
167.36reimbursable through this program.
168.1    In approving or denying applications, the county shall consider the following factors:
168.2    (1) the extent and areas of the functional limitations of the disabled child;
168.3    (2) the degree of need in the home environment for additional support; and
168.4    (3) the potential effectiveness of the grant to maintain and support the person in
168.5the family environment.
168.6    The maximum monthly grant amount shall be $250 per eligible dependent, or
168.7$3,000 per eligible dependent per state fiscal year, within the limits of available funds.
168.8The county social service agency may consider the dependent's supplemental security
168.9income in determining the amount of the support grant.
168.10    Any adjustments to their monthly grant amount must be based on the needs of the
168.11family and funding availability.

168.12    Sec. 7. Minnesota Statutes 2006, section 253B.185, subdivision 2, is amended to read:
168.13    Subd. 2. Transfer to correctional facility. (a) If a person has been committed
168.14under this section and later is committed to the custody of the commissioner of corrections
168.15for any reason, including but not limited to, being sentenced for a crime or revocation of
168.16the person's supervised release or conditional release under section 244.05, 609.108,
168.17subdivision 6
, or 609.109, subdivision 7, the person shall be transferred to a facility
168.18designated by the commissioner of corrections without regard to the procedures provided
168.19in section 253B.18.
168.20    (b) If a person is committed under this section after a commitment to the
168.21commissioner of corrections, the person shall first serve the sentence in a facility
168.22designated by the commissioner of corrections. After the person has served the sentence,
168.23the person shall be transferred to a treatment program designated by the commissioner
168.24of human services.

168.25    Sec. 8. Minnesota Statutes 2006, section 254A.03, subdivision 3, is amended to read:
168.26    Subd. 3. Rules for chemical dependency care. The commissioner of human
168.27services shall establish by rule criteria to be used in determining the appropriate level
168.28of chemical dependency care, whether outpatient, inpatient or short-term treatment
168.29programs, for each recipient of public assistance seeking treatment for alcohol or other
168.30drug dependency and abuse problems. The criteria shall address, at least, the family
168.31relationship, past treatment history, medical or physical problems, arrest record, and
168.32employment situation.

168.33    Sec. 9. Minnesota Statutes 2006, section 254A.16, subdivision 2, is amended to read:
168.34    Subd. 2. Program and service guidelines. (a) The commissioner shall provide
168.35program and service guidelines and technical assistance to the county boards in carrying
169.1out services authorized under sections section 254A.08, 254A.12, 254A.14, and their
169.2responsibilities under chapter 256E.
169.3    (b) The commissioner shall recommend to the governor means of improving
169.4the efficiency and effectiveness of comprehensive program services in the state and
169.5maximizing the use of nongovernmental funds for providing comprehensive programs.

169.6    Sec. 10. Minnesota Statutes 2006, section 254B.02, subdivision 1, is amended to read:
169.7    Subdivision 1. Chemical dependency treatment allocation. The chemical
169.8dependency funds appropriated for allocation shall be placed in a special revenue account.
169.9The commissioner shall annually transfer funds from the chemical dependency fund to pay
169.10for operation of the drug and alcohol abuse normative evaluation system and to pay for all
169.11costs incurred by adding two positions for licensing of chemical dependency treatment
169.12and rehabilitation programs located in hospitals for which funds are not otherwise
169.13appropriated. For each year of the biennium ending June 30, 1999, the commissioner shall
169.14allocate funds to the American Indian chemical dependency tribal account for treatment
169.15of American Indians by eligible vendors under section 254B.05, equal to the amount
169.16allocated in fiscal year 1997. Six percent of the remaining money must be reserved for
169.17tribal allocation under section 254B.09, subdivisions 4 and 5. The commissioner shall
169.18annually divide the money available in the chemical dependency fund that is not held
169.19in reserve by counties from a previous allocation, or allocated to the American Indian
169.20chemical dependency tribal account. Six percent of the remaining money must be
169.21reserved for the nonreservation American Indian chemical dependency allocation for
169.22treatment of American Indians by eligible vendors under section 254B.05, subdivision
169.231
. The remainder of the money must be allocated among the counties according to the
169.24following formula, using state demographer data and other data sources determined by
169.25the commissioner:
169.26    (a) For purposes of this formula, American Indians and children under age 14 are
169.27subtracted from the population of each county to determine the restricted population.
169.28    (b) The amount of chemical dependency fund expenditures for entitled persons for
169.29services not covered by prepaid plans governed by section 256B.69 in the previous year is
169.30divided by the amount of chemical dependency fund expenditures for entitled persons for
169.31all services to determine the proportion of exempt service expenditures for each county.
169.32    (c) The prepaid plan months of eligibility is multiplied by the proportion of exempt
169.33service expenditures to determine the adjusted prepaid plan months of eligibility for
169.34each county.
169.35    (d) The adjusted prepaid plan months of eligibility is added to the number of
169.36restricted population fee for service months of eligibility for the Minnesota family
170.1investment program, general assistance, and medical assistance and divided by the county
170.2restricted population to determine county per capita months of covered service eligibility.
170.3    (e) The number of adjusted prepaid plan months of eligibility for the state is added
170.4to the number of fee for service months of eligibility for the Minnesota family investment
170.5program, general assistance, and medical assistance for the state restricted population and
170.6divided by the state restricted population to determine state per capita months of covered
170.7service eligibility.
170.8    (f) The county per capita months of covered service eligibility is divided by the
170.9state per capita months of covered service eligibility to determine the county welfare
170.10caseload factor.
170.11    (g) The median married couple income for the most recent three-year period
170.12available for the state is divided by the median married couple income for the same period
170.13for each county to determine the income factor for each county.
170.14    (h) The county restricted population is multiplied by the sum of the county welfare
170.15caseload factor and the county income factor to determine the adjusted population.
170.16    (i) $15,000 shall be allocated to each county.
170.17    (j) The remaining funds shall be allocated proportional to the county adjusted
170.18population.

170.19    Sec. 11. Minnesota Statutes 2006, section 254B.02, subdivision 5, is amended to read:
170.20    Subd. 5. Administrative adjustment. The commissioner may make payments to
170.21local agencies from money allocated under this section to support administrative activities
170.22under sections 254B.03 and 254B.04. The administrative payment must not exceed
170.23five percent of the first $50,000, four percent of the next $50,000, and three percent of
170.24the remaining payments for services from the allocation. Twenty-five percent of the
170.25administrative allowance shall be advanced at the beginning of each quarter, based on
170.26the payments for services made in the most recent quarter for which data is available.
170.27Adjustment of any overestimate or underestimate based on actual expenditures shall be
170.28made by the state agency by adjusting the administrative allowance for any succeeding
170.29quarter.

170.30    Sec. 12. Minnesota Statutes 2006, section 254B.03, subdivision 1, is amended to read:
170.31    Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical
170.32dependency services to persons residing within its jurisdiction who meet criteria
170.33established by the commissioner for placement in a chemical dependency residential or
170.34nonresidential treatment service. Chemical dependency money must be administered
170.35by the local agencies according to law and rules adopted by the commissioner under
170.36sections 14.001 to 14.69.
171.1    (b) In order to contain costs, the county board shall, with the approval of the
171.2commissioner of human services, select eligible vendors of chemical dependency services
171.3who can provide economical and appropriate treatment. Unless the local agency is a social
171.4services department directly administered by a county or human services board, the local
171.5agency shall not be an eligible vendor under section 254B.05. The commissioner may
171.6approve proposals from county boards to provide services in an economical manner or to
171.7control utilization, with safeguards to ensure that necessary services are provided. If a
171.8county implements a demonstration or experimental medical services funding plan, the
171.9commissioner shall transfer the money as appropriate. If a county selects a vendor located
171.10in another state, the county shall ensure that the vendor is in compliance with the rules
171.11governing licensure of programs located in the state.
171.12    (c) The calendar year 2002 rate for vendors may not increase more than three
171.13percent above the rate approved in effect on January 1, 2001. The calendar year 2003
171.14rate for vendors may not increase more than three percent above the rate in effect on
171.15January 1, 2002. The calendar years 2004 and 2005 rates may not exceed the rate in
171.16effect on January 1, 2003.
171.17    (d) (c) A culturally specific vendor that provides assessments under a variance under
171.18Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to
171.19persons not covered by the variance.

171.20    Sec. 13. Minnesota Statutes 2006, section 254B.03, subdivision 3, is amended to read:
171.21    Subd. 3. Local agencies to pay state for county share. Local agencies shall submit
171.22invoices to the state on forms supplied by the commissioner and according to procedures
171.23established by the commissioner. Local agencies shall pay the state for the county share
171.24of the invoiced services authorized by the local agency. Payments shall be made at the
171.25beginning of each month for services provided in the previous month. The commissioner
171.26shall bill the county monthly for services, based on the most recent month for which
171.27expenditure information is available. Adjustment of any overestimate or underestimate
171.28based on actual expenditures shall be made by the state agency by adjusting the estimate
171.29for any succeeding month.

171.30    Sec. 14. Minnesota Statutes 2006, section 254B.06, subdivision 3, is amended to read:
171.31    Subd. 3. Payment; denial. The commissioner shall pay eligible vendors for
171.32placements made by local agencies under section 254B.03, subdivision 1, and placements
171.33by tribal designated agencies according to section 254B.09. The commissioner may
171.34reduce or deny payment of the state share when services are not provided according to the
171.35placement criteria established by the commissioner. The commissioner may pay for all or
171.36a portion of improper county chemical dependency placements and bill the county for the
172.1entire payment made when the placement did not comply with criteria established by the
172.2commissioner. The commissioner may make payments to vendors and charge the county
172.3100 percent of the payments if documentation of a county approved placement is received
172.4more than 30 working days, exclusive of weekends and holidays, after the date services
172.5began; or if the county approved invoice is received by the commissioner more than 120
172.6days after the last date of service provided. The commissioner shall not pay vendors until
172.7private insurance company claims have been settled.

172.8    Sec. 15. Minnesota Statutes 2006, section 256.476, subdivision 1, is amended to read:
172.9    Subdivision 1. Purpose and goals. The commissioner of human services shall
172.10establish a consumer support grant program for individuals with functional limitations and
172.11their families who wish to purchase and secure their own supports. The commissioner and
172.12local agencies shall jointly develop an implementation plan which must include a way to
172.13resolve the issues related to county liability. The program shall:
172.14    (1) make support grants available to individuals or families as an effective alternative
172.15to the developmental disability family support program, personal care attendant services,
172.16home health aide services, and private duty nursing services;
172.17    (2) provide consumers more control, flexibility, and responsibility over their services
172.18and supports;
172.19    (3) promote local program management and decision making; and
172.20    (4) encourage the use of informal and typical community supports.

