1.1.................... moves to amend H.F. No. 1362 as follows:
1.2Delete everything after the enacting clause and insert:

1.3"ARTICLE 1
1.4LICENSING

1.5    Section 1. Minnesota Statutes 2008, section 245A.10, subdivision 2, is amended to
1.6read:
1.7    Subd. 2. County fees for background studies and licensing inspections. (a) For
1.8purposes of family and group family child care licensing under this chapter, a county
1.9agency may charge a fee to an applicant or license holder to recover the actual cost of
1.10background studies, but in any case not to exceed $100 annually. A county agency may
1.11also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
1.12license or $100 for a two-year license.
1.13    (b) A county agency may charge a fee to a legal nonlicensed child care provider or
1.14applicant for authorization to recover the actual cost of background studies completed
1.15under section 119B.125, but in any case not to exceed $100 annually.
1.16    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
1.17    (1) in cases of financial hardship;
1.18    (2) if the county has a shortage of providers in the county's area;
1.19    (3) for new providers; or
1.20    (4) for providers who have attained at least 16 hours of training before seeking
1.21initial licensure.
1.22    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
1.23an installment basis for up to one year. If the provider is receiving child care assistance
1.24payments from the state, the provider may have the fees under paragraph (a) or (b)
1.25deducted from the child care assistance payments for up to one year and the state shall
1.26reimburse the county for the county fees collected in this manner.
2.1    (e) For purposes of adult foster care and child foster care licensing under this
2.2chapter, a county agency may charge a fee to a corporate applicant or corporate license
2.3holder to recover the actual cost of background studies. A county agency may also charge
2.4a fee to a corporate applicant or corporate license holder to recover the actual cost of
2.5licensing inspections, not to exceed $500 annually.
2.6    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the
2.7following circumstances:
2.8(1) in cases of financial hardship;
2.9(2) if the county has a shortage of providers in the county's area; or
2.10(3) for new providers.

2.11    Sec. 2. Minnesota Statutes 2008, section 245A.10, subdivision 3, is amended to read:
2.12    Subd. 3. Application fee for initial license or certification. (a) For fees required
2.13under subdivision 1, an applicant for an initial license or certification issued by the
2.14commissioner shall submit a $500 $750 application fee with each new application required
2.15under this subdivision. The application fee shall not be prorated, is nonrefundable, and
2.16is in lieu of the annual license or certification fee that expires on December 31. The
2.17commissioner shall not process an application until the application fee is paid.
2.18(b) Except as provided in clauses (1) to (3), an applicant shall apply for a license
2.19to provide services at a specific location.
2.20(1) For a license to provide waivered residential-based habilitation services to
2.21persons with developmental disabilities or related conditions under chapter 245B, an
2.22applicant shall submit an application for each county in which the waivered services
2.23will be provided.
2.24(2) For a license to provide supported employment, crisis respite, or
2.25semi-independent living services to persons with developmental disabilities or related
2.26conditions under chapter 245B, an applicant shall submit a single application to provide
2.27services statewide.
2.28(3) For a license to provide independent living assistance for youth under section
2.29245A.22 , an applicant shall submit a single application to provide services statewide.

2.30    Sec. 3. Minnesota Statutes 2008, section 245A.10, subdivision 4, is amended to read:
2.31    Subd. 4. License or certification fee for certain programs a child care center.
2.32    (a) A child care centers and programs with a licensed capacity center shall pay an annual
2.33nonrefundable license or certification fee based on the following schedule:
3.1
3.2
3.3
3.4
Licensed Capacity
Child Care Center
License Fee Fiscal Year
2010
Other Program
License FeeFiscal
Year 2011 and
thereafter
3.5
1 to 24 persons
$225 $295
$400 $360
3.6
25 to 49 persons
$340 $410
$600 $475
3.7
50 to 74 persons
$450 $520
$800 $585
3.8
75 to 99 persons
$565 $635
$1,000 $700
3.9
100 to 124 persons
$675 $745
$1,200 $810
3.10
125 to 149 persons
$900 $970
$1,400$1,035
3.11
3.12
150 to 174 persons
$1,050
$1,120
$1,600 $1,185
3.13
3.14
175 to 199 persons
$1,200
$1,270
$1,800 $1,335
3.15
3.16
200 to 224 persons
$1,350
$1,420
$2,000 $1,485
3.17
3.18
225 or more persons
$1,500
$1,570
$2,500 $1,635
3.19    (b) A day training and habilitation program serving persons with developmental
3.20disabilities or related conditions shall be assessed a license fee based on the schedule in
3.21paragraph (a) unless the license holder serves more than 50 percent of the same persons
3.22at two or more locations in the community. Except as provided in paragraph (c), when a
3.23day training and habilitation program serves more than 50 percent of the same persons in
3.24two or more locations in a community, the day training and habilitation program shall pay
3.25a license fee based on the licensed capacity of the largest facility and the other facility
3.26or facilities shall be charged a license fee based on a licensed capacity of a residential
3.27program serving one to 24 persons.
3.28    (c) When a day training and habilitation program serving persons with developmental
3.29disabilities or related conditions seeks a single license allowed under section 245B.07,
3.30subdivision 12, clause (2) or (3), the licensing fee must be based on the combined licensed
3.31capacity for each location.

3.32    Sec. 4. Minnesota Statutes 2008, section 245A.10, is amended by adding a subdivision
3.33to read:
3.34    Subd. 4a. License fee for an adult day care center. An adult day care center
3.35licensed under Minnesota Rules, parts 9555.9600 to 9555.9730, shall pay an annual
3.36nonrefundable license fee based on the following schedule:
3.37
3.38
Licensed Capacity
License Fee Fiscal
Year 2010
License Fee Fiscal Year
2011 and thereafter
3.39
1 to 24 persons
$930
$1,460
3.40
25 to 49 persons
$1,130
$1,660
4.1
50 to 74 persons
$1,330
$1,860
4.2
75 to 99 persons
$1,530
$2,060
4.3
100 or more persons
$1,730
$2,260

4.4    Sec. 5. Minnesota Statutes 2008, section 245A.10, is amended by adding a subdivision
4.5to read:
4.6    Subd. 4b. License fee for day training and habilitation program. (a) A day
4.7training and habilitation program licensed under chapter 245B to provide services to
4.8persons with developmental disabilities shall pay an annual nonrefundable license fee
4.9based on the following schedule:
4.10
4.11
Licensed Capacity
License Fee Fiscal
Year 2010
License Fee Fiscal Year
2011 and thereafter
4.12
1 to 24 persons
$925
$1,430
4.13
25 to 49 persons
$1,125
$1,630
4.14
50 to 74 persons
$1,325
$1,830
4.15
75 to 99 persons
$1,525
$2,030
4.16
100 to 124 persons
$1,725
$2,230
4.17
125 to 149 persons
$1,925
$2,430
4.18
150 to 174 persons
$2,125
$2,630
4.19
175 to 199 persons
$2,325
$2,830
4.20
200 to 224 persons
$2,525
$3,030
4.21
225 or more persons
$3,025
$3,530
4.22(b) A day training and habilitation program licensed under chapter 245B must
4.23be assessed a license fee based on the schedule in paragraph (a) unless the license
4.24holder serves more than 50 percent of the same persons at two or more locations in the
4.25community. Except as provided in paragraph (c), when a day training and habilitation
4.26program serves more than 50 percent of the same persons in two or more locations in a
4.27community, the day training and habilitation program shall pay a license fee based on the
4.28licensed capacity of the largest facility and the other facility or facilities must be charged a
4.29license fee based on a licensed capacity of a residential program serving one to 24 persons.
4.30(c) When a day training and habilitation program serving persons with developmental
4.31disabilities seeks a single license allowed under section 245B.07, subdivision 12, clause (2)
4.32or (3), the licensing fee must be based on the combined licensed capacity for each location.

4.33    Sec. 6. Minnesota Statutes 2008, section 245A.10, is amended by adding a subdivision
4.34to read:
4.35    Subd. 4c. License fee for residential program serving persons with
4.36developmental disabilities. A residential program licensed under chapter 245B whether
5.1certified as an intermediate care facility for persons with developmental disabilities or not
5.2shall pay an annual nonrefundable license fee based on the following schedule:
5.3
5.4
Licensed Capacity
License Fee Fiscal
Year 2010
License Fee Fiscal Year
2011 and thereafter
5.5
1 to 24 persons
$1,000
$1,600
5.6
25 to 49 persons
$1,200
$1,800
5.7
50 to 74 persons
$1,400
$2,000
5.8
75 or more persons
$1,600
$2,200

5.9    Sec. 7. Minnesota Statutes 2008, section 245A.10, is amended by adding a subdivision
5.10to read:
5.11    Subd. 4d. License fee for program providing crisis respite. (a) In fiscal year
5.122010, a program licensed to provide crisis respite services for persons with developmental
5.13disabilities under chapter 245B shall pay an annual nonrefundable license fee of $1,600.
5.14(b) In fiscal year 2011 and thereafter, a program licensed to provide crisis respite
5.15services for persons with developmental disabilities under chapter 245B shall pay an
5.16annual nonrefundable license fee of $2,000.

5.17    Sec. 8. Minnesota Statutes 2008, section 245A.10, is amended by adding a subdivision
5.18to read:
5.19    Subd. 4e. License fee for program providing residential-based habilitation
5.20services. (a) In fiscal year 2010, a program licensed to provide residential-based
5.21habilitation services for persons with developmental disabilities under chapter 245B
5.22shall pay an annual nonrefundable license fee that is based on a base rate of $715 plus
5.23$50 times the number of clients served on the first day of August of the current license
5.24year. State-operated programs are exempt from the license fee under this paragraph and
5.25paragraph (b).
5.26(b) In fiscal year 2011 and thereafter, a program licensed to provide residential-based
5.27habilitation services for persons with developmental disabilities under chapter 245B shall
5.28pay an annual nonrefundable license fee that is based on a base rate of $1,000 plus $70
5.29times the number of clients served on the first day of August of the current license year.

5.30    Sec. 9. Minnesota Statutes 2008, section 245A.10, is amended by adding a subdivision
5.31to read:
5.32    Subd. 4f. License fee for program providing semi-independent living services
5.33or supported employment services. (a) In fiscal year 2010, a program licensed to
5.34provide semi-independent living services for persons with developmental disabilities
6.1under chapter 245B or supported employment services for persons with developmental
6.2disabilities under chapter 245B shall pay an annual nonrefundable license fee of $1,250.
6.3(b) In fiscal year 2011 and thereafter, a program licensed to provide semi-independent
6.4living services for persons with developmental disabilities under chapter 245B or
6.5supported employment services for persons with developmental disabilities under chapter
6.6245B shall pay an annual nonrefundable license fee of $2,000.

6.7    Sec. 10. Minnesota Statutes 2008, section 245A.10, is amended by adding a
6.8subdivision to read:
6.9    Subd. 4g. License fee for residential program serving persons with physical
6.10disabilities. A residential program licensed under Minnesota Rules, parts 9570.2000 to
6.119570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable
6.12license fee based on the following schedule:
6.13
6.14
Licensed Capacity
License Fee Fiscal
Year 2010
License Fee Fiscal Year
2011 and thereafter
6.15
1 to 24 persons
$713
$1,025
6.16
25 to 49 persons
$913
$1,225
6.17
50 to 74 persons
$1,113
$1,425
6.18
75 to 99 persons
$1,313
$1,625
6.19
100 to 124 persons
$1,513
$1,825
6.20
125 or more persons
$1,713
$2,025

6.21    Sec. 11. Minnesota Statutes 2008, section 245A.10, is amended by adding a
6.22subdivision to read:
6.23    Subd. 4h. License fee for residential programs serving adults with mental
6.24illness. (a) In fiscal year 2010, a residential program licensed under Minnesota Rules,
6.25parts 9520.0500 to 9520.0670, to serve adults with mental illness shall pay an annual
6.26nonrefundable license fee of $2,450.
6.27(b) In fiscal year 2011 and thereafter, a residential program licensed under Minnesota
6.28Rules, parts 9520.0500 to 9520.0670, to serve adults with mental illness shall pay an
6.29annual nonrefundable license fee of $4,400.

6.30    Sec. 12. Minnesota Statutes 2008, section 245A.10, is amended by adding a
6.31subdivision to read:
6.32    Subd. 4i. License fee for a children's residential program. (a) In fiscal year 2010,
6.33a children's residential program licensed under Minnesota Rules, chapter 2960, shall pay
6.34an annual nonrefundable license fee of $2,450.
7.1(b) In fiscal year 2011 and thereafter, a children's residential program licensed under
7.2Minnesota Rules, chapter 2960, shall pay an annual nonrefundable license fee of $4,400.

7.3    Sec. 13. Minnesota Statutes 2008, section 245A.10, is amended by adding a
7.4subdivision to read:
7.5    Subd. 4j. License fee for programs licensed to provide drug or chemical
7.6dependency treatment. (a) A program licensed under Minnesota Rules, parts 9530.6405
7.7to 9530.6505 or 9530.6510 to 9530.6590, to provide drug or chemical dependency
7.8treatment shall pay an annual nonrefundable license fee based on the following schedule:
7.9
7.10
Licensed Capacity
License Fee Fiscal
Year 2010
License Fee Fiscal Year
2011 and thereafter
7.11
1 to 24 persons
$755
$1,035
7.12
25 to 49 persons
$955
$1,235
7.13
50 to 74 persons
$1,155
$1,435
7.14
75 to 99 persons
$1,355
$1,635
7.15
100 to 124 persons
$1,555
$1,835
7.16
125 or more persons
$1,755
$2,035
7.17(b) In fiscal year 2010, if a license issued to a program under Minnesota Rules, parts
7.189530.6405 to 9530.6505, does not have a stated licensed capacity, the drug or chemical
7.19dependency treatment program shall pay an annual nonrefundable license fee based on a
7.20licensed capacity of one to 24 persons for fiscal year 2010.
7.21(c) In fiscal year 2011 and thereafter, if a license issued to a program under Minnesota
7.22Rules, parts 9530.6405 to 9530.6505, does not have a stated licensed capacity, the drug or
7.23chemical dependency treatment program shall pay an annual nonrefundable license fee
7.24based on a licensed capacity of one to 24 persons for fiscal year 2011 and thereafter.