172.21    Sec. 16. Minnesota Statutes 2006, section 256.476, subdivision 2, is amended to read:
172.22    Subd. 2. Definitions. For purposes of this section, the following terms have the
172.23meanings given them:
172.24    (a) "County board" means the county board of commissioners for the county of
172.25financial responsibility as defined in section 256G.02, subdivision 4, or its designated
172.26representative. When a human services board has been established under sections 402.01
172.27to 402.10, it shall be considered the county board for the purposes of this section.
172.28    (b) "Family" means the person's birth parents, adoptive parents or stepparents,
172.29siblings or stepsiblings, children or stepchildren, grandparents, grandchildren, niece,
172.30nephew, aunt, uncle, or spouse. For the purposes of this section, a family member is
172.31at least 18 years of age.
172.32    (c) "Functional limitations" means the long-term inability to perform an activity or
172.33task in one or more areas of major life activity, including self-care, understanding and use
172.34of language, learning, mobility, self-direction, and capacity for independent living. For the
172.35purpose of this section, the inability to perform an activity or task results from a mental,
172.36emotional, psychological, sensory, or physical disability, condition, or illness.
173.1    (d) "Informed choice" means a voluntary decision made by the person or,
173.2the person's legal representative, or other authorized representative after becoming
173.3familiarized with the alternatives to:
173.4    (1) select a preferred alternative from a number of feasible alternatives;
173.5    (2) select an alternative which may be developed in the future; and
173.6    (3) refuse any or all alternatives.
173.7    (e) "Local agency" means the local agency authorized by the county board or,
173.8for counties not participating in the consumer grant program by July 1, 2002, the
173.9commissioner, to carry out the provisions of this section.
173.10    (f) "Person" or "persons" means a person or persons meeting the eligibility criteria in
173.11subdivision 3.
173.12    (g) "Authorized representative" means an individual designated by the person or
173.13their legal representative to act on their behalf. This individual may be a family member,
173.14guardian, representative payee, or other individual designated by the person or their legal
173.15representative, if any, to assist in purchasing and arranging for supports. For the purposes
173.16of this section, an authorized representative is at least 18 years of age.
173.17    (h) "Screening" means the screening of a person's service needs under sections
173.18256B.0911 and 256B.092.
173.19    (i) "Supports" means services, care, aids, environmental modifications, or assistance
173.20purchased by the person or the person's family, the person's legal representative, or other
173.21authorized representative. Examples of supports include respite care, assistance with daily
173.22living, and assistive technology. For the purpose of this section, notwithstanding the
173.23provisions of section 144A.43, supports purchased under the consumer support program
173.24are not considered home care services.
173.25    (j) "Program of origination" means the program the individual transferred from
173.26when approved for the consumer support grant program.

173.27    Sec. 17. Minnesota Statutes 2006, section 256.476, subdivision 3, is amended to read:
173.28    Subd. 3. Eligibility to apply for grants. (a) A person is eligible to apply for a
173.29consumer support grant if the person meets all of the following criteria:
173.30    (1) the person is eligible for and has been approved to receive services under
173.31medical assistance as determined under sections 256B.055 and 256B.056 or the person
173.32has been approved to receive a grant under the developmental disability family support
173.33program under section 252.32;
173.34    (2) the person is able to direct and purchase the person's own care and supports, or
173.35the person has a family member, legal representative, or other authorized representative
173.36who can purchase and arrange supports on the person's behalf;
174.1    (3) the person has functional limitations, requires ongoing supports to live in the
174.2community, and is at risk of or would continue institutionalization without such supports;
174.3and
174.4    (4) the person will live in a home. For the purpose of this section, "home" means the
174.5person's own home or home of a person's family member. These homes are natural home
174.6settings and are not licensed by the Department of Health or Human Services.
174.7    (b) Persons may not concurrently receive a consumer support grant if they are:
174.8    (1) receiving personal care attendant and home health aide services, or private duty
174.9nursing under section 256B.0625; a developmental disability family support grant; or
174.10alternative care services under section 256B.0913; or
174.11    (2) residing in an institutional or congregate care setting.
174.12    (c) A person or person's family receiving a consumer support grant shall not be
174.13charged a fee or premium by a local agency for participating in the program.
174.14    (d) Individuals receiving home and community-based waivers under United States
174.15Code, title 42, section 1396h(c), are not eligible for the consumer support grant, except
174.16for individuals receiving consumer support grants before July 1, 2003, as long as other
174.17eligibility criteria are met.
174.18    (e) The commissioner shall establish a budgeted appropriation each fiscal year
174.19for the consumer support grant program. The number of individuals participating in
174.20the program will be adjusted so the total amount allocated to counties does not exceed
174.21the amount of the budgeted appropriation. The budgeted appropriation will be adjusted
174.22annually to accommodate changes in demand for the consumer support grants.

174.23    Sec. 18. Minnesota Statutes 2006, section 256.476, subdivision 4, is amended to read:
174.24    Subd. 4. Support grants; criteria and limitations. (a) A county board may
174.25choose to participate in the consumer support grant program. If a county has not chosen
174.26to participate by July 1, 2002, the commissioner shall contract with another county or
174.27other entity to provide access to residents of the nonparticipating county who choose
174.28the consumer support grant option. The commissioner shall notify the county board
174.29in a county that has declined to participate of the commissioner's intent to enter into
174.30a contract with another county or other entity at least 30 days in advance of entering
174.31into the contract. The local agency shall establish written procedures and criteria to
174.32determine the amount and use of support grants. These procedures must include, at least,
174.33the availability of respite care, assistance with daily living, and adaptive aids. The local
174.34agency may establish monthly or annual maximum amounts for grants and procedures
174.35where exceptional resources may be required to meet the health and safety needs of the
175.1person on a time-limited basis, however, the total amount awarded to each individual may
175.2not exceed the limits established in subdivision 11.
175.3    (b) Support grants to a person or a person's family, a person's legal representative,
175.4or other authorized representative will be provided through a monthly subsidy payment
175.5and be in the form of cash, voucher, or direct county payment to vendor. Support grant
175.6amounts must be determined by the local agency. Each service and item purchased with a
175.7support grant must meet all of the following criteria:
175.8    (1) it must be over and above the normal cost of caring for the person if the person
175.9did not have functional limitations;
175.10    (2) it must be directly attributable to the person's functional limitations;
175.11    (3) it must enable the person or the person's family, a person's legal representative,
175.12or other authorized representative to delay or prevent out-of-home placement of the
175.13person; and
175.14    (4) it must be consistent with the needs identified in the service agreement, when
175.15applicable.
175.16    (c) Items and services purchased with support grants must be those for which there
175.17are no other public or private funds available to the person or the person's family, a person's
175.18legal representative, or other authorized representative. Fees assessed to the person or the
175.19person's family for health and human services are not reimbursable through the grant.
175.20    (d) In approving or denying applications, the local agency shall consider the
175.21following factors:
175.22    (1) the extent and areas of the person's functional limitations;
175.23    (2) the degree of need in the home environment for additional support; and
175.24    (3) the potential effectiveness of the grant to maintain and support the person in the
175.25family environment or the person's own home.
175.26    (e) At the time of application to the program or screening for other services,
175.27the person or the person's family, a person's legal representative, or other authorized
175.28representative shall be provided sufficient information to ensure an informed choice
175.29of alternatives by the person, the person's legal representative, or other authorized
175.30representative, if any, or the person's family. The application shall be made to the local
175.31agency and shall specify the needs of the person and family, the form and amount of
175.32grant requested, the items and services to be reimbursed, and evidence of eligibility for
175.33medical assistance.
175.34    (f) Upon approval of an application by the local agency and agreement on a support
175.35plan for the person or person's family, the local agency shall make grants to the person or
176.1the person's family. The grant shall be in an amount for the direct costs of the services or
176.2supports outlined in the service agreement.
176.3    (g) Reimbursable costs shall not include costs for resources already available, such as
176.4special education classes, day training and habilitation, case management, other services to
176.5which the person is entitled, medical costs covered by insurance or other health programs,
176.6or other resources usually available at no cost to the person or the person's family.
176.7    (h) The state of Minnesota, the county boards participating in the consumer
176.8support grant program, or the agencies acting on behalf of the county boards in the
176.9implementation and administration of the consumer support grant program shall not be
176.10liable for damages, injuries, or liabilities sustained through the purchase of support by
176.11the individual, the individual's family, or the authorized representative under this section
176.12with funds received through the consumer support grant program. Liabilities include but
176.13are not limited to: workers' compensation liability, the Federal Insurance Contributions
176.14Act (FICA), or the Federal Unemployment Tax Act (FUTA). For purposes of this section,
176.15participating county boards and agencies acting on behalf of county boards are exempt
176.16from the provisions of section 268.04.

176.17    Sec. 19. Minnesota Statutes 2006, section 256.476, subdivision 5, is amended to read:
176.18    Subd. 5. Reimbursement, allocations, and reporting. (a) For the purpose of
176.19transferring persons to the consumer support grant program from the developmental
176.20disability family support program and personal care assistant services, home health
176.21aide services, or private duty nursing services, the amount of funds transferred by the
176.22commissioner between the developmental disability family support program account, the
176.23medical assistance account, or the consumer support grant account shall be based on each
176.24county's participation in transferring persons to the consumer support grant program
176.25from those programs and services.
176.26    (b) At the beginning of each fiscal year, county allocations for consumer support
176.27grants shall be based on:
176.28    (1) the number of persons to whom the county board expects to provide consumer
176.29supports grants;
176.30    (2) their eligibility for current program and services;
176.31    (3) the amount of nonfederal dollars allowed under subdivision 11; and
176.32    (4) projected dates when persons will start receiving grants. County allocations shall
176.33be adjusted periodically by the commissioner based on the actual transfer of persons or
176.34service openings, and the nonfederal dollars associated with those persons or service
176.35openings, to the consumer support grant program.
177.1    (c) The amount of funds transferred by the commissioner from the medical
177.2assistance account for an individual may be changed if it is determined by the county or its
177.3agent that the individual's need for support has changed.
177.4    (d) The authority to utilize funds transferred to the consumer support grant account
177.5for the purposes of implementing and administering the consumer support grant program
177.6will not be limited or constrained by the spending authority provided to the program
177.7of origination.
177.8    (e) The commissioner may use up to five percent of each county's allocation, as
177.9adjusted, for payments for administrative expenses, to be paid as a proportionate addition
177.10to reported direct service expenditures.
177.11    (f) The county allocation for each individual or individual's family cannot exceed
177.12the amount allowed under subdivision 11.
177.13    (g) The commissioner may recover, suspend, or withhold payments if the county
177.14board, local agency, or grantee does not comply with the requirements of this section.
177.15    (h) Grant funds unexpended by consumers shall return to the state once a year. The
177.16annual return of unexpended grant funds shall occur in the quarter following the end of
177.17the state fiscal year.

177.18    Sec. 20. Minnesota Statutes 2006, section 256.476, subdivision 10, is amended to read:
177.19    Subd. 10. Consumer responsibilities. Persons receiving grants under this section
177.20shall:
177.21    (1) spend the grant money in a manner consistent with their agreement with the
177.22local agency;
177.23    (2) notify the local agency of any necessary changes in the grant or the items on
177.24which it is spent;
177.25    (3) notify the local agency of any decision made by the person, the a person's legal
177.26representative, or the person's family or other authorized representative that would change
177.27their eligibility for consumer support grants;
177.28    (4) arrange and pay for supports; and
177.29    (5) inform the local agency of areas where they have experienced difficulty securing
177.30or maintaining supports.

177.31    Sec. 21. Minnesota Statutes 2006, section 256.974, is amended to read:
177.32256.974 OFFICE OF OMBUDSMAN FOR OLDER MINNESOTANS
177.33LONG-TERM CARE; LOCAL PROGRAMS.
177.34    The ombudsman for older Minnesotans long-term care serves in the classified service
177.35under section 256.01, subdivision 7, in an office within the Minnesota Board on Aging that
177.36incorporates the long-term care ombudsman program required by the Older Americans
178.1Act, Public Law 100-75 as amended, United States Code, title 42, section 3027(a)(12)
178.2(9) and 3058g (a), and established within the Minnesota Board on Aging. The Minnesota
178.3Board on Aging may make grants to and designate local programs for the provision of
178.4ombudsman services to clients in county or multicounty areas. The local program may not
178.5be an agency engaged in the provision of nursing home care, hospital care, or home care
178.6services either directly or by contract, or have the responsibility for planning, coordinating,
178.7funding, or administering nursing home care, hospital care, or home care services.

178.8    Sec. 22. Minnesota Statutes 2006, section 256.9744, subdivision 1, is amended to read:
178.9    Subdivision 1. Classification. Except as provided in this section, data maintained
178.10by the office under sections 256.974 to 256.9744 are private data on individuals or
178.11nonpublic data as defined in section 13.02, subdivision 9 or 12, and must be maintained
178.12in accordance with the requirements of Public Law 100-75 the Older Americans Act, as
178.13amended, United States Code, title 42, section 3027(a)(12)(D) 3058g(d).

178.14    Sec. 23. Minnesota Statutes 2006, section 256B.0625, subdivision 13c, is amended to
178.15read:
178.16    Subd. 13c. Formulary committee. The commissioner, after receiving
178.17recommendations from professional medical associations and professional pharmacy
178.18associations, and consumer groups shall designate a Formulary Committee to carry
178.19out duties as described in subdivisions 13 to 13g. The Formulary Committee shall be
178.20comprised of four licensed physicians actively engaged in the practice of medicine in
178.21Minnesota one of whom must be actively engaged in the treatment of persons with mental
178.22illness; at least three licensed pharmacists actively engaged in the practice of pharmacy
178.23in Minnesota; and one consumer representative; the remainder to be made up of health
178.24care professionals who are licensed in their field and have recognized knowledge in the
178.25clinically appropriate prescribing, dispensing, and monitoring of covered outpatient drugs.
178.26Members of the Formulary Committee shall not be employed by the Department of
178.27Human Services, but the committee shall be staffed by an employee of the department
178.28who shall serve as an ex officio, nonvoting member of the board committee. The
178.29department's medical director shall also serve as an ex officio, nonvoting member for the
178.30committee. Committee members shall serve three-year terms and may be reappointed
178.31by the commissioner. The Formulary Committee shall meet at least quarterly. The
178.32commissioner may require more frequent Formulary Committee meetings as needed. An
178.33honorarium of $100 per meeting and reimbursement for mileage shall be paid to each
178.34committee member in attendance.

179.1    Sec. 24. Minnesota Statutes 2006, section 256B.0625, subdivision 23, is amended to
179.2read:
179.3    Subd. 23. Day treatment services. Medical assistance covers day treatment
179.4services as specified in sections 245.462, subdivision 8, and 245.4871, subdivision 10, that
179.5are provided under contract with the county board. Notwithstanding Minnesota Rules,
179.6part 9505.0323, subpart 15, the commissioner may set authorization thresholds for day
179.7treatment for adults according to section 256B.0625, subdivision 25. Notwithstanding
179.8Minnesota Rules, part 9505.0323, subpart 15, effective July 1, 2004, medical assistance
179.9covers day treatment services for children as specified under section 256B.0943.

179.10    Sec. 25. Minnesota Statutes 2006, section 256B.0911, subdivision 4c, is amended to
179.11read:
179.12    Subd. 4c. Screening requirements. (a) A person may be screened for nursing
179.13facility admission by telephone or in a face-to-face screening interview. Consultation team
179.14members shall identify each individual's needs using the following categories:
179.15    (1) the person needs no face-to-face screening interview to determine the need
179.16for nursing facility level of care based on information obtained from other health care
179.17professionals;
179.18    (2) the person needs an immediate face-to-face screening interview to determine the
179.19need for nursing facility level of care and complete activities required under subdivision
179.204a; or
179.21    (3) the person may be exempt from screening requirements as outlined in subdivision
179.224b, but will need transitional assistance after admission or in-person follow-along after
179.23a return home.
179.24    (b) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
179.25facility must be screened prior to admission.
179.26    (c) The long-term care consultation team shall recommend a case mix classification
179.27for persons admitted to a certified nursing facility when sufficient information is received
179.28to make that classification. The nursing facility is authorized to conduct all case mix
179.29assessments for persons who have been screened prior to admission for whom the county
179.30did not recommend a case mix classification. The nursing facility is authorized to conduct
179.31all case mix assessments for persons admitted to the facility prior to a preadmission
179.32screening. The county retains the responsibility of distributing appropriate case mix
179.33forms to the nursing facility.
179.34    (d) (c) The county screening or intake activity must include processes to identify
179.35persons who may require transition assistance as described in subdivision 3b.

180.1    Sec. 26. Minnesota Statutes 2006, section 256B.0913, subdivision 4, is amended to
180.2read:
180.3    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
180.4    (a) Funding for services under the alternative care program is available to persons who
180.5meet the following criteria:
180.6    (1) the person has been determined by a community assessment under section
180.7256B.0911 to be a person who would require the level of care provided in a nursing
180.8facility, but for the provision of services under the alternative care program;
180.9    (2) the person is age 65 or older;
180.10    (3) the person would be eligible for medical assistance within 135 days of admission
180.11to a nursing facility;
180.12    (4) the person is not ineligible for the medical assistance program due to an asset
180.13transfer penalty;
180.14    (5) the person needs long-term care services that are not funded through other state
180.15or federal funding;
180.16    (6) the monthly cost of the alternative care services funded by the program for
180.17this person does not exceed 75 percent of the monthly limit described under section
180.18256B.0915, subdivision 3a . This monthly limit does not prohibit the alternative care client
180.19from payment for additional services, but in no case may the cost of additional services
180.20purchased under this section exceed the difference between the client's monthly service
180.21limit defined under section 256B.0915, subdivision 3, and the alternative care program
180.22monthly service limit defined in this paragraph. If medical care-related supplies and
180.23equipment or environmental modifications and adaptations are or will be purchased for
180.24an alternative care services recipient, the costs may be prorated on a monthly basis for
180.25up to 12 consecutive months beginning with the month of purchase. If the monthly cost
180.26of a recipient's other alternative care services exceeds the monthly limit established in
180.27this paragraph, the annual cost of the alternative care services shall be determined. In this
180.28event, the annual cost of alternative care services shall not exceed 12 times the monthly
180.29limit described in this paragraph; and
180.30    (7) the person is making timely payments of the assessed monthly fee.
180.31A person is ineligible if payment of the fee is over 60 days past due, unless the person
180.32agrees to:
180.33    (i) the appointment of a representative payee;
180.34    (ii) automatic payment from a financial account;
180.35    (iii) the establishment of greater family involvement in the financial management of
180.36payments; or
181.1    (iv) another method acceptable to the county lead agency to ensure prompt fee
181.2payments.
181.3    The county shall lead agency may extend the client's eligibility as necessary while
181.4making arrangements to facilitate payment of past-due amounts and future premium
181.5payments. Following disenrollment due to nonpayment of a monthly fee, eligibility shall
181.6not be reinstated for a period of 30 days.
181.7    (b) Alternative care funding under this subdivision is not available for a person
181.8who is a medical assistance recipient or who would be eligible for medical assistance
181.9without a spenddown or waiver obligation. A person whose initial application for medical
181.10assistance and the elderly waiver program is being processed may be served under the
181.11alternative care program for a period up to 60 days. If the individual is found to be eligible
181.12for medical assistance, medical assistance must be billed for services payable under the
181.13federally approved elderly waiver plan and delivered from the date the individual was
181.14found eligible for the federally approved elderly waiver plan. Notwithstanding this
181.15provision, alternative care funds may not be used to pay for any service the cost of which:
181.16(i) is payable by medical assistance; (ii) is used by a recipient to meet a waiver obligation;
181.17or (iii) is used to pay a medical assistance income spenddown for a person who is eligible
181.18to participate in the federally approved elderly waiver program under the special income
181.19standard provision.
181.20    (c) Alternative care funding is not available for a person who resides in a licensed
181.21nursing home, certified boarding care home, hospital, or intermediate care facility, except
181.22for case management services which are provided in support of the discharge planning
181.23process for a nursing home resident or certified boarding care home resident to assist with
181.24a relocation process to a community-based setting.
181.25    (d) Alternative care funding is not available for a person whose income is greater
181.26than the maintenance needs allowance under section 256B.0915, subdivision 1d, but is
181.27equal to or less than 120 percent of the federal poverty guideline effective July 1 in the
181.28fiscal year for which alternative care eligibility is determined, who would be eligible for
181.29the elderly waiver with a waiver obligation.