7.25    Sec. 14. Minnesota Statutes 2008, section 245A.10, is amended by adding a
7.26subdivision to read:
7.27    Subd. 4k. License fee for independent living assistance for youth. A program
7.28licensed to provide independent living assistance for youth under section 245A.22, shall
7.29pay an annual nonrefundable license fee of $2,000.

7.30    Sec. 15. Minnesota Statutes 2008, section 245A.10, is amended by adding a
7.31subdivision to read:
7.32    Subd. 4l. License fee for private agencies that provide child foster care or
7.33adoption services. A private agency licensed under Minnesota Rules, parts 9545.0755
7.34to 9545.0845, to provide child foster care or adoption services shall pay an annual
7.35nonrefundable license fee of $400.

8.1    Sec. 16. Minnesota Statutes 2008, section 245A.10, subdivision 5, is amended to read:
8.2    Subd. 5. License or Mental health center or mental health clinic certification fee
8.3for other programs. (a) Except as provided in paragraphs (b) and (c), a program without
8.4a stated licensed capacity shall pay a license or certification fee of $400.
8.5(b) A mental health center or mental health clinic requesting certification for
8.6purposes of insurance and subscriber contract reimbursement under Minnesota Rules,
8.7parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,000 per year. If the
8.8mental health center or mental health clinic provides services at a primary location with
8.9satellite facilities, the satellite facilities shall be certified with the primary location without
8.10an additional charge.
8.11(c) A program licensed to provide residential-based habilitation services under the
8.12home and community-based waiver for persons with developmental disabilities shall pay
8.13an annual license fee that includes a base rate of $250 plus $38 times the number of clients
8.14served on the first day of August of the current license year. State-operated programs are
8.15exempt from the license fee under this paragraph.

8.16    Sec. 17. Minnesota Statutes 2008, section 245A.10, is amended by adding a
8.17subdivision to read:
8.18    Subd. 7. Human services licensing revenue and appropriations. Effective July
8.191, 2011:
8.20(1) departmental earnings collected under subdivisions 3, 4 to 4l, and 5 shall be
8.21deposited in the state government special revenue fund; and
8.22(2) the direct appropriation to the department for licensing activities in subdivisions
8.233, 4 to 4l, and 5 shall be transferred from the general fund to the state government special
8.24revenue fund.

8.25    Sec. 18. Minnesota Statutes 2008, section 245A.11, subdivision 2a, is amended to read:
8.26    Subd. 2a. Adult foster care license capacity. The commissioner shall issue adult
8.27foster care licenses with a maximum licensed capacity of four beds, including nonstaff
8.28roomers and boarders, except that the commissioner may issue a license with a capacity of
8.29five beds, including roomers and boarders, according to paragraphs (a) to (e).
8.30(a) An adult foster care license holder may have a maximum license capacity of five
8.31if all persons in care are age 55 or over and do not have a serious and persistent mental
8.32illness or a developmental disability.
8.33(b) The commissioner may grant variances to paragraph (a) to allow a foster care
8.34provider with a licensed capacity of five persons to admit an individual under the age of 55
9.1if the variance complies with section 245A.04, subdivision 9, and approval of the variance
9.2is recommended by the county in which the licensed foster care provider is located.
9.3(c) The commissioner may grant variances to paragraph (a) to allow the use of a fifth
9.4bed for emergency crisis services for a person with serious and persistent mental illness
9.5or a developmental disability, regardless of age, if the variance complies with section
9.6245A.04, subdivision 9 , and approval of the variance is recommended by the county in
9.7which the licensed foster care provider is located.
9.8(d) Notwithstanding paragraph (a), If the 2009 legislature adopts a rate reduction
9.9that impacts providers of adult foster care services, the commissioner may issue an adult
9.10foster care license with a capacity of five adults if the fifth bed does not increase the
9.11overall statewide capacity of licensed adult foster care beds in homes that are not the
9.12primary residence of the license holder, over the licensed capacity in such homes on July
9.131, 2009, as identified in a plan submitted to the commissioner by the county, when the
9.14capacity is recommended by the county licensing agency of the county in which the
9.15facility is located and if the recommendation verifies that:
9.16(1) the facility meets the physical environment requirements in the adult foster
9.17care licensing rule;
9.18(2) the five-bed living arrangement is specified for each resident in the resident's:
9.19(i) individualized plan of care;
9.20(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
9.21(iii) individual resident placement agreement under Minnesota Rules, part
9.229555.5105, subpart 19, if required;
9.23(3) the license holder obtains written and signed informed consent from each
9.24resident or resident's legal representative documenting the resident's informed choice to
9.25living in the home and that the resident's refusal to consent would not have resulted in
9.26service termination; and
9.27(4) the facility was licensed for adult foster care before March 1, 2003 2009.
9.28(e) The commissioner shall not issue a new adult foster care license under paragraph
9.29(d) after June 30, 2005 2011. The commissioner shall allow a facility with an adult foster
9.30care license issued under paragraph (d) before June 30, 2005 2011, to continue with a
9.31capacity of five adults if the license holder continues to comply with the requirements in
9.32paragraph (d).
9.33EFFECTIVE DATE.This section is effective July 1, 2009.

9.34    Sec. 19. Minnesota Statutes 2008, section 245A.11, is amended by adding a
9.35subdivision to read:
10.1    Subd. 8. Alternate overnight supervision technology; adult foster care license.
10.2    (a) The commissioner may grant an applicant or license holder an adult foster care license
10.3for a residence that does not have a caregiver in the residence during normal sleeping
10.4hours as required under Minnesota Rules, part 9555.5105, subpart 37, item B, but uses
10.5monitoring technology to alert the license holder when an incident occurs that may
10.6jeopardize the health, safety, or rights of a foster care recipient. The applicant or license
10.7holder must comply with all other requirements under Minnesota Rules, parts 9555.5105
10.8to 9555.6265, and the requirements under this subdivision. The license printed by the
10.9commissioner must state in bold and large font:
10.10    (1) that staff are not present on-site overnight; and
10.11    (2) the telephone number of the county's common entry point for making reports of
10.12suspected maltreatment of vulnerable adults under section 626.557, subdivision 9.
10.13(b) Applications for a license under this section must be submitted directly to
10.14the Department of Human Services licensing division. The licensing division must
10.15immediately notify the host county and lead county contract agency and the host county
10.16licensing agency. The licensing division must collaborate with the county licensing
10.17agency in the review of the application and the licensing of the program.
10.18    (c) Before a license is issued by the commissioner, and for the duration of the license,
10.19the applicant or license holder must establish, maintain, and document the implementation
10.20of written policies and procedures addressing the requirements in paragraphs (d) to (f).
10.21    (d) The applicant or license holder must have policies and procedures that:
10.22    (1) establish characteristics of target populations that will be admitted into the home
10.23and characteristics of populations that will not be accepted into the home;
10.24    (2) explain the discharge process when a foster care recipient requires overnight
10.25supervision or other services that cannot be provided by the license holder due to the
10.26limited hours that the license holder is on-site;
10.27    (3) describe the types of events to which the program will respond with a physical
10.28presence when those events occur in the home during time when staff are not on-site, and
10.29how the license holder's response plan meets the requirements in paragraph (e), clause
10.30(1) or (2);
10.31    (4) establish a process for documenting a review of the implementation and
10.32effectiveness of the response protocol for the response required under paragraph (e),
10.33clause (1) or (2). The documentation must include:
10.34    (i) a description of the triggering incident;
10.35    (ii) the date and time of the triggering incident;
10.36    (iii) the time of the response or responses under paragraph (e), clause (1) or (2);
11.1    (iv) whether the response met the resident's needs;
11.2    (v) whether the existing policies and response protocols were followed; and
11.3    (vi) whether the existing policies and protocols are adequate or need modification.
11.4    When no physical presence response is completed for a three-month period, the
11.5license holder's written policies and procedures must require a physical presence response
11.6drill be to conducted for which the effectiveness of the response protocol under paragraph
11.7(e), clause (1) or (2), will be reviewed and documented as required under this clause; and
11.8    (5) establish that emergency and nonemergency phone numbers are posted in a
11.9prominent location in a common area of the home where they can be easily observed by a
11.10person responding to an incident who is not otherwise affiliated with the home.
11.11    (e) The license holder must document and include in the license application which
11.12response alternative under clause (1) or (2) is in place for responding to situations that
11.13present a serious risk to the health, safety, or rights of people receiving foster care services
11.14in the home:
11.15    (1) response alternative (1) requires only the technology to provide an electronic
11.16notification or alert to the license holder that an event is underway that requires a response.
11.17Under this alternative, no more than ten minutes will pass before the license holder will be
11.18physically present on-site to respond to the situation; or
11.19    (2) response alternative (2) requires the electronic notification and alert system
11.20under alternative (1), but more than ten minutes may pass before the license holder is
11.21present on-site to respond to the situation. Under alternative (2), all of the following
11.22conditions are met:
11.23    (i) the license holder has a written description of the interactive technological
11.24applications that will assist the licenser holder in communicating with and assessing the
11.25needs related to care, health, and safety of the foster care recipients. This interactive
11.26technology must permit the license holder to remotely assess the well being of the foster
11.27care recipient without requiring the initiation or participation by the foster care recipient.
11.28Requiring the foster care recipient to initiate a telephone call or answer a telephone call
11.29does not meet this requirement;
11.30(ii) the license holder documents how the remote license holder is qualified and
11.31capable of meeting the needs of the foster care recipients and assessing foster care
11.32recipients' needs under item (i), during the absence of the license holder on-site;
11.33(iii) the license holder maintains written procedures to dispatch emergency response
11.34personnel to the site in the event of an identified emergency; and
11.35    (iv) each foster care recipient's individualized plan of care, individual service plan
11.36under section 256B.092, subdivision 1b, if required, or individual resident placement
12.1agreement under Minnesota Rules, part 9555.5105, subpart 19, if required, identifies the
12.2maximum response time, which may be greater than ten minutes, for the license holder
12.3to be on-site for that foster care recipient.
12.4    (f) All placement agreements, individual service agreements, and plans applicable
12.5to the foster care recipient must clearly state that the adult foster care license category is
12.6a program without the presence of a caregiver in the residence during normal sleeping
12.7hours; the protocols in place for responding to situations that present a serious risk to
12.8health, safety, or rights of foster care recipients under paragraph (e), clause (1) or (2); and a
12.9signed informed consent from each foster care recipient or the person's legal representative
12.10documenting the person's or legal representative's agreement with placement in the
12.11program. If electronic monitoring technology is used in the home, the informed consent
12.12form must also explain the following:
12.13    (1) how any electronic monitoring is incorporated into the alternative supervision
12.14system;
12.15    (2) the backup system for any electronic monitoring in times of electrical outages or
12.16other equipment malfunctions;
12.17    (3) how the license holder is trained on the use of the technology;
12.18    (4) the event types and license holder response times established under paragraph (e);
12.19    (5) how the license holder protects the foster care recipient's privacy related to
12.20electronic monitoring and related to any electronically recorded data generated by the
12.21monitoring system. The consent form must explain where and how the electronically
12.22recorded data is stored, with whom it will be shared, and how long it is retained; and
12.23    (6) the risks and benefits of the alternative overnight supervision system.
12.24    The written explanations under clauses (1) to (6) may be accomplished through
12.25cross-references to other policies and procedures as long as they are explained to the
12.26person giving consent, and the person giving consent is offered a copy.
12.27(g) Nothing in this section requires the applicant or license holder to develop or
12.28maintain separate or duplicative policies, procedures, documentation, consent forms, or
12.29individual plans that may be required for other licensing standards, if the requirements of
12.30this section are incorporated into those documents.
12.31(h) The commissioner may grant variances to the requirements of this section
12.32according to section 245A.04, subdivision 9.
12.33(i) For the purposes of paragraphs (c) to (h), "license holder" has the meaning
12.34under section 245A.02, subdivision 9, and additionally includes all staff, volunteers, and
12.35contractors affiliated with the license holder.

12.36    Sec. 20. Minnesota Statutes 2008, section 245A.16, subdivision 1, is amended to read:
13.1    Subdivision 1. Delegation of authority to agencies. (a) County agencies and
13.2private agencies that have been designated or licensed by the commissioner to perform
13.3licensing functions and activities under section 245A.04 and background studies for
13.4adult foster care, family adult day services, and family child care, under chapter 245C; to
13.5recommend denial of applicants under section 245A.05; to issue correction orders, to issue
13.6variances, and recommend a conditional license under section 245A.06, or to recommend
13.7suspending or revoking a license or issuing a fine under section 245A.07, shall comply
13.8with rules and directives of the commissioner governing those functions and with this
13.9section. The following variances are excluded from the delegation of variance authority
13.10and may be issued only by the commissioner:
13.11    (1) dual licensure of family child care and child foster care, dual licensure of child
13.12and adult foster care, and adult foster care and family child care;
13.13    (2) adult foster care maximum capacity;
13.14    (3) adult foster care minimum age requirement;
13.15    (4) child foster care maximum age requirement;
13.16    (5) variances regarding disqualified individuals except that county agencies may
13.17issue variances under section 245C.30 regarding disqualified individuals when the county
13.18is responsible for conducting a consolidated reconsideration according to sections 245C.25
13.19and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
13.20and a disqualification based on serious or recurring maltreatment; and
13.21    (6) the required presence of a caregiver in the adult foster care residence during
13.22normal sleeping hours.
13.23    (b) County agencies must report information about disqualification reconsiderations
13.24under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
13.25granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
13.26prescribed by the commissioner.
13.27    (c) For family day care programs, the commissioner may authorize licensing reviews
13.28every two years after a licensee has had at least one annual review.
13.29    (d) For family adult day services programs, the commissioner may authorize
13.30licensing reviews every two years after a licensee has had at least one annual review.
13.31    (e) A license issued under this section may be issued for up to two years.