181.30    Sec. 27. Minnesota Statutes 2006, section 256B.0913, subdivision 5, is amended to
181.31read:
181.32    Subd. 5. Services covered under alternative care. Alternative care funding may
181.33be used for payment of costs of:
181.34    (1) adult day care;
181.35    (2) home health aide;
181.36    (3) homemaker services;
182.1    (4) personal care;
182.2    (5) case management;
182.3    (6) respite care;
182.4    (7) care-related supplies and equipment;
182.5    (8) meals delivered to the home;
182.6    (9) nonmedical transportation;
182.7    (10) nursing services;
182.8    (11) chore services;
182.9    (12) companion services;
182.10    (13) nutrition services;
182.11    (14) training for direct informal caregivers;
182.12    (15) telehome care to provide services in their own homes in conjunction with
182.13in-home visits;
182.14    (16) discretionary services, for which counties may make payment from their
182.15alternative care program allocation or services not otherwise defined in this section
182.16or section 256B.0625, following approval by the commissioner consumer-directed
182.17community services under the alternative care programs which are available statewide and
182.18limited to the average monthly expenditures representative of all alternative care program
182.19participants for the same case mix resident class assigned in the most recent fiscal year for
182.20which complete expenditure data is available;
182.21    (17) environmental modifications and adaptations; and
182.22    (18) direct cash payments for which counties may make payment from their
182.23alternative care program allocation to clients for the purpose of purchasing services,
182.24following approval by the commissioner, and subject to the provisions of subdivision 5h,
182.25until approval and implementation of consumer-directed services through the federally
182.26approved elderly waiver plan. Upon implementation, consumer-directed services under
182.27the alternative care program are available statewide and limited to the average monthly
182.28expenditures representative of all alternative care program participants for the same case
182.29mix resident class assigned in the most recent fiscal year for which complete expenditure
182.30data is available discretionary services, for which lead agencies may make payment from
182.31their alternative care program allocation for services not otherwise defined in this section
182.32or section 256B.0625, following approval by the commissioner.
182.33    Total annual payments for discretionary services and direct cash payments, until
182.34the federally approved consumer-directed service option is implemented statewide, for
182.35all clients within a county may served by a lead agency must not exceed 25 percent of
182.36that county's lead agency's annual alternative care program base allocation. Thereafter,
183.1discretionary services are limited to 25 percent of the county's annual alternative care
183.2program base allocation.

183.3    Sec. 28. Minnesota Statutes 2006, section 256B.0913, subdivision 5a, is amended to
183.4read:
183.5    Subd. 5a. Services; service definitions; service standards. (a) Unless specified in
183.6statute, the services, service definitions, and standards for alternative care services shall
183.7be the same as the services, service definitions, and standards specified in the federally
183.8approved elderly waiver plan, except for transitional support services, assisted living
183.9services, adult foster care services, and residential care services.
183.10    (b) The county lead agency must ensure that the funds are not used to supplant
183.11services available through other public assistance or services programs. For a provider of
183.12supplies and equipment when the monthly cost of the supplies and equipment is less than
183.13$250, persons or agencies must be employed by or under a contract with the county lead
183.14agency or the public health nursing agency of the local board of health in order to receive
183.15funding under the alternative care program. Supplies and equipment may be purchased
183.16from a vendor not certified to participate in the Medicaid program if the cost for the
183.17item is less than that of a Medicaid vendor.
183.18    (c) Personal care services must meet the service standards defined in the federally
183.19approved elderly waiver plan, except that a county lead agency may contract with a
183.20client's relative who meets the relative hardship waiver requirements or a relative who
183.21meets the criteria and is also the responsible party under an individual service plan that
183.22ensures the client's health and safety and supervision of the personal care services by a
183.23qualified professional as defined in section 256B.0625, subdivision 19c. Relative hardship
183.24is established by the county lead agency when the client's care causes a relative caregiver
183.25to do any of the following: resign from a paying job, reduce work hours resulting in lost
183.26wages, obtain a leave of absence resulting in lost wages, incur substantial client-related
183.27expenses, provide services to address authorized, unstaffed direct care time, or meet
183.28special needs of the client unmet in the formal service plan.

183.29    Sec. 29. Minnesota Statutes 2006, section 256B.0913, subdivision 8, is amended to
183.30read:
183.31    Subd. 8. Requirements for individual care plan. (a) The case manager shall
183.32implement the plan of care for each alternative care client and ensure that a client's
183.33service needs and eligibility are reassessed at least every 12 months. The plan shall
183.34include any services prescribed by the individual's attending physician as necessary to
183.35allow the individual to remain in a community setting. In developing the individual's care
183.36plan, the case manager should include the use of volunteers from families and neighbors,
184.1religious organizations, social clubs, and civic and service organizations to support the
184.2formal home care services. The county lead agency shall be held harmless for damages or
184.3injuries sustained through the use of volunteers under this subdivision including workers'
184.4compensation liability. The county of service case manager shall provide documentation
184.5in each individual's plan of care and, if requested, to the commissioner that the most
184.6cost-effective alternatives available have been offered to the individual and that the
184.7individual was free to choose among available qualified providers, both public and private,
184.8including qualified case management or service coordination providers other than those
184.9employed by any county; however, the county or tribe maintains responsibility for prior
184.10authorizing services in accordance with statutory and administrative requirements. The
184.11case manager must give the individual a ten-day written notice of any denial, termination,
184.12or reduction of alternative care services.
184.13    (b) The county of service or tribe must provide access to and arrange for case
184.14management services, including assuring implementation of the plan. "County of service"
184.15has the meaning given it in Minnesota Rules, part 9505.0015, subpart 11. The county of
184.16service must notify the county of financial responsibility of the approved care plan and
184.17the amount of encumbered funds.

184.18    Sec. 30. Minnesota Statutes 2006, section 256B.0913, subdivision 9, is amended to
184.19read:
184.20    Subd. 9. Contracting provisions for providers. Alternative care funds paid to
184.21service providers are subject to audit by the commissioner for fiscal and utilization control.
184.22    The lead agency must select providers for contracts or agreements using the
184.23following criteria and other criteria established by the county lead agency:
184.24    (1) the need for the particular services offered by the provider;
184.25    (2) the population to be served, including the number of clients, the length of time
184.26services will be provided, and the medical condition of clients;
184.27    (3) the geographic area to be served;
184.28    (4) quality assurance methods, including appropriate licensure, certification, or
184.29standards, and supervision of employees when needed;
184.30    (5) rates for each service and unit of service exclusive of county lead agency
184.31administrative costs;
184.32    (6) evaluation of services previously delivered by the provider; and
184.33    (7) contract or agreement conditions, including billing requirements, cancellation,
184.34and indemnification.
184.35    The county lead agency must evaluate its own agency services under the criteria
184.36established for other providers.

185.1    Sec. 31. Minnesota Statutes 2006, section 256B.0913, subdivision 10, is amended to
185.2read:
185.3    Subd. 10. Allocation formula. (a) The alternative care appropriation for fiscal
185.4years 1992 and beyond shall cover only alternative care eligible clients. By July 1 15 of
185.5each year, the commissioner shall allocate to county agencies the state funds available for
185.6alternative care for persons eligible under subdivision 2.
185.7    (b) The adjusted base for each county lead agency is the county's lead agency's
185.8current fiscal year base allocation plus any targeted funds approved during the current
185.9fiscal year. Calculations for paragraphs (c) and (d) are to be made as follows: for each
185.10county lead agency, the determination of alternative care program expenditures shall be
185.11based on payments for services rendered from April 1 through March 31 in the base year,
185.12to the extent that claims have been submitted and paid by June 1 of that year.
185.13    (c) If the alternative care program expenditures as defined in paragraph (b) are 95
185.14percent or more of the county's lead agency's adjusted base allocation, the allocation for
185.15the next fiscal year is 100 percent of the adjusted base, plus inflation to the extent that
185.16inflation is included in the state budget.
185.17    (d) If the alternative care program expenditures as defined in paragraph (b) are less
185.18than 95 percent of the county's lead agency's adjusted base allocation, the allocation
185.19for the next fiscal year is the adjusted base allocation less the amount of unspent funds
185.20below the 95 percent level.
185.21    (e) If the annual legislative appropriation for the alternative care program is
185.22inadequate to fund the combined county lead agency allocations for a biennium, the
185.23commissioner shall distribute to each county lead agency the entire annual appropriation
185.24as that county's lead agency's percentage of the computed base as calculated in paragraphs
185.25(c) and (d).
185.26    (f) On agreement between the commissioner and the lead agency, the commissioner
185.27may have discretion to reallocate alternative care base allocations distributed to lead
185.28agencies in which the base amount exceeds program expenditures.

185.29    Sec. 32. Minnesota Statutes 2006, section 256B.0913, subdivision 11, is amended to
185.30read:
185.31    Subd. 11. Targeted funding. (a) The purpose of targeted funding is to make
185.32additional money available to counties lead agencies with the greatest need. Targeted
185.33funds are not intended to be distributed equitably among all counties lead agencies, but
185.34rather, allocated to those with long-term care strategies that meet state goals.
186.1    (b) The funds available for targeted funding shall be the total appropriation for each
186.2fiscal year minus county lead agency allocations determined under subdivision 10 as
186.3adjusted for any inflation increases provided in appropriations for the biennium.
186.4    (c) The commissioner shall allocate targeted funds to counties lead agencies that
186.5demonstrate to the satisfaction of the commissioner that they have developed feasible
186.6plans to increase alternative care spending. In making targeted funding allocations, the
186.7commissioner shall use the following priorities:
186.8    (1) counties lead agencies that received a lower allocation in fiscal year 1991 than in
186.9fiscal year 1990. Counties remain in this priority until they have been restored to their
186.10fiscal year 1990 level plus inflation;
186.11    (2) counties lead agencies that sustain a base allocation reduction for failure to spend
186.1295 percent of the allocation if they demonstrate that the base reduction should be restored;
186.13    (3) counties lead agencies that propose projects to divert community residents from
186.14nursing home placement or convert nursing home residents to community living; and
186.15    (4) counties lead agencies that can otherwise justify program growth by
186.16demonstrating the existence of waiting lists, demographically justified needs, or other
186.17unmet needs.
186.18    (d) Counties Lead agencies that would receive targeted funds according to
186.19paragraph (c) must demonstrate to the commissioner's satisfaction that the funds
186.20would be appropriately spent by showing how the funds would be used to further the
186.21state's alternative care goals as described in subdivision 1, and that the county has the
186.22administrative and service delivery capability to use them.
186.23    (e) The commissioner shall request applications make applications available for
186.24targeted funds by November 1 of each year. The counties lead agencies selected for
186.25targeted funds shall be notified of the amount of their additional funding. Targeted funds
186.26allocated to a county lead agency in one year shall be treated as part of the county's lead
186.27agency's base allocation for that year in determining allocations for subsequent years. No
186.28reallocations between counties lead agencies shall be made.

186.29    Sec. 33. Minnesota Statutes 2006, section 256B.0913, subdivision 12, is amended to
186.30read:
186.31    Subd. 12. Client fees. (a) A fee is required for all alternative care eligible clients
186.32to help pay for the cost of participating in the program. The amount of the fee for the
186.33alternative care client shall be determined as follows:
186.34    (1) when the alternative care client's income less recurring and predictable medical
186.35expenses is less than 100 percent of the federal poverty guideline effective on July 1 of
187.1the state fiscal year in which the fee is being computed, and total assets are less than
187.2$10,000, the fee is zero;
187.3    (2) when the alternative care client's income less recurring and predictable medical
187.4expenses is equal to or greater than 100 percent but less than 150 percent of the federal
187.5poverty guideline effective on July 1 of the state fiscal year in which the fee is being
187.6computed, and total assets are less than $10,000, the fee is five percent of the cost of
187.7alternative care services;
187.8    (3) when the alternative care client's income less recurring and predictable medical
187.9expenses is equal to or greater than 150 percent but less than 200 percent of the federal
187.10poverty guidelines effective on July 1 of the state fiscal year in which the fee is being
187.11computed and assets are less than $10,000, the fee is 15 percent of the cost of alternative
187.12care services;
187.13    (4) when the alternative care client's income less recurring and predictable medical
187.14expenses is equal to or greater than 200 percent of the federal poverty guidelines effective
187.15on July 1 of the state fiscal year in which the fee is being computed and assets are less than
187.16$10,000, the fee is 30 percent of the cost of alternative care services; and
187.17    (5) when the alternative care client's assets are equal to or greater than $10,000, the
187.18fee is 30 percent of the cost of alternative care services.
187.19    For married persons, total assets are defined as the total marital assets less the
187.20estimated community spouse asset allowance, under section 256B.059, if applicable. For
187.21married persons, total income is defined as the client's income less the monthly spousal
187.22allotment, under section 256B.058.
187.23    All alternative care services shall be included in the estimated costs for the purpose
187.24of determining the fee.
187.25    Fees are due and payable each month alternative care services are received unless the
187.26actual cost of the services is less than the fee, in which case the fee is the lesser amount.
187.27    (b) The fee shall be waived by the commissioner when:
187.28    (1) a person who is residing in a nursing facility is receiving case management only;
187.29    (2) a married couple is requesting an asset assessment under the spousal
187.30impoverishment provisions;
187.31    (3) a person is found eligible for alternative care, but is not yet receiving alternative
187.32care services including case management services; or
187.33    (4) a person has chosen to participate in a consumer-directed service plan for which
187.34the cost is no greater than the total cost of the person's alternative care service plan less
187.35the monthly fee amount that would otherwise be assessed.
188.1    (c) The county agency must record in the state's receivable system the client's
188.2assessed fee amount or the reason the fee has been waived. The commissioner will bill
188.3and collect the fee from the client. Money collected must be deposited in the general fund
188.4and is appropriated to the commissioner for the alternative care program. The client must
188.5supply the county lead agency with the client's Social Security number at the time of
188.6application. The county lead agency shall supply the commissioner with the client's Social
188.7Security number and other information the commissioner requires to collect the fee from
188.8the client. The commissioner shall collect unpaid fees using the Revenue Recapture Act in
188.9chapter 270A and other methods available to the commissioner. The commissioner may
188.10require counties lead agencies to inform clients of the collection procedures that may be
188.11used by the state if a fee is not paid. This paragraph does not apply to alternative care
188.12pilot projects authorized in Laws 1993, First Special Session chapter 1, article 5, section
188.13133, if a county operating under the pilot project reports the following dollar amounts
188.14to the commissioner quarterly:
188.15    (1) total fees billed to clients;
188.16    (2) total collections of fees billed; and
188.17    (3) balance of fees owed by clients.
188.18If a county lead agency does not adhere to these reporting requirements, the commissioner
188.19may terminate the billing, collecting, and remitting portions of the pilot project and require
188.20the county lead agency involved to operate under the procedures set forth in this paragraph.

188.21    Sec. 34. Minnesota Statutes 2006, section 256B.0913, subdivision 13, is amended to
188.22read:
188.23    Subd. 13. County Lead agency biennial plan. The county lead agency biennial
188.24plan for long-term care consultation services under section 256B.0911, the alternative
188.25care program under this section, and waivers for the elderly under section 256B.0915,
188.26shall be submitted by the lead agency as the home and community-based services quality
188.27assurance plan on a form provided by the commissioner.

188.28    Sec. 35. Minnesota Statutes 2006, section 256B.0913, subdivision 14, is amended to
188.29read:
188.30    Subd. 14. Provider requirements, payment, and rate adjustments. (a) Unless
188.31otherwise specified in statute, providers must be enrolled as Minnesota health care
188.32program providers and abide by the requirements for provider participation according to
188.33Minnesota Rules, part 9505.0195.
188.34    (b) Payment for provided alternative care services as approved by the client's
188.35case manager shall occur through the invoice processing procedures of the department's
188.36Medicaid Management Information System (MMIS). To receive payment, the county lead
189.1agency or vendor must submit invoices within 12 months following the date of service.
189.2The county lead agency and its vendors under contract shall not be reimbursed for services
189.3which exceed the county allocation.
189.4    (c) The county lead agency shall negotiate individual rates with vendors and may
189.5authorize service payment for actual costs up to the county's current approved rate.
189.6Notwithstanding any other rule or statutory provision to the contrary, the commissioner
189.7shall not be authorized to increase rates by an annual inflation factor, unless so authorized
189.8by the legislature. To improve access to community services and eliminate payment
189.9disparities between the alternative care program and the elderly waiver program, the
189.10commissioner shall establish statewide maximum service rate limits and eliminate
189.11county-specific service rate limits.
189.12    (1) Effective July 1, 2001, for service rate limits, except those in subdivision 5,
189.13paragraphs (d) and (i), the rate limit for each service shall be the greater of the alternative
189.14care statewide maximum rate or the elderly waiver statewide maximum rate.
189.15    (2) Counties Lead agencies may negotiate individual service rates with vendors for
189.16actual costs up to the statewide maximum service rate limit.

189.17    Sec. 36. Minnesota Statutes 2006, section 256B.0919, subdivision 3, is amended to
189.18read:
189.19    Subd. 3. County certification of persons providing adult foster care to related
189.20persons. A person exempt from licensure under section 245A.03, subdivision 2, who
189.21provides adult foster care to a related individual age 65 and older, and who meets the
189.22requirements in Minnesota Rules, parts 9555.5105 to 9555.6265, may be certified by the
189.23county to provide adult foster care. A person certified by the county to provide adult foster
189.24care may be reimbursed for services provided and eligible for funding under sections
189.25256B.0913 and section 256B.0915, if the relative would suffer a financial hardship as
189.26a result of providing care. For purposes of this subdivision, financial hardship refers
189.27to a situation in which a relative incurs a substantial reduction in income as a result of
189.28resigning from a full-time job or taking a leave of absence without pay from a full-time
189.29job to care for the client.