13.32    Sec. 21. Minnesota Statutes 2008, section 245A.16, subdivision 3, is amended to read:
13.33    Subd. 3. Recommendations to commissioner. The county or private agency
13.34shall not make recommendations to the commissioner regarding licensure without first
13.35conducting an inspection, and for adult foster care, family adult day services, and family
14.1child care, a background study of the applicant under chapter 245C. The county or private
14.2agency must forward its recommendation to the commissioner regarding the appropriate
14.3licensing action within 20 working days of receipt of a completed application.

14.4    Sec. 22. Minnesota Statutes 2008, section 245C.04, subdivision 1, is amended to read:
14.5    Subdivision 1. Licensed programs. (a) The commissioner shall conduct a
14.6background study of an individual required to be studied under section 245C.03,
14.7subdivision 1
, at least upon application for initial license for all license types.
14.8    (b) The commissioner shall conduct a background study of an individual required to
14.9be studied under section 245C.03, subdivision 1, at reapplication for a license for adult
14.10foster care, family adult day services, and family child care.
14.11    (c) The commissioner is not required to conduct a study of an individual at the time
14.12of reapplication for a license if the individual's background study was completed by the
14.13commissioner of human services for an adult foster care license holder that is also:
14.14    (1) registered under chapter 144D; or
14.15    (2) licensed to provide home and community-based services to people with
14.16disabilities at the foster care location and the license holder does not reside in the foster
14.17care residence; and
14.18    (3) the following conditions are met:
14.19    (i) a study of the individual was conducted either at the time of initial licensure or
14.20when the individual became affiliated with the license holder;
14.21    (ii) the individual has been continuously affiliated with the license holder since
14.22the last study was conducted; and
14.23    (iii) the last study of the individual was conducted on or after October 1, 1995.
14.24    (d) From July 1, 2007, to June 30, 2009, the commissioner of human services shall
14.25conduct a study of an individual required to be studied under section 245C.03, at the
14.26time of reapplication for a child foster care license. The county or private agency shall
14.27collect and forward to the commissioner the information required under section 245C.05,
14.28subdivisions 1, paragraphs (a) and (b), and 5, paragraphs (a) and (b). The background
14.29study conducted by the commissioner of human services under this paragraph must
14.30include a review of the information required under section 245C.08, subdivisions 1,
14.31paragraph (a), clauses (1) to (5), 3, and 4.
14.32    (e) The commissioner of human services shall conduct a background study of an
14.33individual specified under section 245C.03, subdivision 1, paragraph (a), clauses (2)
14.34to (6), who is newly affiliated with a child foster care license holder. The county or
14.35private agency shall collect and forward to the commissioner the information required
15.1under section 245C.05, subdivisions 1 and 5. The background study conducted by the
15.2commissioner of human services under this paragraph must include a review of the
15.3information required under section 245C.08, subdivisions 1, 3, and 4.
15.4    (f) From January 1, 2010, to December 31, 2012, unless otherwise specified in
15.5paragraph (c), the commissioner shall conduct a study of an individual required to be
15.6studied under section 245C.03 at the time of reapplication for an adult foster care license.
15.7The county shall collect and forward to the commissioner the information required under
15.8section 245C.05, subdivision 1, paragraphs (a) and (b), and subdivision 5, paragraphs (a)
15.9and (b). The background study conducted by the commissioner under this paragraph
15.10must include a review of the information required under section 245C.08, subdivision 1,
15.11paragraph (a), clauses (1) to (5), and subdivisions 3 and 4.
15.12(g) The commissioner shall conduct a background study of an individual specified
15.13under section 245C.03, subdivision 1, paragraph (a), clauses (2) to (6), who is newly
15.14affiliated with an adult foster care license holder. The county shall collect and forward
15.15to the commissioner the information required under section 245C.05, subdivision 1,
15.16paragraphs (a) and (b), and subdivision 5, paragraphs (a) and (b). The background
15.17study conducted by the commissioner under this paragraph must include a review of
15.18the information required under section 245C.08, subdivision 1, paragraph (a), and
15.19subdivisions 3 and 4.
15.20 (h) Applicants for licensure, license holders, and other entities as provided in this
15.21chapter must submit completed background study forms to the commissioner before
15.22individuals specified in section 245C.03, subdivision 1, begin positions allowing direct
15.23contact in any licensed program.
15.24    (g) (i) For purposes of this section, a physician licensed under chapter 147 is
15.25considered to be continuously affiliated upon the license holder's receipt from the
15.26commissioner of health or human services of the physician's background study results.

15.27    Sec. 23. Minnesota Statutes 2008, section 245C.05, subdivision 4, is amended to read:
15.28    Subd. 4. Electronic transmission. For background studies conducted by the
15.29Department of Human Services, the commissioner shall implement a system for the
15.30electronic transmission of:
15.31    (1) background study information to the commissioner;
15.32    (2) background study results to the license holder; and
15.33    (3) background study results to county and private agencies for background studies
15.34conducted by the commissioner for child foster care; and
16.1(4) background study results to county agencies for background studies conducted
16.2by the commissioner for adult foster care.

16.3    Sec. 24. Minnesota Statutes 2008, section 245C.08, subdivision 2, is amended to read:
16.4    Subd. 2. Background studies conducted by a county agency. (a) For a background
16.5study conducted by a county agency for adult foster care, family adult day services, and
16.6family child care services, the commissioner shall review:
16.7    (1) information from the county agency's record of substantiated maltreatment
16.8of adults and the maltreatment of minors;
16.9    (2) information from juvenile courts as required in subdivision 4 for individuals
16.10listed in section 245C.03, subdivision 1, clauses (2), (5), and (6); and
16.11    (3) information from the Bureau of Criminal Apprehension.
16.12    (b) If the individual has resided in the county for less than five years, the study shall
16.13include the records specified under paragraph (a) for the previous county or counties of
16.14residence for the past five years.
16.15    (c) Notwithstanding expungement by a court, the county agency may consider
16.16information obtained under paragraph (a), clause (3), unless the commissioner received
16.17notice of the petition for expungement and the court order for expungement is directed
16.18specifically to the commissioner.

16.19    Sec. 25. Minnesota Statutes 2008, section 245C.10, is amended by adding a
16.20subdivision to read:
16.21    Subd. 5. Adult foster care services. The commissioner shall recover the cost
16.22of background studies required under section 245C.03, subdivision 1, for the purposes
16.23of adult foster care licensing, through a fee of no more than $20 per study charged to
16.24the license holder. The fees collected under this subdivision are appropriated to the
16.25commissioner for the purpose of conducting background studies.

16.26    Sec. 26. Minnesota Statutes 2008, section 245C.10, is amended by adding a
16.27subdivision to read:
16.28    Subd. 8. Private agencies. The commissioner shall recover the cost of conducting
16.29background studies under section 245C.33 for studies initiated by private agencies for the
16.30purpose of adoption through a fee of no more than $70 per study charged to the private
16.31agency. The fees collected under this subdivision are appropriated to the commissioner for
16.32the purpose of conducting background studies.

17.1    Sec. 27. Minnesota Statutes 2008, section 245C.17, is amended by adding a
17.2subdivision to read:
17.3    Subd. 6. Notice to county agency. For studies on individuals related to a license to
17.4provide adult foster care, the commissioner shall also provide a notice of the background
17.5study results to the county agency that initiated the background study.

17.6    Sec. 28. Minnesota Statutes 2008, section 245C.20, is amended to read:
17.7245C.20 LICENSE HOLDER RECORD KEEPING.
17.8A licensed program shall document the date the program initiates a background
17.9study under this chapter in the program's personnel files. When a background study is
17.10completed under this chapter, a licensed program shall maintain a notice that the study
17.11was undertaken and completed in the program's personnel files. Except when background
17.12studies are initiated through the commissioner's online system, if a licensed program
17.13has not received a response from the commissioner under section 245C.17 within 45
17.14days of initiation of the background study request, the licensed program must contact the
17.15commissioner human services licensing division to inquire about the status of the study. If
17.16a license holder initiates a background study under the commissioner's online system, but
17.17the background study subject's name does not appear in the list of active or recent studies
17.18initiated by that license holder, the license holder must either contact the human services
17.19licensing division or resubmit the background study information online for that individual.

17.20    Sec. 29. Minnesota Statutes 2008, section 245C.21, subdivision 1a, is amended to read:
17.21    Subd. 1a. Submission of reconsideration request to county or private agency.
17.22    (a) For disqualifications related to studies conducted by county agencies for family child
17.23care and family adult day services, and for disqualifications related to studies conducted
17.24by the commissioner for child foster care and adult foster care, the individual shall
17.25submit the request for reconsideration to the county or private agency that initiated the
17.26background study.
17.27    (b) For disqualifications related to studies conducted by the commissioner for child
17.28foster care, the individual shall submit the request for reconsideration to the private agency
17.29that initiated the background study.
17.30(c) A reconsideration request shall be submitted within 30 days of the individual's
17.31receipt of the disqualification notice or the time frames specified in subdivision 2,
17.32whichever time frame is shorter.
18.1    (c) (d) The county or private agency shall forward the individual's request for
18.2reconsideration and provide the commissioner with a recommendation whether to set aside
18.3the individual's disqualification.

18.4    Sec. 30. Minnesota Statutes 2008, section 245C.23, subdivision 2, is amended to read:
18.5    Subd. 2. Commissioner's notice of disqualification that is not set aside. (a) The
18.6commissioner shall notify the license holder of the disqualification and order the license
18.7holder to immediately remove the individual from any position allowing direct contact
18.8with persons receiving services from the license holder if:
18.9    (1) the individual studied does not submit a timely request for reconsideration
18.10under section 245C.21;
18.11    (2) the individual submits a timely request for reconsideration, but the commissioner
18.12does not set aside the disqualification for that license holder under section 245C.22;
18.13    (3) an individual who has a right to request a hearing under sections 245C.27 and
18.14256.045 , or 245C.28 and chapter 14 for a disqualification that has not been set aside, does
18.15not request a hearing within the specified time; or
18.16    (4) an individual submitted a timely request for a hearing under sections 245C.27
18.17and 256.045, or 245C.28 and chapter 14, but the commissioner does not set aside the
18.18disqualification under section 245A.08, subdivision 5, or 256.045.
18.19    (b) If the commissioner does not set aside the disqualification under section 245C.22,
18.20and the license holder was previously ordered under section 245C.17 to immediately
18.21remove the disqualified individual from direct contact with persons receiving services or
18.22to ensure that the individual is under continuous, direct supervision when providing direct
18.23contact services, the order remains in effect pending the outcome of a hearing under
18.24sections 245C.27 and 256.045, or 245C.28 and chapter 14.
18.25    (c) For background studies related to child foster care, the commissioner shall
18.26also notify the county or private agency that initiated the study of the results of the
18.27reconsideration.
18.28(d) For background studies related to adult foster care, the commissioner shall also
18.29notify the county that initiated the study of the results of the reconsideration.

18.30    Sec. 31. Minnesota Statutes 2008, section 256B.092, is amended by adding a
18.31subdivision to read:
18.32    Subd. 5b. Revised per diem based on legislated rate reduction. Notwithstanding
18.33section 252.28, subdivision 3, paragraph (d), if the 2009 legislature adopts a rate reduction
18.34that impacts payment to providers of adult foster care services, the commissioner may
18.35issue adult foster care licenses that permit a capacity of five adults. The application for a
19.1five-bed license must meet the requirements of section 245A.11, subdivision 2a. Prior to
19.2admission of the fifth recipient of adult foster care services, the county must negotiate a
19.3revised per diem rate for room and board and waiver services that reflects the legislated
19.4rate reduction and results in an overall average per diem reduction for all foster care
19.5recipients in that home. The revised per diem must allow the provider to maintain, as
19.6much as possible, the level of services or enhanced services provided in the residence,
19.7while mitigating the losses of the legislated rate reduction.
19.8EFFECTIVE DATE.This section is effective July 1, 2009.

19.9    Sec. 32. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
19.10    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure
19.11that the average per capita expenditures estimated in any fiscal year for home and
19.12community-based waiver recipients does not exceed the average per capita expenditures
19.13that would have been made to provide institutional services for recipients in the absence
19.14of the waiver.
19.15(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
19.16need-based methods for allocating to local agencies the home and community-based
19.17waivered service resources available to support recipients with disabilities in need of
19.18the level of care provided in a nursing facility or a hospital. The commissioner shall
19.19allocate resources to single counties and county partnerships in a manner that reflects
19.20consideration of:
19.21(1) an incentive-based payment process for achieving outcomes;
19.22(2) the need for a state-level risk pool;
19.23(3) the need for retention of management responsibility at the state agency level; and
19.24(4) a phase-in strategy as appropriate.
19.25(c) Until the allocation methods described in paragraph (b) are implemented, the
19.26annual allowable reimbursement level of home and community-based waiver services
19.27shall be the greater of:
19.28(1) the statewide average payment amount which the recipient is assigned under the
19.29waiver reimbursement system in place on June 30, 2001, modified by the percentage of
19.30any provider rate increase appropriated for home and community-based services; or
19.31(2) an amount approved by the commissioner based on the recipient's extraordinary
19.32needs that cannot be met within the current allowable reimbursement level. The
19.33increased reimbursement level must be necessary to allow the recipient to be discharged
19.34from an institution or to prevent imminent placement in an institution. The additional
19.35reimbursement may be used to secure environmental modifications; assistive technology
20.1and equipment; and increased costs for supervision, training, and support services
20.2necessary to address the recipient's extraordinary needs. The commissioner may approve
20.3an increased reimbursement level for up to one year of the recipient's relocation from an
20.4institution or up to six months of a determination that a current waiver recipient is at
20.5imminent risk of being placed in an institution.
20.6(d) Beginning July 1, 2001, medically necessary private duty nursing services will be
20.7authorized under this section as complex and regular care according to sections 256B.0651
20.8and 256B.0653 to 256B.0656. The rate established by the commissioner for registered
20.9nurse or licensed practical nurse services under any home and community-based waiver as
20.10of January 1, 2001, shall not be reduced.
20.11(e) Notwithstanding section 252.28, subdivision 3, paragraph (d), if the 2009
20.12legislature adopts a rate reduction that impacts payment to providers of adult foster care
20.13services, the commissioner may issue adult foster care licenses that permit a capacity of
20.14five adults. The application for a five-bed license must meet the requirements of section
20.15245A.11, subdivision 2a. Prior to admission of the fifth recipient of adult foster care
20.16services, the county must negotiate a revised per diem rate for room and board and waiver
20.17services that reflects the legislated rate reduction and results in an overall average per
20.18diem reduction for all foster care recipients in that home. The revised per diem must allow
20.19the provider to maintain, as much as possible, the level of services or enhanced services
20.20provided in the residence, while mitigating the losses of the legislated rate reduction.
20.21EFFECTIVE DATE.This section is effective July 1, 2009.