189.30    Sec. 37. Minnesota Statutes 2006, section 256B.0943, subdivision 6, is amended to
189.31read:
189.32    Subd. 6. Provider entity clinical infrastructure requirements. (a) To be
189.33an eligible provider entity under this section, a provider entity must have a clinical
189.34infrastructure that utilizes diagnostic assessment, an individualized treatment plan,
189.35service delivery, and individual treatment plan review that are culturally competent,
189.36child-centered, and family-driven to achieve maximum benefit for the client. The provider
190.1entity must review and update the clinical policies and procedures every three years and
190.2must distribute the policies and procedures to staff initially and upon each subsequent
190.3update.
190.4    (b) The clinical infrastructure written policies and procedures must include policies
190.5and procedures for:
190.6    (1) providing or obtaining a client's diagnostic assessment that identifies acute and
190.7chronic clinical disorders, co-occurring medical conditions, sources of psychological and
190.8environmental problems, and a functional assessment. The functional assessment must
190.9clearly summarize the client's individual strengths and needs;
190.10    (2) developing an individual treatment plan that is:
190.11    (i) based on the information in the client's diagnostic assessment;
190.12    (ii) developed no later than the end of the first psychotherapy session after the
190.13completion of the client's diagnostic assessment by the mental health professional who
190.14provides the client's psychotherapy;
190.15    (iii) developed through a child-centered, family-driven planning process that
190.16identifies service needs and individualized, planned, and culturally appropriate
190.17interventions that contain specific treatment goals and objectives for the client and the
190.18client's family or foster family;
190.19    (iv) reviewed at least once every 90 days and revised, if necessary; and
190.20    (v) signed by the client or, if appropriate, by the client's parent or other person
190.21authorized by statute to consent to mental health services for the client;
190.22    (3) developing an individual behavior plan that documents services to be provided
190.23by the mental health behavioral aide. The individual behavior plan must include:
190.24    (i) detailed instructions on the service to be provided;
190.25    (ii) time allocated to each service;
190.26    (iii) methods of documenting the child's behavior;
190.27    (iv) methods of monitoring the child's progress in reaching objectives; and
190.28    (v) goals to increase or decrease targeted behavior as identified in the individual
190.29treatment plan;
190.30    (4) clinical supervision of the mental health practitioner and mental health behavioral
190.31aide. A mental health professional must document the clinical supervision the professional
190.32provides by cosigning individual treatment plans and making entries in the client's record
190.33on supervisory activities. Clinical supervision does not include the authority to make or
190.34terminate court-ordered placements of the child. A clinical supervisor must be available
190.35for urgent consultation as required by the individual client's needs or the situation. Clinical
190.36supervision may occur individually or in a small group to discuss treatment and review
191.1progress toward goals. The focus of clinical supervision must be the client's treatment
191.2needs and progress and the mental health practitioner's or behavioral aide's ability to
191.3provide services;
191.4    (4a) CTSS certified provider entities providing day treatment programs must meet
191.5the conditions in items (i) to (iii):
191.6    (i) the provider supervisor must be present and available on the premises more
191.7than 50 percent of the time in a five-working-day period during which the supervisee is
191.8providing a mental health service;
191.9    (ii) the diagnosis and the client's individual treatment plan or a change in the
191.10diagnosis or individual treatment plan must be made by or reviewed, approved, and signed
191.11by the provider supervisor; and
191.12    (iii) every 30 days, the supervisor must review and sign the record of the client's care
191.13for all activities in the preceding 30-day period;
191.14    (4b) for all other services provided under CTSS, clinical supervision standards
191.15provided in items (i) to (iii) must be used:
191.16    (i) medical assistance shall reimburse a mental health practitioner who maintains a
191.17consulting relationship with a mental health professional who accepts full professional
191.18responsibility and is present on site for at least one observation during the first 12 hours
191.19in which the mental health practitioner provides the individual, family, or group skills
191.20training to the child or the child's family;
191.21    (ii) thereafter, the mental health professional is required to be present on site for
191.22observation as clinically appropriate when the mental health practitioner is providing
191.23individual, family, or group skills training to the child or the child's family; and
191.24    (iii) the observation must be a minimum of one clinical unit. The on-site presence of
191.25the mental health professional must be documented in the child's record and signed by the
191.26mental health professional who accepts full professional responsibility;
191.27    (5) providing direction to a mental health behavioral aide. For entities that employ
191.28mental health behavioral aides, the clinical supervisor must be employed by the provider
191.29entity or other certified children's therapeutic supports and services provider entity to
191.30ensure necessary and appropriate oversight for the client's treatment and continuity
191.31of care. The mental health professional or mental health practitioner giving direction
191.32must begin with the goals on the individualized treatment plan, and instruct the mental
191.33health behavioral aide on how to construct therapeutic activities and interventions that
191.34will lead to goal attainment. The professional or practitioner giving direction must also
191.35instruct the mental health behavioral aide about the client's diagnosis, functional status,
191.36and other characteristics that are likely to affect service delivery. Direction must also
192.1include determining that the mental health behavioral aide has the skills to interact with
192.2the client and the client's family in ways that convey personal and cultural respect and
192.3that the aide actively solicits information relevant to treatment from the family. The aide
192.4must be able to clearly explain the activities the aide is doing with the client and the
192.5activities' relationship to treatment goals. Direction is more didactic than is supervision
192.6and requires the professional or practitioner providing it to continuously evaluate the
192.7mental health behavioral aide's ability to carry out the activities of the individualized
192.8treatment plan and the individualized behavior plan. When providing direction, the
192.9professional or practitioner must:
192.10    (i) review progress notes prepared by the mental health behavioral aide for accuracy
192.11and consistency with diagnostic assessment, treatment plan, and behavior goals and the
192.12professional or practitioner must approve and sign the progress notes;
192.13    (ii) identify changes in treatment strategies, revise the individual behavior plan,
192.14and communicate treatment instructions and methodologies as appropriate to ensure
192.15that treatment is implemented correctly;
192.16    (iii) demonstrate family-friendly behaviors that support healthy collaboration among
192.17the child, the child's family, and providers as treatment is planned and implemented;
192.18    (iv) ensure that the mental health behavioral aide is able to effectively communicate
192.19with the child, the child's family, and the provider; and
192.20    (v) record the results of any evaluation and corrective actions taken to modify the
192.21work of the mental health behavioral aide;
192.22    (6) providing service delivery that implements the individual treatment plan and
192.23meets the requirements under subdivision 9; and
192.24    (7) individual treatment plan review. The review must determine the extent to which
192.25the services have met the goals and objectives in the previous treatment plan. The review
192.26must assess the client's progress and ensure that services and treatment goals continue to
192.27be necessary and appropriate to the client and the client's family or foster family. Revision
192.28of the individual treatment plan does not require a new diagnostic assessment unless the
192.29client's mental health status has changed markedly. The updated treatment plan must be
192.30signed by the client, if appropriate, and by the client's parent or other person authorized by
192.31statute to give consent to the mental health services for the child.

192.32    Sec. 38. Minnesota Statutes 2006, section 256B.0943, subdivision 9, is amended to
192.33read:
192.34    Subd. 9. Service delivery criteria. (a) In delivering services under this section, a
192.35certified provider entity must ensure that:
193.1    (1) each individual provider's caseload size permits the provider to deliver services
193.2to both clients with severe, complex needs and clients with less intensive needs. The
193.3provider's caseload size should reasonably enable the provider to play an active role in
193.4service planning, monitoring, and delivering services to meet the client's and client's
193.5family's needs, as specified in each client's individual treatment plan;
193.6    (2) site-based programs, including day treatment and preschool programs, provide
193.7staffing and facilities to ensure the client's health, safety, and protection of rights, and that
193.8the programs are able to implement each client's individual treatment plan;
193.9    (3) a day treatment program is provided to a group of clients by a multidisciplinary
193.10team under the clinical supervision of a mental health professional. The day treatment
193.11program must be provided in and by: (i) an outpatient hospital accredited by the Joint
193.12Commission on Accreditation of Health Organizations and licensed under sections
193.13144.50 to 144.55; (ii) a community mental health center under section 245.62; and (iii)
193.14an entity that is under contract with the county board to operate a program that meets
193.15the requirements of sections 245.4712, subdivision 2, and 245.4884, subdivision 2,
193.16and Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must
193.17stabilize the client's mental health status while developing and improving the client's
193.18independent living and socialization skills. The goal of the day treatment program must be
193.19to reduce or relieve the effects of mental illness and provide training to enable the client
193.20to live in the community. The program must be available at least one day a week for a
193.21minimum three-hour time block. The three-hour time block must include at least one
193.22hour, but no more than two hours, of individual or group psychotherapy. The remainder
193.23of the three-hour time block may include recreation therapy, socialization therapy, or
193.24independent living skills therapy, but only if the therapies are included in the client's
193.25individual treatment plan. Day treatment programs are not part of inpatient or residential
193.26treatment services; and
193.27    (4) a preschool program is a structured treatment program offered to a child who
193.28is at least 33 months old, but who has not yet reached the first day of kindergarten, by a
193.29preschool multidisciplinary team in a day program licensed under Minnesota Rules, parts
193.309503.0005 to 9503.0175. The program must be available at least one day a week for a
193.31minimum two-hour time block. The structured treatment program may include individual
193.32or group psychotherapy and recreation therapy, socialization therapy, or independent
193.33living skills therapy, if included in the client's individual treatment plan.
193.34    (b) A provider entity must deliver the service components of children's therapeutic
193.35services and supports in compliance with the following requirements:
194.1    (1) individual, family, and group psychotherapy must be delivered as specified in
194.2Minnesota Rules, part 9505.0323;
194.3    (2) individual, family, or group skills training must be provided by a mental health
194.4professional or a mental health practitioner who has a consulting relationship with a
194.5mental health professional who accepts full professional responsibility for the training;
194.6    (3) crisis assistance must be time-limited and designed to resolve or stabilize crisis
194.7through arrangements for direct intervention and support services to the child and the
194.8child's family. Crisis assistance must utilize resources designed to address abrupt or
194.9substantial changes in the functioning of the child or the child's family as evidenced by
194.10a sudden change in behavior with negative consequences for well being, a loss of usual
194.11coping mechanisms, or the presentation of danger to self or others;
194.12    (4) medically necessary services that are provided by a mental health behavioral
194.13aide must be designed to improve the functioning of the child and support the family in
194.14activities of daily and community living. A mental health behavioral aide must document
194.15the delivery of services in written progress notes. The mental health behavioral aide
194.16must implement goals in the treatment plan for the child's emotional disturbance that
194.17allow the child to acquire developmentally and therapeutically appropriate daily living
194.18skills, social skills, and leisure and recreational skills through targeted activities. These
194.19activities may include:
194.20    (i) assisting a child as needed with skills development in dressing, eating, and
194.21toileting;
194.22    (ii) assisting, monitoring, and guiding the child to complete tasks, including
194.23facilitating the child's participation in medical appointments;
194.24    (iii) observing the child and intervening to redirect the child's inappropriate behavior;
194.25    (iv) assisting the child in using age-appropriate self-management skills as related
194.26to the child's emotional disorder or mental illness, including problem solving, decision
194.27making, communication, conflict resolution, anger management, social skills, and
194.28recreational skills;
194.29    (v) implementing deescalation techniques as recommended by the mental health
194.30professional;
194.31    (vi) implementing any other mental health service that the mental health professional
194.32has approved as being within the scope of the behavioral aide's duties; or
194.33    (vii) assisting the parents to develop and use parenting skills that help the child
194.34achieve the goals outlined in the child's individual treatment plan or individual behavioral
194.35plan. Parenting skills must be directed exclusively to the child's treatment; and
194.36    (5) direction of a mental health behavioral aide must include the following:
195.1    (i) a total of one hour of on-site observation by a mental health professional during
195.2the first 12 hours of service provided to a child;
195.3    (ii) ongoing on-site observation by a mental health professional or mental health
195.4practitioner for at least a total of one hour during every 40 hours of service provided
195.5to a child; and
195.6    (iii) immediate accessibility of the mental health professional or mental health
195.7practitioner to the mental health behavioral aide during service provision.

195.8    Sec. 39. Minnesota Statutes 2006, section 256B.0943, subdivision 11, is amended to
195.9read:
195.10    Subd. 11. Documentation and billing. (a) A provider entity must document the
195.11services it provides under this section. The provider entity must ensure that the entity's
195.12documentation standards meet the requirements of federal and state laws. Services billed
195.13under this section that are not documented according to this subdivision shall be subject to
195.14monetary recovery by the commissioner. The provider entity may not bill for anything
195.15other than direct service time.
195.16    (b) An individual mental health provider must promptly document the following
195.17in a client's record after providing services to the client:
195.18    (1) each occurrence of the client's mental health service, including the date, type,
195.19length, and scope of the service;
195.20    (2) the name of the person who gave the service;
195.21    (3) contact made with other persons interested in the client, including representatives
195.22of the courts, corrections systems, or schools. The provider must document the name
195.23and date of each contact;
195.24    (4) any contact made with the client's other mental health providers, case manager,
195.25family members, primary caregiver, legal representative, or the reason the provider did
195.26not contact the client's family members, primary caregiver, or legal representative, if
195.27applicable; and
195.28    (5) required clinical supervision, as appropriate.

195.29    Sec. 40. Minnesota Statutes 2006, section 256B.0943, subdivision 12, is amended to
195.30read:
195.31    Subd. 12. Excluded services. The following services are not eligible for medical
195.32assistance payment as children's therapeutic services and supports:
195.33    (1) service components of children's therapeutic services and supports
195.34simultaneously provided by more than one provider entity unless prior authorization is
195.35obtained;
196.1    (2) children's therapeutic services and supports provided in violation of medical
196.2assistance policy in Minnesota Rules, part 9505.0220;
196.3    (3) mental health behavioral aide services provided by a personal care assistant who
196.4is not qualified as a mental health behavioral aide and employed by a certified children's
196.5therapeutic services and supports provider entity;
196.6    (4) service components of CTSS that are the responsibility of a residential or
196.7program license holder, including foster care providers under the terms of a service
196.8agreement or administrative rules governing licensure; and
196.9    (5) adjunctive activities that may be offered by a provider entity but are not
196.10otherwise covered by medical assistance, including:
196.11    (i) a service that is primarily recreation oriented or that is provided in a setting that
196.12is not medically supervised. This includes sports activities, exercise groups, activities
196.13such as craft hours, leisure time, social hours, meal or snack time, trips to community
196.14activities, and tours;
196.15    (ii) a social or educational service that does not have or cannot reasonably be
196.16expected to have a therapeutic outcome related to the client's emotional disturbance;
196.17    (iii) consultation with other providers or service agency staff about the care or
196.18progress of a client;
196.19    (iv) prevention or education programs provided to the community; and
196.20    (v) treatment for clients with primary diagnoses of alcohol or other drug abuse.; and
196.21    (6) activities that are not direct service time.

196.22    Sec. 41. Minnesota Statutes 2006, section 256B.431, subdivision 1, is amended to read:
196.23    Subdivision 1. In general. The commissioner shall determine prospective
196.24payment rates for resident care costs. For rates established on or after July 1, 1985, the
196.25commissioner shall develop procedures for determining operating cost payment rates that
196.26take into account the mix of resident needs, geographic location, and other factors as
196.27determined by the commissioner. The commissioner shall consider whether the fact that a
196.28facility is attached to a hospital or has an average length of stay of 180 days or less should
196.29be taken into account in determining rates. The commissioner shall consider the use of the
196.30standard metropolitan statistical areas when developing groups by geographic location.
196.31The commissioner shall provide notice to each nursing facility on or before May 1 August
196.3215 of the rates effective for the following rate year except that if legislation is pending on
196.33May 1 August 15 that may affect rates for nursing facilities, the commissioner shall set the
196.34rates after the legislation is enacted and provide notice to each facility as soon as possible.
196.35    Compensation for top management personnel shall continue to be categorized as a
196.36general and administrative cost and is subject to any limits imposed on that cost category.

197.1    Sec. 42. Minnesota Statutes 2006, section 256B.431, subdivision 3f, is amended to
197.2read:
197.3    Subd. 3f. Property costs after July 1, 1988. (a) Investment per bed limit. For the
197.4rate year beginning July 1, 1988, the replacement-cost-new per bed limit must be $32,571
197.5per licensed bed in multiple bedrooms and $48,857 per licensed bed in a single bedroom.
197.6For the rate year beginning July 1, 1989, the replacement-cost-new per bed limit for a
197.7single bedroom must be $49,907 adjusted according to Minnesota Rules, part 9549.0060,
197.8subpart 4, item A, subitem (1). Beginning January 1, 1990, the replacement-cost-new per
197.9bed limits must be adjusted annually as specified in Minnesota Rules, part 9549.0060,
197.10subpart 4, item A, subitem (1). Beginning January 1, 1991, the replacement-cost-new per
197.11bed limits will be adjusted annually as specified in Minnesota Rules, part 9549.0060,
197.12subpart 4, item A, subitem (1), except that the index utilized will be the Bureau of the
197.13Census: Composite fixed-weighted price index as published in the C30 Report, Value
197.14of New Construction Put in Place Economic Analysis: Price Indexes for Private Fixed
197.15Investments in Structures; Special Care.
197.16    (b) Rental factor. For the rate year beginning July 1, 1988, the commissioner shall
197.17increase the rental factor as established in Minnesota Rules, part 9549.0060, subpart 8,
197.18item A, by 6.2 percent rounded to the nearest 100th percent for the purpose of reimbursing
197.19nursing facilities for soft costs and entrepreneurial profits not included in the cost valuation
197.20services used by the state's contracted appraisers. For rate years beginning on or after July
197.211, 1989, the rental factor is the amount determined under this paragraph for the rate year
197.22beginning July 1, 1988.
197.23    (c) Occupancy factor. For rate years beginning on or after July 1, 1988, in order
197.24to determine property-related payment rates under Minnesota Rules, part 9549.0060,
197.25for all nursing facilities except those whose average length of stay in a skilled level of
197.26care within a nursing facility is 180 days or less, the commissioner shall use 95 percent
197.27of capacity days. For a nursing facility whose average length of stay in a skilled level of
197.28care within a nursing facility is 180 days or less, the commissioner shall use the greater of
197.29resident days or 80 percent of capacity days but in no event shall the divisor exceed 95
197.30percent of capacity days.
197.31    (d) Equipment allowance. For rate years beginning on July 1, 1988, and July 1,
197.321989, the commissioner shall add ten cents per resident per day to each nursing facility's
197.33property-related payment rate. The ten-cent property-related payment rate increase is not
197.34cumulative from rate year to rate year. For the rate year beginning July 1, 1990, the
197.35commissioner shall increase each nursing facility's equipment allowance as established
197.36in Minnesota Rules, part 9549.0060, subpart 10, by ten cents per resident per day. For
198.1rate years beginning on or after July 1, 1991, the adjusted equipment allowance must be
198.2adjusted annually for inflation as in Minnesota Rules, part 9549.0060, subpart 10, item E.
198.3For the rate period beginning October 1, 1992, the equipment allowance for each nursing
198.4facility shall be increased by 28 percent. For rate years beginning after June 30, 1993, the
198.5allowance must be adjusted annually for inflation.
198.6    (e) Post chapter 199 related-organization debts and interest expense. For rate
198.7years beginning on or after July 1, 1990, Minnesota Rules, part 9549.0060, subpart 5, item
198.8E, shall not apply to outstanding related organization debt incurred prior to May 23, 1983,
198.9provided that the debt was an allowable debt under Minnesota Rules, parts 9510.0010
198.10to 9510.0480, the debt is subject to repayment through annual principal payments, and
198.11the nursing facility demonstrates to the commissioner's satisfaction that the interest rate
198.12on the debt was less than market interest rates for similar arm's-length transactions at
198.13the time the debt was incurred. If the debt was incurred due to a sale between family
198.14members, the nursing facility must also demonstrate that the seller no longer participates
198.15in the management or operation of the nursing facility. Debts meeting the conditions of
198.16this paragraph are subject to all other provisions of Minnesota Rules, parts 9549.0010
198.17to 9549.0080.
198.18    (f) Building capital allowance for nursing facilities with operating leases. For
198.19rate years beginning on or after July 1, 1990, a nursing facility with operating lease costs
198.20incurred for the nursing facility's buildings shall receive its building capital allowance
198.21computed in accordance with Minnesota Rules, part 9549.0060, subpart 8. If an operating
198.22lease provides that the lessee's rent is adjusted to recognize improvements made by the
198.23lessor and related debt, the costs for capital improvements and related debt shall be allowed
198.24in the computation of the lessee's building capital allowance, provided that reimbursement
198.25for these costs under an operating lease shall not exceed the rate otherwise paid.

198.26    Sec. 43. Minnesota Statutes 2006, section 256B.431, subdivision 17e, is amended to
198.27read:
198.28    Subd. 17e. Replacement-costs-new per bed limit effective July 1, 2001.
198.29    Notwithstanding Minnesota Rules, part 9549.0060, subpart 11, item C, subitem (2),
198.30for a total replacement, as defined in paragraph (f) subdivision 17d, authorized under
198.31section 144A.071 or 144A.073 after July 1, 1999, or any building project that is a
198.32relocation, renovation, upgrading, or conversion completed on or after July 1, 2001, the
198.33replacement-costs-new per bed limit shall be $74,280 per licensed bed in multiple-bed
198.34rooms, $92,850 per licensed bed in semiprivate rooms with a fixed partition separating
198.35the resident beds, and $111,420 per licensed bed in single rooms. Minnesota Rules, part
199.19549.0060, subpart 11, item C, subitem (2), does not apply. These amounts must be
199.2adjusted annually as specified in subdivision 3f, paragraph (a), beginning January 1, 2000.