20.22    Sec. 33. WAIVER.
20.23By December 1, 2009, the commissioner shall request all federal approvals and
20.24waiver amendments to the disability home and community-based waivers to allow properly
20.25licensed adult foster care homes to provide residential services for up to five individuals.
20.26EFFECTIVE DATE.This section is effective July 1, 2009.

20.27    Sec. 34. REPEALER.
20.28(a) Minnesota Statutes 2008, section 256B.092, subdivision 5a, is repealed effective
20.29July 1, 2009.
20.30(b) Minnesota Rules, part 9555.6125, subpart 4, item B, is repealed.

20.31ARTICLE 2
20.32MFIP, CHILDREN, AND ADULT SUPPORTS

20.33    Section 1. Minnesota Statutes 2008, section 256D.051, subdivision 2a, is amended to
20.34read:
21.1    Subd. 2a. Duties of commissioner. In addition to any other duties imposed by law,
21.2the commissioner shall:
21.3(1) based on this section and section 256D.052 and Code of Federal Regulations,
21.4title 7, section 273.7, supervise the administration of food stamp employment and training
21.5services to county agencies;
21.6(2) disburse money appropriated for food stamp employment and training services
21.7to county agencies based upon the county's costs as specified in section 256D.051,
21.8subdivision 6c
;
21.9(3) accept and supervise the disbursement of any funds that may be provided by the
21.10federal government or from other sources for use in this state for food stamp employment
21.11and training services;
21.12(4) apply for the maximum allowable federal matching funds under United States
21.13Code, title 7, section 2025, paragraph (h), for state expenditures made on behalf of family
21.14stabilization services participants voluntarily engaged in food stamp employment and
21.15training activities, where appropriate;
21.16(5) cooperate with other agencies including any agency of the United States or of
21.17another state in all matters concerning the powers and duties of the commissioner under
21.18this section and section 256D.052; and
21.19(5) (6) in cooperation with the commissioner of employment and economic
21.20development, ensure that each component of an employment and training program carried
21.21out under this section is delivered through a statewide workforce development system,
21.22unless the component is not available locally through such a system.

21.23    Sec. 2. Minnesota Statutes 2008, section 256D.0515, is amended to read:
21.24256D.0515 ASSET LIMITATIONS FOR FOOD STAMP HOUSEHOLDS.
21.25All food stamp households must be determined eligible for the benefit discussed
21.26under section 256.029. Food stamp households must demonstrate that:
21.27(1) their gross income meets the federal Food Stamp requirements under United
21.28States Code, title 7, section 2014(c); and
21.29(2) they have financial resources, excluding vehicles, of less than $7,000.

21.30    Sec. 3. Minnesota Statutes 2008, section 256D.06, subdivision 2, is amended to read:
21.31    Subd. 2. Emergency need. (a) Notwithstanding the provisions of subdivision 1, a
21.32grant of emergency general assistance shall, to the extent funds are available, be made to
21.33an eligible single adult, married couple, or family for an emergency need, as defined in
21.34rules promulgated by the commissioner, where the recipient requests temporary assistance
21.35not exceeding 30 days if an emergency situation appears to exist under criteria adopted by
22.1the county agency and the individual or family is ineligible for MFIP or DWP or is not a
22.2participant of MFIP or DWP and whose annual net income is no greater than 200 percent
22.3of the federal poverty level for the previous calendar year. If an applicant or recipient
22.4relates facts to the county agency which may be sufficient to constitute an emergency
22.5situation, the county agency shall, to the extent funds are available, advise the person of the
22.6procedure for applying for assistance according to this subdivision. An emergency general
22.7assistance grant is available to a recipient not more than once in any 12-month period.
22.8(b) Funding for an emergency general assistance program is limited to the
22.9appropriation. Each fiscal year, the commissioner shall allocate to counties the money
22.10appropriated for emergency general assistance grants based on each county agency's
22.11average share of state's emergency general expenditures for the immediate past three fiscal
22.12years as determined by the commissioner, and may reallocate any unspent amounts to
22.13other counties.
22.14(c) No county shall be allocated less than $1,000 for the fiscal year.
22.15(d) Should an emergency be declared as provided in section 12.31, the commissioner
22.16may immediately reallocate unspent funds without regard to the other provisions of this
22.17section to meet the emergency needs. The emergency reallocation must be excluded from
22.18calculations for subsequent allocations as provided in paragraphs (b) and (c).
22.19(e) Any emergency general assistance expenditures by a county above the amount of
22.20the commissioner's allocation to the county must be made from county funds.

22.21    Sec. 4. Minnesota Statutes 2008, section 256D.09, subdivision 6, is amended to read:
22.22    Subd. 6. Recovery of overpayments. (a) If an amount of general assistance or
22.23family general assistance is paid to a recipient in excess of the payment due, it shall be
22.24recoverable by the county agency. The agency shall give written notice to the recipient of
22.25its intention to recover the overpayment.
22.26(b) Except as provided for interim assistance in section 256D.06, subdivision
22.275, when an overpayment occurs, the county agency shall recover the overpayment
22.28from a current recipient by reducing the amount of aid payable to the assistance unit of
22.29which the recipient is a member, for one or more monthly assistance payments, until
22.30the overpayment is repaid. All county agencies in the state shall reduce the assistance
22.31payment by three percent of the assistance unit's standard of need in nonfraud cases and
22.32ten percent where fraud has occurred, or the amount of the monthly payment, whichever is
22.33less, for all overpayments.
22.34(c) In cases when there is both an overpayment and underpayment, the county
22.35agency shall offset one against the other in correcting the payment.
23.1(d) Overpayments may also be voluntarily repaid, in part or in full, by the individual,
23.2in addition to the aid reductions provided in this subdivision, to include further voluntary
23.3reductions in the grant level agreed to in writing by the individual, until the total amount
23.4of the overpayment is repaid.
23.5(e) The county agency shall make reasonable efforts to recover overpayments to
23.6persons no longer on assistance under standards adopted in rule by the commissioner
23.7of human services. The county agency need not attempt to recover overpayments of
23.8less than $35 paid to an individual no longer on assistance if the individual does not
23.9receive assistance again within three years, unless the individual has been convicted of
23.10violating section 256.98.
23.11(f) Establishment of an overpayment is limited to 12 months prior to the month of
23.12discovery due to an agency error and six years prior to the month of discovery due to a
23.13client error or an intentional program violation determined under section 256.046.

23.14    Sec. 5. Minnesota Statutes 2008, section 256D.46, is amended to read:
23.15256D.46 EMERGENCY MINNESOTA SUPPLEMENTAL AID.
23.16    Subdivision 1. Eligibility. A county agency must grant emergency Minnesota
23.17supplemental aid, to the extent funds are available, if the recipient is without adequate
23.18resources to resolve an emergency that, if unresolved, will threaten the health or safety
23.19of the recipient. For the purposes of this section, the term "recipient" includes persons
23.20for whom a group residential housing benefit is being paid under sections 256I.01 to
23.21256I.06. Recipients of Minnesota supplemental aid who have emergent need may apply
23.22for emergency general assistance medical care under section 256D.06, subdivision 2.
23.23    Subd. 2. Income and resource test. All income and resources available to the
23.24recipient must be considered in determining the recipient's ability to meet the emergency
23.25need. Property that can be liquidated in time to resolve the emergency and income,
23.26excluding an amount equal to the Minnesota supplemental aid standard of assistance, that
23.27is normally disregarded or excluded under the Minnesota supplemental aid program must
23.28be considered available to meet the emergency need.
23.29    Subd. 3. Payment amount. The amount of assistance granted under emergency
23.30Minnesota supplemental aid is limited to the amount necessary to resolve the emergency.
23.31An emergency Minnesota supplemental aid grant is available to a recipient no more
23.32than once in any 12-month period. Funding for emergency Minnesota supplemental
23.33aid is limited to the appropriation. Each fiscal year, the commissioner shall allocate to
23.34counties the money appropriated for emergency Minnesota supplemental aid grants based
23.35on each county agency's average share of state's emergency Minnesota supplemental aid
24.1expenditures for the immediate past three fiscal years as determined by the commissioner,
24.2and may reallocate any unspent amounts to other counties. Any emergency Minnesota
24.3supplemental aid expenditures by a county above the amount of the commissioner's
24.4allocation to the county must be made from county funds.

24.5    Sec. 6. Minnesota Statutes 2008, section 256D.49, subdivision 3, is amended to read:
24.6    Subd. 3. Overpayment of monthly grants and recovery of ATM errors. (a) When
24.7the county agency determines that an overpayment of the recipient's monthly payment
24.8of Minnesota supplemental aid has occurred, it shall issue a notice of overpayment
24.9to the recipient. If the person is no longer receiving Minnesota supplemental aid, the
24.10county agency may request voluntary repayment or pursue civil recovery. If the person is
24.11receiving Minnesota supplemental aid, the county agency shall recover the overpayment
24.12by withholding an amount equal to three percent of the standard of assistance for the
24.13recipient or the total amount of the monthly grant, whichever is less.
24.14(b) Establishment of an overpayment is limited to 12 months prior to the month of
24.15discovery due to an agency error and six years prior to the month of discovery due to a
24.16client error or an intentional program violation determined under section 256.046.
24.17(c) For recipients receiving benefits via electronic benefit transfer, if the overpayment
24.18is a result of an automated teller machine (ATM) dispensing funds in error to the recipient,
24.19the agency may recover the ATM error by immediately withdrawing funds from the
24.20recipient's electronic benefit transfer account, up to the amount of the error.
24.21(d) Residents of nursing homes, regional treatment centers, and licensed residential
24.22facilities with negotiated rates shall not have overpayments recovered from their personal
24.23needs allowance.

24.24    Sec. 7. Minnesota Statutes 2008, section 256I.03, subdivision 7, is amended to read:
24.25    Subd. 7. Countable income. "Countable income" means all income received by an
24.26applicant or recipient less any applicable exclusions or disregards. For a recipient of any
24.27cash benefit from the SSI program, countable income means the SSI benefit limit in effect
24.28at the time the person is in a GRH setting less $20, less the medical assistance personal
24.29needs allowance. If the SSI limit has been reduced for a person due to events occurring
24.30prior to the persons entering the GRH setting, countable income means actual income less
24.31any applicable exclusions and disregards.

24.32    Sec. 8. Minnesota Statutes 2008, section 256J.20, subdivision 3, is amended to read:
24.33    Subd. 3. Other property limitations. To be eligible for MFIP, the equity value of
24.34all nonexcluded real and personal property of the assistance unit must not exceed $2,000
25.1for applicants and $5,000 for ongoing participants. The value of assets in clauses (1) to
25.2(19) must be excluded when determining the equity value of real and personal property:
25.3    (1) a licensed vehicle up to a loan value of less than or equal to $15,000 $7,500. If the
25.4assistance unit owns more than one licensed vehicle, the county agency shall determine the
25.5loan value of all additional vehicles and exclude the combined loan value of less than or
25.6equal to $7,500. The county agency shall apply any excess loan value as if it were equity
25.7value to the asset limit described in this section,. If the assistance unit owns more than
25.8one licensed vehicle, the county agency shall determine the vehicle with the highest loan
25.9value and count only the loan value over $7,500, excluding: (i) the value of one vehicle
25.10per physically disabled person when the vehicle is needed to transport the disabled unit
25.11member; this exclusion does not apply to mentally disabled people; (ii) the value of special
25.12equipment for a disabled member of the assistance unit; and (iii) any vehicle used for
25.13long-distance travel, other than daily commuting, for the employment of a unit member.
25.14    The county agency shall count the loan value of all other vehicles and apply this
25.15amount as if it were equity value to the asset limit described in this section. To establish the
25.16loan value of vehicles, a county agency must use the N.A.D.A. Official Used Car Guide,
25.17Midwest Edition, for newer model cars. When a vehicle is not listed in the guidebook,
25.18or when the applicant or participant disputes the loan value listed in the guidebook as
25.19unreasonable given the condition of the particular vehicle, the county agency may require
25.20the applicant or participant document the loan value by securing a written statement from
25.21a motor vehicle dealer licensed under section 168.27, stating the amount that the dealer
25.22would pay to purchase the vehicle. The county agency shall reimburse the applicant or
25.23participant for the cost of a written statement that documents a lower loan value;
25.24    (2) the value of life insurance policies for members of the assistance unit;
25.25    (3) one burial plot per member of an assistance unit;
25.26    (4) the value of personal property needed to produce earned income, including
25.27tools, implements, farm animals, inventory, business loans, business checking and
25.28savings accounts used at least annually and used exclusively for the operation of a
25.29self-employment business, and any motor vehicles if at least 50 percent of the vehicle's use
25.30is to produce income and if the vehicles are essential for the self-employment business;
25.31    (5) the value of personal property not otherwise specified which is commonly
25.32used by household members in day-to-day living such as clothing, necessary household
25.33furniture, equipment, and other basic maintenance items essential for daily living;
25.34    (6) the value of real and personal property owned by a recipient of Supplemental
25.35Security Income or Minnesota supplemental aid;
26.1    (7) the value of corrective payments, but only for the month in which the payment
26.2is received and for the following month;
26.3    (8) a mobile home or other vehicle used by an applicant or participant as the
26.4applicant's or participant's home;
26.5    (9) money in a separate escrow account that is needed to pay real estate taxes or
26.6insurance and that is used for this purpose;
26.7    (10) money held in escrow to cover employee FICA, employee tax withholding,
26.8sales tax withholding, employee worker compensation, business insurance, property rental,
26.9property taxes, and other costs that are paid at least annually, but less often than monthly;
26.10    (11) monthly assistance payments for the current month's or short-term emergency
26.11needs under section 256J.626, subdivision 2;
26.12    (12) the value of school loans, grants, or scholarships for the period they are
26.13intended to cover;
26.14    (13) payments listed in section 256J.21, subdivision 2, clause (9), which are held
26.15in escrow for a period not to exceed three months to replace or repair personal or real
26.16property;
26.17    (14) income received in a budget month through the end of the payment month;
26.18    (15) savings from earned income of a minor child or a minor parent that are set aside
26.19in a separate account designated specifically for future education or employment costs;
26.20    (16) the federal earned income credit, Minnesota working family credit, state and
26.21federal income tax refunds, state homeowners and renters credits under chapter 290A,
26.22property tax rebates and other federal or state tax rebates in the month received and the
26.23following month;
26.24    (17) payments excluded under federal law as long as those payments are held in a
26.25separate account from any nonexcluded funds;
26.26    (18) the assets of children ineligible to receive MFIP benefits because foster care or
26.27adoption assistance payments are made on their behalf; and
26.28    (19) the assets of persons whose income is excluded under section 256J.21,
26.29subdivision 2
, clause (43).
26.30EFFECTIVE DATE.This section is effective March 1, 2010.

26.31    Sec. 9. Minnesota Statutes 2008, section 256J.24, subdivision 5a, is amended to read:
26.32    Subd. 5a. Food portion of MFIP transitional standard. The commissioner
26.33shall adjust the food portion of the MFIP transitional standard by October 1 each year
26.34beginning October 1998 as needed to reflect the cost-of-living adjustments to the food
26.35Stamp support program. The commissioner shall annually publish in the State Register
27.1the transitional standard for an assistance unit of sizes one to ten in the State Register
27.2whenever an adjustment is made.

27.3    Sec. 10. Minnesota Statutes 2008, section 256J.24, subdivision 10, is amended to read:
27.4    Subd. 10. MFIP exit level. The commissioner shall adjust the MFIP earned income
27.5disregard to ensure that most participants do not lose eligibility for MFIP until their
27.6income reaches at least 115 110 percent of the federal poverty guidelines in effect in
27.7October of each fiscal year at the time of the adjustment. The adjustment to the disregard
27.8shall be based on a household size of three, and the resulting earned income disregard
27.9percentage must be applied to all household sizes. The adjustment under this subdivision
27.10must be implemented at the same time as the October food stamp or whenever there is a
27.11food support cost-of-living adjustment is reflected in the food portion of MFIP transitional
27.12standard as required under subdivision 5a.

27.13    Sec. 11. Minnesota Statutes 2008, section 256J.37, subdivision 3a, is amended to read:
27.14    Subd. 3a. Rental subsidies; unearned income. (a) Effective July 1, 2003, The
27.15county agency shall count $50 $100 of the value of public and assisted rental subsidies
27.16provided through the Department of Housing and Urban Development (HUD) as unearned
27.17income to the cash portion of the MFIP grant. The full amount of the subsidy must be
27.18counted as unearned income when the subsidy is less than $50 $100. The income from
27.19this subsidy shall be budgeted according to section 256J.34.
27.20(b) The provisions of this subdivision shall not apply to an MFIP assistance unit
27.21which includes a participant who is:
27.22(1) age 60 or older;
27.23(2) a caregiver who is suffering from an illness, injury, or incapacity that has been
27.24certified by a qualified professional when the illness, injury, or incapacity is expected
27.25to continue for more than 30 days and prevents the person from obtaining or retaining
27.26employment; or
27.27(3) a caregiver whose presence in the home is required due to the illness or
27.28incapacity of another member in the assistance unit, a relative in the household, or a foster
27.29child in the household when the illness or incapacity and the need for the participant's
27.30presence in the home has been certified by a qualified professional and is expected to
27.31continue for more than 30 days.
27.32(c) The provisions of this subdivision shall not apply to an MFIP assistance unit
27.33where the parental caregiver is an SSI recipient.
27.34(d) Prior to implementing this provision, the commissioner must identify the MFIP
27.35participants subject to this provision and provide written notice to these participants at
28.1least 30 days before the first grant reduction. The notice must inform the participant of the
28.2basis for the potential grant reduction, the exceptions to the provision, if any, and inform
28.3the participant of the steps necessary to claim an exception. A person who is found not to
28.4meet one of the exceptions to the provision must be notified and informed of the right to a
28.5fair hearing under section 256J.40. The notice must also inform the participant that the
28.6participant may be eligible for a rent reduction resulting from a reduction in the MFIP
28.7grant and encourage the participant to contact the local housing authority.
28.8EFFECTIVE DATE.This section is effective February 1, 2010.

28.9    Sec. 12. Minnesota Statutes 2008, section 256J.37, is amended by adding a subdivision
28.10to read:
28.11    Subd. 11. Treatment of Supplemental Security Income. Effective March 1,
28.122010, the county shall reduce the cash portion of the MFIP grant by up to $125 for an
28.13MFIP assistance unit that includes one or more Supplemental Security Income (SSI)
28.14recipients who reside in the household, and who would otherwise be included in the MFIP
28.15assistance unit under section 256J.24, subdivision 2, but are excluded solely due to the
28.16SSI recipient status under section 256J.24, subdivision 3, paragraph (a), clause (1). If
28.17the SSI recipient or recipients receive less than $125 of SSI, only the amount received
28.18must be used in calculating the MFIP cash assistance payment. This provision does not
28.19apply to relative caregivers who could elect to be included in the MFIP assistance unit
28.20under section 256J.24, subdivision 4, unless the caregiver's children or stepchildren are
28.21included in the MFIP assistance unit.
28.22EFFECTIVE DATE.This section is effective March 1, 2010.

28.23    Sec. 13. Minnesota Statutes 2008, section 256J.38, subdivision 1, is amended to read:
28.24    Subdivision 1. Scope of overpayment. (a) When a participant or former participant
28.25receives an overpayment due to agency, client, or ATM error, or due to assistance received
28.26while an appeal is pending and the participant or former participant is determined
28.27ineligible for assistance or for less assistance than was received, the county agency must
28.28recoup or recover the overpayment using the following methods:
28.29(1) reconstruct each affected budget month and corresponding payment month;
28.30(2) use the policies and procedures that were in effect for the payment month; and
28.31(3) do not allow employment disregards in section 256J.21, subdivision 3 or 4, in the
28.32calculation of the overpayment when the unit has not reported within two calendar months
28.33following the end of the month in which the income was received.
29.1(b) Establishment of an overpayment is limited to 12 months prior to the month of
29.2discovery due to agency error and six years prior to the month of discovery due to client
29.3error or an intentional program violation determined under section 256.046.

29.4    Sec. 14. Minnesota Statutes 2008, section 256J.575, subdivision 3, is amended to read:
29.5    Subd. 3. Eligibility. (a) The following MFIP or diversionary work program (DWP)
29.6participants are eligible for the services under this section:
29.7    (1) a participant who meets the requirements for or has been granted a hardship
29.8extension under section 256J.425, subdivision 2 or 3, except that it is not necessary for
29.9the participant to have reached or be approaching 60 months of eligibility for this section
29.10to apply;
29.11    (2) a participant who is applying for Supplemental Security Income or Social
29.12Security disability insurance; and
29.13    (3) a participant who is a noncitizen who has been in the United States for 12 or
29.14fewer months.
29.15    (b) Families must meet all other eligibility requirements for MFIP established in
29.16this chapter. Families are eligible for financial assistance to the same extent as if they
29.17were participating in MFIP.
29.18    (c) A participant under paragraph (a), clause (3), must be provided with English as a
29.19second language opportunities and skills training for up to 12 months. After 12 months,
29.20the case manager and participant must determine whether the participant should continue
29.21with English as a second language classes or skills training, or both, and continue to
29.22receive family stabilization services.
29.23EFFECTIVE DATE.This section is effective March 1, 2010.

29.24    Sec. 15. Minnesota Statutes 2008, section 256J.621, is amended to read:
29.25256J.621 WORK PARTICIPATION CASH BENEFITS.
29.26    (a) Effective October 1, 2009, upon exiting the diversionary work program (DWP)
29.27or upon terminating the Minnesota family investment program with earnings, a participant
29.28who is employed may be eligible for work participation cash benefits of $75 $50 per
29.29month to assist in meeting the family's basic needs as the participant continues to move
29.30toward self-sufficiency.
29.31    (b) To be eligible for work participation cash benefits, the participant shall not
29.32receive MFIP or diversionary work program assistance during the month and the
29.33participant or participants must meet the following work requirements:
30.1    (1) if the participant is a single caregiver and has a child under six years of age, the
30.2participant must be employed at least 87 hours per month;
30.3    (2) if the participant is a single caregiver and does not have a child under six years of
30.4age, the participant must be employed at least 130 hours per month; or
30.5    (3) if the household is a two-parent family, at least one of the parents must be
30.6employed an average of at least 130 hours per month.
30.7    Whenever a participant exits the diversionary work program or is terminated from
30.8MFIP and meets the other criteria in this section, work participation cash benefits are
30.9available for up to 24 consecutive months.
30.10    (c) Expenditures on the program are maintenance of effort state funds under
30.11a separate state program for participants under paragraph (b), clauses (1) and (2).
30.12Expenditures for participants under paragraph (b), clause (3), are nonmaintenance of effort
30.13funds. Months in which a participant receives work participation cash benefits under this
30.14section do not count toward the participant's MFIP 60-month time limit.

30.15    Sec. 16. Minnesota Statutes 2008, section 256J.626, subdivision 6, is amended to read:
30.16    Subd. 6. Base allocation to counties and tribes; definitions. (a) For purposes of
30.17this section, the following terms have the meanings given.
30.18    (1) "2002 historic spending base" means the commissioner's determination of
30.19the sum of the reimbursement related to fiscal year 2002 of county or tribal agency
30.20expenditures for the base programs listed in clause (6) (5), items (i) through (iv), and
30.21earnings related to calendar year 2002 in the base program listed in clause (6) (5), item
30.22(v), and the amount of spending in fiscal year 2002 in the base program listed in clause
30.23(6) (5), item (vi), issued to or on behalf of persons residing in the county or tribal service
30.24delivery area.
30.25    (2) "Adjusted caseload factor" means a factor weighted:
30.26    (i) 47 percent on the MFIP cases in each county at four points in time in the most
30.27recent 12-month period for which data is available multiplied by the county's caseload
30.28difficulty factor; and
30.29    (ii) 53 percent on the count of adults on MFIP in each county and tribe at four points
30.30in time in the most recent 12-month period for which data is available multiplied by the
30.31county or tribe's caseload difficulty factor.
30.32    (3) "Caseload difficulty factor" means a factor determined by the commissioner for
30.33each county and tribe based upon the self-support index described in section 256J.751,
30.34subdivision 2
, clause (6).
31.1    (4) "Initial allocation" means the amount potentially available to each county or tribe
31.2based on the formula in paragraphs (b) through (d).
31.3    (5) (4) "Final allocation" means the amount available to each county or tribe based
31.4on the formula in paragraphs (b) through (d), after adjustment by subdivision 7 and (c).
31.5    (6) (5) "Base programs" means the:
31.6    (i) MFIP employment and training services under Minnesota Statutes 2002, section
31.7256J.62, subdivision 1 , in effect June 30, 2002;
31.8    (ii) bilingual employment and training services to refugees under Minnesota Statutes
31.92002, section 256J.62, subdivision 6, in effect June 30, 2002;
31.10    (iii) work literacy language programs under Minnesota Statutes 2002, section
31.11256J.62, subdivision 7 , in effect June 30, 2002;
31.12    (iv) supported work program authorized in Laws 2001, First Special Session chapter
31.139, article 17, section 2, in effect June 30, 2002;
31.14    (v) administrative aid program under section 256J.76 in effect December 31, 2002;
31.15and
31.16    (vi) emergency assistance program under Minnesota Statutes 2002, section 256J.48,
31.17in effect June 30, 2002.
31.18    (b) The commissioner shall:
31.19    (1) beginning July 1, 2003, determine the initial allocation of funds available under
31.20this section according to clause (2);
31.21    (2) allocate all of the funds available for the period beginning July 1, 2003, and
31.22ending December 31, 2004, to each county or tribe in proportion to the county's or tribe's
31.23share of the statewide 2002 historic spending base;
31.24    (3) determine for calendar year 2005 the initial allocation of funds to be made
31.25available under this section in proportion to the county or tribe's initial allocation for the
31.26period of July 1, 2003, to December 31, 2004;
31.27    (4) determine for calendar year 2006 the initial allocation of funds to be made
31.28available under this section based 90 percent on the proportion of the county or tribe's
31.29share of the statewide 2002 historic spending base and ten percent on the proportion of
31.30the county or tribe's share of the adjusted caseload factor;
31.31    (5) determine for calendar year 2007 the initial allocation of funds to be made
31.32available under this section based 70 percent on the proportion of the county or tribe's
31.33share of the statewide 2002 historic spending base and 30 percent on the proportion of the
31.34county or tribe's share of the adjusted caseload factor; and
31.35    (6) determine for calendar year 2008 and subsequent years the initial allocation of
31.36allocate funds to be made available under this section based 50 percent on the proportion
32.1of the county or tribe's share of the statewide 2002 historic spending base and 50 percent
32.2on the proportion of the county or tribe's share of the adjusted caseload factor.
32.3    (c) With the commencement of a new or expanded tribal TANF program or an
32.4agreement under section 256.01, subdivision 2, paragraph (g), in which some or all of
32.5the responsibilities of particular counties under this section are transferred to a tribe,
32.6the commissioner shall:
32.7    (1) in the case where all responsibilities under this section are transferred to a tribal
32.8program, determine the percentage of the county's current caseload that is transferring to a
32.9tribal program and adjust the affected county's allocation accordingly; and
32.10    (2) in the case where a portion of the responsibilities under this section are
32.11transferred to a tribal program, the commissioner shall consult with the affected county or
32.12counties to determine an appropriate adjustment to the allocation.
32.13    (d) Effective January 1, 2005, counties and tribes will have their final allocations
32.14adjusted based on the performance provisions of subdivision 7.
32.15EFFECTIVE DATE.This section is effective January 1, 2010.