199.3    Sec. 44. Minnesota Statutes 2006, section 256D.03, subdivision 4, is amended to read:
199.4    Subd. 4. General assistance medical care; services. (a)(i) For a person who is
199.5eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
199.6care covers, except as provided in paragraph (c):
199.7    (1) inpatient hospital services;
199.8    (2) outpatient hospital services;
199.9    (3) services provided by Medicare certified rehabilitation agencies;
199.10    (4) prescription drugs and other products recommended through the process
199.11established in section 256B.0625, subdivision 13;
199.12    (5) equipment necessary to administer insulin and diagnostic supplies and equipment
199.13for diabetics to monitor blood sugar level;
199.14    (6) eyeglasses and eye examinations provided by a physician or optometrist;
199.15    (7) hearing aids;
199.16    (8) prosthetic devices;
199.17    (9) laboratory and X-ray services;
199.18    (10) physician's services;
199.19    (11) medical transportation except special transportation;
199.20    (12) chiropractic services as covered under the medical assistance program;
199.21    (13) podiatric services;
199.22    (14) dental services as covered under the medical assistance program;
199.23    (15) outpatient services provided by a mental health center or clinic that is under
199.24contract with the county board and is established under section 245.62;
199.25    (16) day treatment services for mental illness provided under contract with the
199.26county board;
199.27    (17) prescribed medications for persons who have been diagnosed as mentally ill as
199.28necessary to prevent more restrictive institutionalization;
199.29    (18) psychological services, medical supplies and equipment, and Medicare
199.30premiums, coinsurance and deductible payments;
199.31    (19) medical equipment not specifically listed in this paragraph when the use of
199.32the equipment will prevent the need for costlier services that are reimbursable under
199.33this subdivision;
199.34    (20) services performed by a certified pediatric nurse practitioner, a certified family
199.35nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
199.36nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
200.1practitioner in independent practice, if (1) the service is otherwise covered under this
200.2chapter as a physician service, (2) the service provided on an inpatient basis is not included
200.3as part of the cost for inpatient services included in the operating payment rate, and (3) the
200.4service is within the scope of practice of the nurse practitioner's license as a registered
200.5nurse, as defined in section 148.171;
200.6    (21) services of a certified public health nurse or a registered nurse practicing in
200.7a public health nursing clinic that is a department of, or that operates under the direct
200.8authority of, a unit of government, if the service is within the scope of practice of the
200.9public health nurse's license as a registered nurse, as defined in section 148.171;
200.10    (22) telemedicine consultations, to the extent they are covered under section
200.11256B.0625, subdivision 3b ; and
200.12    (23) mental health telemedicine and psychiatric consultation as covered under
200.13section 256B.0625, subdivisions 46 and 48.
200.14    (ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
200.15paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
200.16to inpatient hospital services, including physician services provided during the inpatient
200.17hospital stay. A $1,000 deductible is required for each inpatient hospitalization.
200.18    (b) Effective August 1, 2005, sex reassignment surgery is not covered under this
200.19subdivision.
200.20    (c) In order to contain costs, the commissioner of human services shall select
200.21vendors of medical care who can provide the most economical care consistent with high
200.22medical standards and shall where possible contract with organizations on a prepaid
200.23capitation basis to provide these services. The commissioner shall consider proposals by
200.24counties and vendors for prepaid health plans, competitive bidding programs, block grants,
200.25or other vendor payment mechanisms designed to provide services in an economical
200.26manner or to control utilization, with safeguards to ensure that necessary services are
200.27provided. Before implementing prepaid programs in counties with a county operated or
200.28affiliated public teaching hospital or a hospital or clinic operated by the University of
200.29Minnesota, the commissioner shall consider the risks the prepaid program creates for the
200.30hospital and allow the county or hospital the opportunity to participate in the program in a
200.31manner that reflects the risk of adverse selection and the nature of the patients served by
200.32the hospital, provided the terms of participation in the program are competitive with the
200.33terms of other participants considering the nature of the population served. Payment for
200.34services provided pursuant to this subdivision shall be as provided to medical assistance
200.35vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
200.36payments made during fiscal year 1990 and later years, the commissioner shall consult
201.1with an independent actuary in establishing prepayment rates, but shall retain final control
201.2over the rate methodology.
201.3    (d) Effective January 1, 2008, drug coverage under general assistance medical care
201.4is limited to prescription drugs that:
201.5    (i) are covered under the medical assistance program as described in section
201.6256B.0625, subdivisions 13 and 13d; and
201.7    (ii) are provided by manufacturers that have fully executed general assistance
201.8medical care rebate agreements with the commissioner and comply with the agreements.
201.9Prescription drug coverage under general assistance medical care must conform to
201.10coverage under the medical assistance program according to section 256B.0625,
201.11subdivisions 13 to 13g.
201.12    (d) (e) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
201.13co-payments for services provided on or after October 1, 2003:
201.14    (1) $25 for eyeglasses;
201.15    (2) $25 for nonemergency visits to a hospital-based emergency room;
201.16    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
201.17subject to a $12 per month maximum for prescription drug co-payments. No co-payments
201.18shall apply to antipsychotic drugs when used for the treatment of mental illness; and
201.19    (4) 50 percent coinsurance on restorative dental services.
201.20    (e) (f) Co-payments shall be limited to one per day per provider for nonpreventive
201.21visits, eyeglasses, and nonemergency visits to a hospital-based emergency room.
201.22Recipients of general assistance medical care are responsible for all co-payments in this
201.23subdivision. The general assistance medical care reimbursement to the provider shall be
201.24reduced by the amount of the co-payment, except that reimbursement for prescription
201.25drugs shall not be reduced once a recipient has reached the $12 per month maximum for
201.26prescription drug co-payments. The provider collects the co-payment from the recipient.
201.27Providers may not deny services to recipients who are unable to pay the co-payment,
201.28except as provided in paragraph (f).
201.29    (f) (g) If it is the routine business practice of a provider to refuse service to an
201.30individual with uncollected debt, the provider may include uncollected co-payments
201.31under this section. A provider must give advance notice to a recipient with uncollected
201.32debt before services can be denied.
201.33    (g) (h) Any county may, from its own resources, provide medical payments for
201.34which state payments are not made.
201.35    (h) (i) Chemical dependency services that are reimbursed under chapter 254B must
201.36not be reimbursed under general assistance medical care.
202.1    (i) (j) The maximum payment for new vendors enrolled in the general assistance
202.2medical care program after the base year shall be determined from the average usual and
202.3customary charge of the same vendor type enrolled in the base year.
202.4    (j) (k) The conditions of payment for services under this subdivision are the same
202.5as the conditions specified in rules adopted under chapter 256B governing the medical
202.6assistance program, unless otherwise provided by statute or rule.
202.7    (k) (l) Inpatient and outpatient payments shall be reduced by five percent, effective
202.8July 1, 2003. This reduction is in addition to the five percent reduction effective July 1,
202.92003, and incorporated by reference in paragraph (i).
202.10    (l) (m) Payments for all other health services except inpatient, outpatient, and
202.11pharmacy services shall be reduced by five percent, effective July 1, 2003.
202.12    (m) (n) Payments to managed care plans shall be reduced by five percent for services
202.13provided on or after October 1, 2003.
202.14    (n) (o) A hospital receiving a reduced payment as a result of this section may apply
202.15the unpaid balance toward satisfaction of the hospital's bad debts.
202.16    (o) (p) Fee-for-service payments for nonpreventive visits shall be reduced by $3
202.17for services provided on or after January 1, 2006. For purposes of this subdivision, a
202.18visit means an episode of service which is required because of a recipient's symptoms,
202.19diagnosis, or established illness, and which is delivered in an ambulatory setting by
202.20a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
202.21audiologist, optician, or optometrist.
202.22    (p) (q) Payments to managed care plans shall not be increased as a result of the
202.23removal of the $3 nonpreventive visit co-payment effective January 1, 2006.

202.24    Sec. 45. Minnesota Statutes 2006, section 256E.35, subdivision 2, is amended to read:
202.25    Subd. 2. Definitions. (a) The definitions in this subdivision apply to this section.
202.26    (b) "Family asset account" means a savings account opened by a household
202.27participating in the Minnesota family assets for independence initiative.
202.28    (c) "Fiduciary organization" means:
202.29    (1) a community action agency that has obtained recognition under section 268.53
202.30256E.31
;
202.31    (2) a federal community development credit union serving the seven-county
202.32metropolitan area; or
202.33    (3) a women-oriented economic development agency serving the seven-county
202.34metropolitan area.
203.1    (d) "Financial institution" means a bank, bank and trust, savings bank, savings
203.2association, or credit union, the deposits of which are insured by the Federal Deposit
203.3Insurance Corporation or the National Credit Union Administration.
203.4    (e) "Permissible use" means:
203.5    (1) postsecondary educational expenses at an accredited public postsecondary
203.6institution including books, supplies, and equipment required for courses of instruction;
203.7    (2) acquisition costs of acquiring, constructing, or reconstructing a residence,
203.8including any usual or reasonable settlement, financing, or other closing costs;
203.9    (3) business capitalization expenses for expenditures on capital, plant, equipment,
203.10working capital, and inventory expenses of a legitimate business pursuant to a business
203.11plan approved by the fiduciary organization; and
203.12    (4) acquisition costs of a principal residence within the meaning of section 1034 of
203.13the Internal Revenue Code of 1986 which do not exceed 100 percent of the average area
203.14purchase price applicable to the residence determined according to section 143(e)(2) and
203.15(3) of the Internal Revenue Code of 1986.
203.16    (f) "Household" means all individuals who share use of a dwelling unit as primary
203.17quarters for living and eating separate from other individuals.

203.18    Sec. 46. Minnesota Statutes 2006, section 256L.03, subdivision 5, is amended to read:
203.19    Subd. 5. Co-payments and coinsurance. (a) Except as provided in paragraphs (b)
203.20and (c), the MinnesotaCare benefit plan shall include the following co-payments and
203.21coinsurance requirements for all enrollees:
203.22    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
203.23subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
203.24$3,000 per family;
203.25    (2) $3 per prescription for adult enrollees;
203.26    (3) $25 for eyeglasses for adult enrollees;
203.27    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
203.28episode of service which is required because of a recipient's symptoms, diagnosis, or
203.29established illness, and which is delivered in an ambulatory setting by a physician or
203.30physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
203.31audiologist, optician, or optometrist; and
203.32    (5) $6 for nonemergency visits to a hospital-based emergency room.
203.33    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
203.34children under the age of 21 in households with family income equal to or less than 175
203.35percent of the federal poverty guidelines. Paragraph (a), clause (1), does not apply to
203.36parents and relative caretakers of children under the age of 21 in households with family
204.1income greater than 175 percent of the federal poverty guidelines for inpatient hospital
204.2admissions occurring on or after January 1, 2001.
204.3    (c) Paragraph (a), clauses (1) to (4), do does not apply to pregnant women and
204.4children under the age of 21.
204.5    (d) Adult enrollees with family gross income that exceeds 175 percent of the
204.6federal poverty guidelines and who are not pregnant shall be financially responsible for
204.7the coinsurance amount, if applicable, and amounts which exceed the $10,000 inpatient
204.8hospital benefit limit.
204.9    (e) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
204.10or changes from one prepaid health plan to another during a calendar year, any charges
204.11submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
204.12expenses incurred by the enrollee for inpatient services, that were submitted or incurred
204.13prior to enrollment, or prior to the change in health plans, shall be disregarded.