32.16    Sec. 17. Minnesota Statutes 2008, section 256J.751, is amended by adding a
32.17subdivision to read:
32.18    Subd. 2a. County performance standards. (a) For the purpose of this section, the
32.19following terms have the meanings given:
32.20(1) "Caseload reduction credit" (CRC) means the measure of how much the
32.21Minnesota TANF caseload, including the separate state program caseload, has fallen
32.22relative to the federal fiscal year 2005 caseload based on caseload data from October
32.231 to September 30.
32.24(2) "TANF participation rate target" means a 50 percent participation rate reduced by
32.25the CRC as calculated by the Department of Human Services.
32.26(b) A county or tribe shall negotiate a multiyear improvement plan with the
32.27commissioner if the county or tribe does not:
32.28(1) achieve the TANF participation rate target or a five percentage point improvement
32.29over the county or tribe's previous year's TANF participation rate under subdivision 2,
32.30clause (7), as averaged across 12 consecutive months for the most recent year for which
32.31the measurements are available; or
32.32(2) perform within or above its range of expected performance on the annualized
32.33three-year self-support index under subdivision 2, clause (6).
33.1(c) A county or tribe that has successfully negotiated an improvement plan must
33.2provide a semiannual report indicating that the plan has been implemented, the impact of
33.3the plan, and any anticipated changes to the plan.

33.4    Sec. 18. Minnesota Statutes 2008, section 256J.95, subdivision 12, is amended to read:
33.5    Subd. 12. Conversion or referral to MFIP. (a) If at any time during the DWP
33.6application process or during the four-month DWP eligibility period, it is determined that
33.7a participant is unlikely to benefit from the diversionary work program, the county shall
33.8convert or refer the participant to MFIP as specified in paragraph (d). Participants who are
33.9determined to be unlikely to benefit from the diversionary work program must develop
33.10and sign an employment plan. Participants who meet any one of the criteria in paragraph
33.11(b) shall be considered to be unlikely to benefit from DWP, provided the necessary
33.12documentation is available to support the determination.
33.13(b) A participant who: meets the eligibility requirements under section 256J.575,
33.14subdivision 3, must be considered to be unlikely to benefit from DWP, provided the
33.15necessary documentation is available to support the determination.
33.16(1) has been determined by a qualified professional as being unable to obtain or retain
33.17employment due to an illness, injury, or incapacity that is expected to last at least 60 days;
33.18(2) is required in the home as a caregiver because of the illness, injury, or incapacity,
33.19of a family member, or a relative in the household, or a foster child, and the illness, injury,
33.20or incapacity and the need for a person to provide assistance in the home has been certified
33.21by a qualified professional and is expected to continue more than 60 days;
33.22(3) is determined by a qualified professional as being needed in the home to care for
33.23a child or adult meeting the special medical criteria in section 256J.561, subdivision 2,
33.24paragraph (d), clause (3);
33.25(4) is pregnant and is determined by a qualified professional as being unable to
33.26obtain or retain employment due to the pregnancy; or
33.27(5) has applied for SSI or SSDI.
33.28(c) In a two-parent family unit, both parents must be if one parent is determined
33.29to be unlikely to benefit from the diversionary work program before, the family unit
33.30can must be converted or referred to MFIP.
33.31(d) A participant who is determined to be unlikely to benefit from the diversionary
33.32work program shall be converted to MFIP and, if the determination was made within 30
33.33days of the initial application for benefits, no additional application form is required.
33.34A participant who is determined to be unlikely to benefit from the diversionary work
33.35program shall be referred to MFIP and, if the determination is made more than 30
34.1days after the initial application, the participant must submit a program change request
34.2form. The county agency shall process the program change request form by the first of
34.3the following month to ensure that no gap in benefits is due to delayed action by the
34.4county agency. In processing the program change request form, the county must follow
34.5section 256J.32, subdivision 1, except that the county agency shall not require additional
34.6verification of the information in the case file from the DWP application unless the
34.7information in the case file is inaccurate, questionable, or no longer current.
34.8(e) The county shall not request a combined application form for a participant who
34.9has exhausted the four months of the diversionary work program, has continued need for
34.10cash and food assistance, and has completed, signed, and submitted a program change
34.11request form within 30 days of the fourth month of the diversionary work program. The
34.12county must process the program change request according to section 256J.32, subdivision
34.131
, except that the county agency shall not require additional verification of information
34.14in the case file unless the information is inaccurate, questionable, or no longer current.
34.15When a participant does not request MFIP within 30 days of the diversionary work
34.16program benefits being exhausted, a new combined application form must be completed
34.17for any subsequent request for MFIP.
34.18EFFECTIVE DATE.This section is effective March 1, 2010.

34.19    Sec. 19. Minnesota Statutes 2008, section 393.07, subdivision 10, is amended to read:
34.20    Subd. 10. Food stamp program; Maternal and Child Nutrition Act. (a) The local
34.21social services agency shall establish and administer the food stamp program according
34.22to rules of the commissioner of human services, the supervision of the commissioner as
34.23specified in section 256.01, and all federal laws and regulations. The commissioner of
34.24human services shall monitor food stamp program delivery on an ongoing basis to ensure
34.25that each county complies with federal laws and regulations. Program requirements to be
34.26monitored include, but are not limited to, number of applications, number of approvals,
34.27number of cases pending, length of time required to process each application and deliver
34.28benefits, number of applicants eligible for expedited issuance, length of time required
34.29to process and deliver expedited issuance, number of terminations and reasons for
34.30terminations, client profiles by age, household composition and income level and sources,
34.31and the use of phone certification and home visits. The commissioner shall determine the
34.32county-by-county and statewide participation rate.
34.33(b) On July 1 of each year, the commissioner of human services shall determine a
34.34statewide and county-by-county food stamp program participation rate. The commissioner
34.35may designate a different agency to administer the food stamp program in a county if the
35.1agency administering the program fails to increase the food stamp program participation
35.2rate among families or eligible individuals, or comply with all federal laws and regulations
35.3governing the food stamp program. The commissioner shall review agency performance
35.4annually to determine compliance with this paragraph.
35.5(c) A person who commits any of the following acts has violated section 256.98 or
35.6609.821 , or both, and is subject to both the criminal and civil penalties provided under
35.7those sections:
35.8(1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a
35.9willful statement or misrepresentation, or intentional concealment of a material fact, food
35.10stamps or vouchers issued according to sections 145.891 to 145.897 to which the person
35.11is not entitled or in an amount greater than that to which that person is entitled or which
35.12specify nutritional supplements to which that person is not entitled; or
35.13(2) presents or causes to be presented, coupons or vouchers issued according to
35.14sections 145.891 to 145.897 for payment or redemption knowing them to have been
35.15received, transferred or used in a manner contrary to existing state or federal law; or
35.16(3) willfully uses, possesses, or transfers food stamp coupons, authorization to
35.17purchase cards or vouchers issued according to sections 145.891 to 145.897 in any manner
35.18contrary to existing state or federal law, rules, or regulations; or
35.19(4) buys or sells food stamp coupons, authorization to purchase cards, other
35.20assistance transaction devices, vouchers issued according to sections 145.891 to 145.897,
35.21or any food obtained through the redemption of vouchers issued according to sections
35.22145.891 to 145.897 for cash or consideration other than eligible food.
35.23(d) A peace officer or welfare fraud investigator may confiscate food stamps,
35.24authorization to purchase cards, or other assistance transaction devices found in the
35.25possession of any person who is neither a recipient of the food stamp program nor
35.26otherwise authorized to possess and use such materials. Confiscated property shall be
35.27disposed of as the commissioner may direct and consistent with state and federal food
35.28stamp law. The confiscated property must be retained for a period of not less than 30 days
35.29to allow any affected person to appeal the confiscation under section 256.045.
35.30(e) Food stamp overpayment claims which are due in whole or in part to client
35.31error shall be established by the county agency for a period of six years from the date of
35.32any resultant overpayment. Establishment of a food stamp overpayment is limited to 12
35.33months prior to the month of discovery due to an agency error and six years prior to the
35.34month of discovery due to a client error or an intentional program violation determined
35.35under section 256.046.
36.1(f) With regard to the federal tax revenue offset program only, recovery incentives
36.2authorized by the federal food and consumer service shall be retained at the rate of 50
36.3percent by the state agency and 50 percent by the certifying county agency.
36.4(g) A peace officer, welfare fraud investigator, federal law enforcement official,
36.5or the commissioner of health may confiscate vouchers found in the possession of any
36.6person who is neither issued vouchers under sections 145.891 to 145.897, nor otherwise
36.7authorized to possess and use such vouchers. Confiscated property shall be disposed of
36.8as the commissioner of health may direct and consistent with state and federal law. The
36.9confiscated property must be retained for a period of not less than 30 days.
36.10(h) The commissioner of human services may seek a waiver from the United States
36.11Department of Agriculture to allow the state to specify foods that may and may not be
36.12purchased in Minnesota with benefits funded by the federal Food Stamp Program. The
36.13commissioner shall consult with the members of the house of representatives and senate
36.14policy committees having jurisdiction over food support issues in developing the waiver.
36.15The commissioner, in consultation with the commissioners of health and education, shall
36.16develop a broad public health policy related to improved nutrition and health status. The
36.17commissioner must seek legislative approval prior to implementing the waiver.

36.18    Sec. 20. AMERICAN INDIAN CHILD WELFARE PROJECTS.
36.19Notwithstanding Minnesota Statutes, section 16A.28, the commissioner of human
36.20services shall extend payment of state fiscal year 2009 funds in state fiscal year 2010
36.21to tribes participating in the American Indian child welfare projects under Minnesota
36.22Statutes, section 256.01, subdivision 14b. Future extensions of payment for a tribe
36.23participating in the Indian child welfare projects under Minnesota Statutes, section 256.01,
36.24subdivision 14b, must be granted according to the commissioner's authority under
36.25Minnesota Statutes, section 16A.28.

36.26    Sec. 21. REPEALER.
36.27(a) Minnesota Statutes 2008, sections 256I.06, subdivision 9; and 256J.626,
36.28subdivision 7, are repealed.
36.29(b) Minnesota Rules, parts 9500.1243, subpart 3; and 9500.1261, subparts 3, 4, 5,
36.30and 6, are repealed.

36.31ARTICLE 3
36.32CHILD SUPPORT

36.33    Section 1. Minnesota Statutes 2008, section 518A.53, subdivision 1, is amended to
36.34read:
37.1    Subdivision 1. Definitions. (a) For the purpose of this section, the following terms
37.2have the meanings provided in this subdivision unless otherwise stated.
37.3(b) "Payor of funds" means any person or entity that provides funds to an obligor,
37.4including an employer as defined under chapter 24 of the Internal Revenue Code,
37.5section 3401(d), an independent contractor, payor of worker's compensation benefits or
37.6unemployment benefits, or a financial institution as defined in section 13B.06.
37.7(c) "Business day" means a day on which state offices are open for regular business.
37.8(d) The term "arrears" means amounts owed under a support order that are past due
37.9as used in this section has the meaning provided in section 518A.26.
37.10EFFECTIVE DATE.This section is effective April 1, 2010.

37.11    Sec. 2. Minnesota Statutes 2008, section 518A.53, subdivision 4, is amended to read:
37.12    Subd. 4. Collection services. (a) The commissioner of human services shall prepare
37.13and make available to the courts a notice of services that explains child support and
37.14maintenance collection services available through the public authority, including income
37.15withholding, and the fees for such services. Upon receiving a petition for dissolution of
37.16marriage or legal separation, the court administrator shall promptly send the notice of
37.17services to the petitioner and respondent at the addresses stated in the petition.
37.18(b) Either the obligee or obligor may at any time apply to the public authority for
37.19either full IV-D services or for income withholding only services.
37.20(c) For those persons applying for income withholding only services, a monthly
37.21service fee of $15 must be charged to the obligor. This fee is in addition to the amount of
37.22the support order and shall be withheld through income withholding. The public authority
37.23shall explain the service options in this section to the affected parties and encourage the
37.24application for full child support collection services.
37.25(d) If the obligee is not a current recipient of public assistance as defined in section
37.26256.741 , the person who applied for services may at any time choose to terminate either
37.27full IV-D services or income withholding only services regardless of whether income
37.28withholding is currently in place. The obligee or obligor may reapply for either full IV-D
37.29services or income withholding only services at any time. Unless the applicant is a
37.30recipient of public assistance as defined in section 256.741, a $25 application fee shall be
37.31charged at the time of each application.
37.32(e) When a person terminates IV-D services, if an arrearage for public assistance as
37.33defined in section 256.741 exists, the public authority may continue income withholding,
37.34as well as use any other enforcement remedy for the collection of child support, until all
37.35public assistance arrears are paid in full. Income withholding shall be in an amount equal
38.1to 20 percent of the support order in effect at the time the services terminated., unless the
38.2support order includes a specific monthly payback amount. If the support order includes a
38.3specific monthly payback amount, income withholding shall be in the specific amount
38.4ordered. The provisions of this paragraph apply to all support orders in effect on or before
38.5January 1, 2010, and to all support orders in effect after January 1, 2010.
38.6EFFECTIVE DATE.This section is effective April 1, 2010.

38.7    Sec. 3. Minnesota Statutes 2008, section 518A.53, subdivision 10, is amended to read:
38.8    Subd. 10. Arrearage order. (a) This section does not prevent the court from
38.9ordering the payor of funds to withhold amounts to satisfy the obligor's previous arrearage
38.10in support order payments. This remedy shall not operate to exclude availability of other
38.11remedies to enforce judgments. The employer or payor of funds shall withhold from
38.12the obligor's income an additional amount equal to 20 percent of the monthly child
38.13support or maintenance obligation until the arrearage is paid., unless the support order
38.14includes a specific monthly payback amount. If the support order includes a specific
38.15monthly payback amount, income withholding shall be in the specific amount ordered.
38.16The provisions of this paragraph apply to all support orders in effect on or before January
38.171, 2010, and to all support orders in effect after January 1, 2010.
38.18(b) Notwithstanding any law to the contrary, funds from income sources included
38.19in section 518A.26, subdivision 8, whether periodic or lump sum, are not exempt from
38.20attachment or execution upon a judgment for child support arrearage.
38.21(c) Absent an order to the contrary, if an arrearage exists at the time a support
38.22order would otherwise terminate, income withholding shall continue in effect or may be
38.23implemented in an amount equal to the support order plus an additional 20 percent of the
38.24monthly child support obligation, until all arrears have been paid in full.
38.25EFFECTIVE DATE.This section is effective April 1, 2010.

38.26ARTICLE 4
38.27STATE-OPERATED SERVICES

38.28    Section 1. Minnesota Statutes 2008, section 246.50, subdivision 5, is amended to read:
38.29    Subd. 5. Cost of care. "Cost of care" means the commissioner's charge for services
38.30provided to any person admitted to a state facility.
38.31For purposes of this subdivision, "charge for services" means the cost of services,
38.32treatment, maintenance, bonds issued for capital improvements, depreciation of buildings
38.33and equipment, and indirect costs related to the operation of state facilities. The
38.34commissioner may determine the charge for services on an anticipated average per diem
39.1basis as an all inclusive charge per facility, per disability group, or per treatment program.
39.2The commissioner may determine a charge per service, using a method that includes direct
39.3and indirect costs. usual and customary fee charged for services provided to clients. The
39.4usual and customary fee shall be established in a manner required to appropriately bill
39.5services to all payers and shall include the costs related to the operations of any program
39.6offered by the state.

39.7    Sec. 2. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision
39.8to read:
39.9    Subd. 10. State-operated community-based program. "State-operated
39.10community-based program" means any program operated in the community including
39.11community behavioral health hospitals, crisis centers, residential facilities, outpatient
39.12services, and other community-based services developed and operated by the state and
39.13under the commissioner's control.

39.14    Sec. 3. Minnesota Statutes 2008, section 246.50, is amended by adding a subdivision
39.15to read:
39.16    Subd. 11. Health plan company. "Health plan company" has the meaning given it
39.17in section 62Q.01, subdivision 4, and also includes a demonstration provider as defined in
39.18section 256B.69, subdivision 2, paragraph (b), a county or group of counties participating
39.19in county-based purchasing according to section 256B.692, and a children's mental health
39.20collaborative under contract to provide medical assistance for individuals enrolled in
39.21the prepaid medical assistance and MinnesotaCare programs under sections 245.493 to
39.22245.495.

39.23    Sec. 4. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision
39.24to read:
39.25    Subd. 1a. Clients in state-operated community-based programs; determination.
39.26For clients admitted to a state-operated community-based program, the commissioner shall
39.27make an investigation to determine the available health plan coverage for services being
39.28provided. If the health plan coverage requires a co-pay or deductible, or if there is no
39.29available health plan coverage, the commission shall make an investigation as necessary
39.30to determine, and as circumstances require redetermine, what part of the noncovered
39.31cost of care, if any, the client is able to pay. If the client is unable to pay the uncovered
39.32cost of care, the commissioner shall make a determination as to the ability of the client's
39.33relatives to pay. The client and relatives shall provide the commissioner documents and
39.34proof necessary to determine their ability to pay. Failure to provide the commissioner with
40.1sufficient information to determine ability to pay may make the client or relatives liable
40.2for the full cost of care until the time when sufficient information is provided. If it is
40.3determined that the responsible party does not have the ability to pay, the commissioner
40.4shall waive payment of the portion that exceeds ability to pay under the determination.

40.5    Sec. 5. Minnesota Statutes 2008, section 246.51, is amended by adding a subdivision
40.6to read:
40.7    Subd. 1b. Clients served by regional treatment centers or nursing homes;
40.8determination. For clients served in regional treatment centers or nursing homes operated
40.9by state-operated services, the commissioner shall make investigation as necessary to
40.10determine, and as circumstances require redetermine, what part of the cost of care, if any,
40.11the client is able to pay. If the client is unable to pay the full cost of care, the commissioner
40.12shall determine whether the client's relatives have the ability to pay. The client and
40.13relatives shall provide the commissioner documents and proof necessary to determine their
40.14ability to pay. Failure to provide the commissioner with sufficient information to determine
40.15ability to pay may make the client or relatives liable for the full cost of care until the time
40.16when sufficient information is provided. No parent shall be liable for the cost of care given
40.17a client at a regional treatment center after the client has reached the age of 18 years.

40.18    Sec. 6. Minnesota Statutes 2008, section 246.511, is amended to read:
40.19246.511 RELATIVE RESPONSIBILITY.
40.20Except for chemical dependency services paid for with funds provided under chapter
40.21254B, a client's relatives shall not, pursuant to the commissioner's authority under section
40.22246.51 , be ordered to pay more than ten percent of the cost of the following: (1) for
40.23services provided in a community-based service, the noncovered cost of care as determined
40.24under the ability to pay determination; and (2) for services provided at a regional treatment
40.25center operated by state-operated services, 20 percent of the cost of care, unless they
40.26reside outside the state. Parents of children in state facilities shall have their responsibility
40.27to pay determined according to section 252.27, subdivision 2, or in rules adopted under
40.28chapter 254B if the cost of care is paid under chapter 254B. The commissioner may
40.29accept voluntary payments in excess of ten 20 percent. The commissioner may require
40.30full payment of the full per capita cost of care in state facilities for clients whose parent,
40.31parents, spouse, guardian, or conservator do not reside in Minnesota.

40.32    Sec. 7. Minnesota Statutes 2008, section 246.52, is amended to read:
40.33246.52 PAYMENT FOR CARE; ORDER; ACTION.
41.1The commissioner shall issue an order to the client or the guardian of the estate, if
41.2there be one, and relatives determined able to pay requiring them to pay monthly to the
41.3state of Minnesota the amounts so determined the total of which shall not exceed the full
41.4cost of care. Such order shall specifically state the commissioner's determination and shall
41.5be conclusive unless appealed from as herein provided. When a client or relative fails to
41.6pay the amount due hereunder the attorney general, upon request of the commissioner,
41.7may institute, or direct the appropriate county attorney to institute, civil action to recover
41.8such amount.

41.9    Sec. 8. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision
41.10to read:
41.11    Subd. 1a. Client. "Client" means a person who is admitted to the Minnesota sex
41.12offender program or subject to a court hold order under section 253B.185 for the purpose
41.13of assessment, diagnosis, care, treatment, supervision, or other services provided by the
41.14Minnesota sex offender program.

41.15    Sec. 9. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision
41.16to read:
41.17    Subd. 1b. Client's county. "Client's county" means the county of the client's
41.18legal settlement for poor relief purposes at the time of commitment. If the client has no
41.19legal settlement for poor relief in this state, it means the county of commitment, except
41.20that when a client with no legal settlement for poor relief is committed while serving a
41.21sentence at a penal institution, it means the county from which the client was sentenced.

41.22    Sec. 10. Minnesota Statutes 2008, section 246B.01, is amended by adding a
41.23subdivision to read:
41.24    Subd. 2a. Cost of care. "Cost of care" means the commissioner's charge for housing
41.25and treatment services provided to any person admitted to the Minnesota sex offender
41.26program.
41.27For purposes of this subdivision, "charge for housing and treatment services" means
41.28the cost of services, treatment, maintenance, bonds issued for capital improvements,
41.29depreciation of buildings and equipment, and indirect costs related to the operation of
41.30state facilities. The commissioner may determine the charge for services on an anticipated
41.31average per diem basis as an all-inclusive charge per facility.

41.32    Sec. 11. Minnesota Statutes 2008, section 246B.01, is amended by adding a subdivision
41.33to read:
42.1    Subd. 2b. Local social services agency. "Local social services agency" means the
42.2local social services agency of the client's county as defined in subdivision 1b and of the
42.3county of commitment, and any other local social services agency possessing information
42.4regarding, or requested by the commissioner to investigate, the financial circumstances
42.5of a client.

42.6    Sec. 12. [246B.07] PAYMENT FOR CARE AND TREATMENT:
42.7DETERMINATION.
42.8    Subdivision 1. Procedures. The commissioner shall make investigation as
42.9necessary to determine, and as circumstances require redetermine, what part of the cost of
42.10care, if any, the client is able to pay. The client shall provide the commissioner documents
42.11and proof necessary to determine the ability to pay. Failure to provide the commissioner
42.12with sufficient information to determine ability to pay may make the client liable for the
42.13full cost of care until the time when sufficient information is provided.
42.14    Subd. 2. Rules. The commissioner shall adopt, pursuant to the Administrative
42.15Procedure Act, rules establishing uniform standards for determination of client liability
42.16for care provided by the Minnesota sex offender program. These rules shall have the
42.17force and effect of law.
42.18    Subd. 3. Applicability. The commissioner may recover, under sections 246B.07 to
42.19246B.10, the cost of any care provided by the Minnesota sex offender program.

42.20    Sec. 13. [246B.08] PAYMENT FOR CARE; ORDER; ACTION.
42.21The commissioner shall issue an order to the client or the guardian of the estate, if
42.22there is one, requiring them to pay to the state the amounts so determined, the total of which
42.23shall not exceed the full cost of care. The order shall specifically state the commissioner's
42.24determination and must be conclusive, unless appealed. When a client fails to pay the
42.25amount due, the attorney general, upon request of the commissioner, may institute, or
42.26direct the appropriate county attorney to institute, civil action to recover the amount.

42.27    Sec. 14. [246B.09] CLAIM AGAINST ESTATE OF DECEASED CLIENT.
42.28    Subdivision 1. Client's estate. Upon the death of a client, or a former client, the
42.29total cost of care given the client, less the amount actually paid toward the cost of care by
42.30the client, shall be filed by the commissioner as a claim against the estate of the client
42.31with the court having jurisdiction to probate the estate and all proceeds collected by the
42.32state in the case shall be divided between the state and county in proportion to the cost
42.33of care each has borne.
43.1    Subd. 2. Preferred status. An estate claim in subdivision 1 shall be considered an
43.2expense of the last illness for purposes of section 524.3-805.
43.3If the commissioner of human services determines that the property or estate of a
43.4client is not more than needed to care for and maintain the spouse and minor or dependent
43.5children of a deceased client, the commissioner has the power to compromise the claim of
43.6the state in a manner deemed just and proper.
43.7    Subd. 3. Exception from statute of limitations. Any statute of limitations that
43.8limits the commissioner in recovering the cost of care obligation incurred by a client or
43.9former client must not apply to any claim against an estate made under this section to
43.10recover cost of care.

43.11    Sec. 15. [246B.10] LIABILITY OF COUNTY; REIMBURSEMENT.
43.12The client's county shall pay to the state a portion of the cost of care provided in
43.13the Minnesota sex offender program to a client legally settled in that county. A county's
43.14payment shall be made from the county's own sources of revenue and payments shall
43.15equal ten percent of the cost of care, as determined by the commissioner, for each day or
43.16portion of a day, that the client spends at the facility. If payments received by the state
43.17under sections 246.50 to 246.53 exceed 90 percent of the cost of care, the county shall
43.18be responsible for paying the state only the remaining amount. The county shall not be
43.19entitled to reimbursement from the client, the client's estate, or from the client's relatives,
43.20except as provided in section 246B.07.

43.21    Sec. 16. REPEALER.
43.22Minnesota Statutes 2008, sections 246.51, subdivision 1; and 246.53, subdivision
43.233, are repealed.

43.24ARTICLE 5
43.25DEPARTMENT OF HEALTH

43.26    Section 1. Minnesota Statutes 2008, section 13.465, subdivision 8, is amended to read:
43.27    Subd. 8. Adoption records. Various adoption records are classified under section
43.28259.53, subdivision 1 . Access to the original birth record of a person who has been
43.29adopted is governed by section 259.89 144.2253.
43.30EFFECTIVE DATE.This section is effective August 1, 2010.

43.31    Sec. 2. Minnesota Statutes 2008, section 62J.495, is amended to read:
43.3262J.495 HEALTH INFORMATION TECHNOLOGY AND
43.33INFRASTRUCTURE.
44.1    Subdivision 1. Implementation. By January 1, 2015, all hospitals and health care
44.2providers must have in place an interoperable electronic health records system within their
44.3hospital system or clinical practice setting. The commissioner of health, in consultation
44.4with the e-Health Information Technology and Infrastructure Advisory Committee,
44.5shall develop a statewide plan to meet this goal, including uniform standards to be used
44.6for the interoperable system for sharing and synchronizing patient data across systems.
44.7The standards must be compatible with federal efforts. The uniform standards must be
44.8developed by January 1, 2009, with a status report on the development of these standards
44.9submitted to the legislature by January 15, 2008 and updated on an ongoing basis. The
44.10commissioner shall include an update on standards development as part of an annual
44.11report to the legislature.
44.12    Subd. 1a. Definitions. (a) "Certified electronic health record technology" means an
44.13electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH
44.14Act to meet the standards and implementation specifications adopted under section 3004
44.15as applicable.
44.16(b) "Commissioner" means the commissioner of health.
44.17(c) "Electronic data intermediary" means any entity that provides the infrastructure to
44.18connect computer systems or other electronic devices utilized by prescribing practitioners
44.19with those used by pharmacies, health plans, third party administrators, and pharmacy
44.20benefit manager in order to facilitate the secure transmission of electronic prescriptions,
44.21refill authorization requests, communications, and other prescription-related information
44.22between such entities.
44.23(d) "HITECH Act" means the Health Information Technology for Economic and
44.24Clinical Health Act in division A, title XIII and division B, title IV of the American
44.25Recovery and Reinvestment Act of 2009, including federal regulations adopted under
44.26that act.
44.27(e) "Interoperable electronic health record" means an electronic health record that
44.28securely exchanges health information with another electronic health record system that
44.29meets national requirements for certification under the HITECH Act.
44.30(f) "Qualified electronic health record" means an electronic record of health-related
44.31information on an individual that includes patient demographic and clinical health
44.32information and has the capacity to:
44.33(1) provide clinical decision support;
44.34(2) support physician order entry;
44.35(3) capture and query information relevant to health care quality; and
45.1(4) exchange electronic health information with, and integrate such information
45.2from, other sources.
45.3    Subd. 2. E-Health Information Technology and Infrastructure Advisory
45.4Committee. (a) The commissioner shall establish a an e-Health Information Technology
45.5and Infrastructure Advisory Committee governed by section 15.059 to advise the
45.6commissioner on the following matters:
45.7    (1) assessment of the adoption and effective use of health information technology by
45.8the state, licensed health care providers and facilities, and local public health agencies;
45.9    (2) recommendations for implementing a statewide interoperable health information
45.10infrastructure, to include estimates of necessary resources, and for determining standards
45.11for administrative clinical data exchange, clinical support programs, patient privacy
45.12requirements, and maintenance of the security and confidentiality of individual patient
45.13data;
45.14    (3) recommendations for encouraging use of innovative health care applications
45.15using information technology and systems to improve patient care and reduce the cost
45.16of care, including applications relating to disease management and personal health
45.17management that enable remote monitoring of patients' conditions, especially those with
45.18chronic conditions; and
45.19    (4) other related issues as requested by the commissioner.
45.20    (b) The members of the e-Health Information Technology and Infrastructure
45.21Advisory Committee shall include the commissioners, or commissioners' designees, of
45.22health, human services, administration, and commerce and additional members to be
45.23appointed by the commissioner to include persons representing Minnesota's local public
45.24health agencies, licensed hospitals and other licensed facilities and providers, private
45.25purchasers, the medical and nursing professions, health insurers and health plans, the
45.26state quality improvement organization, academic and research institutions, consumer
45.27advisory organizations with an interest and expertise in health information technology, and
45.28other stakeholders as identified by the Health Information Technology and Infrastructure
45.29Advisory Committee commissioner to fulfill the requirements of section 3013, paragraph
45.30(g) of the HITECH Act.
45.31    (c) The commissioner shall prepare and issue an annual report not later than January
45.3230 of each year outlining progress to date in implementing a statewide health information
45.33infrastructure and recommending future projects action on policy and necessary resources
45.34to continue the promotion of adoption and effective use of health information technology.
45.35(d) Notwithstanding section 15.059, this subdivision expires June 30, 2015.
46.1    Subd. 3. Interoperable electronic health record requirements. (a) To meet the
46.2requirements of subdivision 1, hospitals and health care providers must meet the following
46.3criteria when implementing an interoperable electronic health records system within their
46.4hospital system or clinical practice setting.
46.5(a) The electronic health record must be a qualified electronic health record.
46.6    (b) The electronic health record must be certified by the Certification Commission
46.7for Healthcare Information Technology, or its successor Office of the National Coordinator
46.8pursuant to the HITECH Act. This criterion only applies to hospitals and health care
46.9providers whose practice setting is a practice setting covered by the Certification
46.10Commission for Healthcare Information Technology certifications only if a certified
46.11electronic health record product for the provider's particular practice setting is available.
46.12This criterion shall be considered met if a hospital or health care provider is using an
46.13electronic health records system that has been certified within the last three years, even if a
46.14more current version of the system has been certified within the three-year period.
46.15(c) The electronic health record must meet the standards established according to
46.16section 3004 of the HITECH Act as applicable.
46.17(d) The electronic health record must have the ability to generate information on
46.18clinical quality measures and other measures reported under sections 4101, 4102, and
46.194201 of the HITECH Act.
46.20    (c) (e) A health care provider who is a prescriber or dispenser of controlled
46.21substances legend drugs must have an electronic health record system that meets the
46.22requirements of section 62J.497.
46.23    Subd. 4. Coordination with national HIT activities. (a) The commissioner,
46.24in consultation with the e-Health Advisory Committee, shall update the statewide
46.25implementation plan required under subdivision 2 and released June 2008, to be consistent
46.26with the updated Federal HIT Strategic Plan released by the Office of the National
46.27Coordinator in accordance with section 3001 of the HITECH Act. The statewide plan
46.28shall meet the requirements for a plan required under section 3013 of the HITECH Act.
46.29(b) The commissioner, in consultation with the e-Health Advisory Committee, shall
46.30work to ensure coordination between state, regional, and national efforts to support and
46.31accelerate efforts to effectively use health information technology to improve the quality
46.32and coordination of health care and continuity of patient care among health care providers,
46.33to reduce medical errors, to improve population health, to reduce health disparities, and
46.34to reduce chronic disease. The commissioner's coordination efforts shall include but not
46.35be limited to:
47.1(1) assisting in the development and support of health information technology
47.2regional extension centers established under section 3012(c) of the HITECH Act to
47.3provide technical assistance and disseminate best practices; and
47.4(2) providing supplemental information to the best practices gathered by regional
47.5centers to ensure that the information is relayed in a meaningful way to the Minnesota
47.6health care community.
47.7(c) The commissioner, in consultation with the e-Health Advisory Committee, shall
47.8monitor national activity related to health information technology and shall coordinate
47.9statewide input on policy development. The commissioner shall coordinate statewide
47.10responses to proposed federal regulations in order to ensure that the needs of the
47.11Minnesota health care community are adequately and efficiently addressed in the proposed
47.12regulations. The commissioner's responses may include, but are not limited to:
47.13(1) reviewing and evaluating any standard, implementation specification, or
47.14certification criteria proposed by the national HIT standards committee;
47.15(2) reviewing and evaluating policy proposed by the national HIT policy
47.16committee relating to the implementation of a nationwide health information technology
47.17infrastructure;
47.18(3) monitoring and responding to activity related to the development of quality
47.19measures and other measures as required by section 4101 of the HITECH Act. Any
47.20response related to quality measures shall consider and address the quality efforts required
47.21under chapter 62U; and
47.22(4) monitoring and responding to national activity related to privacy, security, and
47.23data stewardship of electronic health information and individually identifiable health
47.24information.
47.25(d) To the extent that the state is either required or allowed to apply, or designate an
47.26entity to apply for or carry out activities and programs under section 3013 of the HITECH
47.27Act, the commissioner of health, in consultation with the e-Health Advisory Committee
47.28and the commissioner of human services, shall be the lead applicant or sole designating
47.29authority. The commissioner shall make such designations consistent with the goals and
47.30objectives of sections 62J.495 to 62J.497, and sections 62J.50 to 62J.61.
47.31(e) The commissioner of human services shall apply for funding necessary to
47.32administer the incentive payments to providers authorized under title IV of the American
47.33Recovery and Reinvestment Act.
47.34(f) The commissioner shall include in the report to the legislature information on the
47.35activities of this subdivision and provide recommendations on any relevant policy changes
47.36that should be considered in Minnesota.
48.1    Subd. 5. Collection of data for assessment and eligibility determination. (a) The
48.2commissioner of health, in consultation with the commissioner of human services, may
48.3require providers, dispensers, group purchasers, and electronic data intermediaries to
48.4submit data in a form and manner specified by the commissioner to assess the status of
48.5adoption, effective use, and interoperability of electronic health records for the purpose of:
48.6(1) demonstrating Minnesota's progress on goals established by the Office of the
48.7National Coordinator to accelerate the adoption and effective use of health information
48.8technology established under the HITECH Act;
48.9(2) assisting the Center for Medicare and Medicaid Services and Department of
48.10Human Services in determining eligibility of health care professionals and hospitals
48.11to receive federal incentives for the adoption and effective use of health information
48.12technology under the HITECH Act or other federal incentive programs;
48.13(3) assisting the Office of the National Coordinator in completing required
48.14assessments of the impact of the implementation and effective use of health information
48.15technology in achieving goals identified in the national strategic plan, and completing
48.16studies required by the HITECH Act;
48.17(4) providing the data necessary to assist the Office of the National Coordinator in
48.18conducting evaluations of regional extension centers as required by the HITECH Act; and
48.19(5) other purposes as necessary to support the implementation of the HITECH Act.
48.20(b) The commissioner shall coordinate with the commissioner of human services
48.21and other state agencies in the collection of data required under this section to:
48.22(1) avoid duplicative reporting requirements;
48.23(2) maximize efficiencies in the development of reports on state activities as
48.24required by HITECH; and
48.25(3) determine health professional and hospital eligibility for incentives available
48.26under the HITECH Act.
48.27    Subd. 6. Data classification. (a) Data collected on providers, dispensers, group
48.28purchasers, and electronic data intermediaries under this section are private data on
48.29individuals or nonpublic data, as defined in section 13.02. Notwithstanding the definition
48.30of summary data in section 13.02, subdivision 19, summary data prepared under this
48.31subdivision may be derived from nonpublic data.
48.32(b) Nothing in this section authorizes the collection of individual patient data.

48.33    Sec. 3. Minnesota Statutes 2008, section 62J.496, is amended to read:
48.3462J.496 ELECTRONIC HEALTH RECORD SYSTEM REVOLVING
48.35ACCOUNT AND LOAN PROGRAM.
49.1    Subdivision 1. Account establishment. (a) An account is established to: provide
49.2loans to eligible borrowers to assist in financing the installation or support of an
49.3interoperable health record system. The system must provide for the interoperable
49.4exchange of health care information between the applicant and, at a minimum, a hospital
49.5system, pharmacy, and a health care clinic or other physician group.
49.6(1) finance the purchase of certified electronic health records or qualified electronic
49.7health records as defined in section 62J.495, subdivision 1a;
49.8(2) enhance the utilization of electronic health record technology, which may include
49.9costs associated with upgrading the technology to meet the criteria necessary to be a
49.10certified electronic health record or a qualified electronic health record;
49.11(3) train personnel in the use of electronic health record technology; and
49.12(4) improve the secure electronic exchange of health information.
49.13(b) Amounts deposited in the account, including any grant funds obtained through
49.14federal or other sources, loan repayments, and interest earned on the amounts shall be
49.15used only for awarding loans or loan guarantees, as a source of reserve and security for
49.16leveraged loans, or for the administration of the account.
49.17(c) The commissioner may accept contributions to the account from private sector
49.18entities subject to the following provisions:
49.19(1) the contributing entity may not specify the recipient or recipients of any loan
49.20issued under this subdivision;
49.21(2) the commissioner shall make public the identity of any private contributor to the
49.22loan fund, as well as the amount of the contribution provided; and
49.23(3) the commissioner may issue letters of commendation or make other awards that
49.24have no financial value to any such entity.
49.25A contributing entity may not specify that the recipient or recipients of any loan use
49.26specific products or services, nor may the contributing entity imply that a contribution is
49.27an endorsement of any specific product or service.
49.28(d) The commissioner may use the loan funds to reimburse private sector entities
49.29for any contribution made to the loan fund. Reimbursement to private entities may not
49.30exceed the principle amount contributed to the loan fund.
49.31(e) The commissioner may use funds deposited in the account to guarantee, or
49.32purchase insurance for, a local obligation if the guarantee or purchase would improve
49.33credit market access or reduce the interest rate applicable to the obligation involved.
49.34(f) The commissioner may use funds deposited in the account as a source of revenue
49.35or security for the payment of principal and interest on revenue or bonds issued by the
49.36state if the proceeds of the sale of the bonds will be deposited into the loan fund.
50.1    Subd. 2. Eligibility. (a) "Eligible borrower" means one of the following:
50.2(1) federally qualified health centers;
50.3    (1) (2) community clinics, as defined under section 145.9268;
50.4    (2) (3) hospitals eligible for rural hospital capital improvement grants, as defined
50.5in section 144.148;
50.6    (3) physician clinics located in a community with a population of less than 50,000
50.7according to United States Census Bureau statistics and outside the seven-county
50.8metropolitan area;
50.9(4) individual or small group physician practices that are focused primarily on
50.10primary care;
50.11    (4) (5) nursing facilities licensed under sections 144A.01 to 144A.27; and
50.12(6) local public health departments as defined in chapter 145A; and
50.13    (5) (7) other providers of health or health care services approved by the
50.14commissioner for which interoperable electronic health record capability would improve
50.15quality of care, patient safety, or community health.
50.16 (b) The commissioner shall administer the loan fund to prioritize support and
50.17assistance to:
50.18(1) critical access hospitals;
50.19(2) federally qualified health centers;
50.20(3) entities that serve uninsured, underinsured, and medically underserved
50.21individuals, regardless of whether such area is urban or rural; and
50.22(4) individual or small group practices that are primarily focused on primary care.
50.23    (b) To be eligible for a loan under this section, the (c) An eligible applicant must
50.24submit a loan application to the commissioner of health on forms prescribed by the
50.25commissioner. The application must include, at a minimum:
50.26    (1) the amount of the loan requested and a description of the purpose or project
50.27for which the loan proceeds will be used;
50.28    (2) a quote from a vendor;
50.29    (3) a description of the health care entities and other groups participating in the
50.30project;
50.31    (4) evidence of financial stability and a demonstrated ability to repay the loan; and
50.32    (5) a description of how the system to be financed interconnects interoperates or
50.33plans in the future to interconnect interoperate with other health care entities and provider
50.34groups located in the same geographical area;
50.35(6) a plan on how the certified electronic health record technology will be maintained
50.36and supported over time; and
51.1(7) any other requirements for applications included or developed pursuant to
51.2section 3014 of the HITECH Act.
51.3    Subd. 3. Loans. (a) The commissioner of health may make a no interest, or low
51.4interest, loan to a provider or provider group who is eligible under subdivision 2 on a
51.5first-come, first-served basis provided that the applicant is able to comply with this section
51.6consistent with the priorities established in subdivision 2. The total accumulative loan
51.7principal must not exceed $1,500,000 $3,000,000 per loan. The interest rate for each
51.8loan, if imposed, shall not exceed the current market interest rate. The commissioner of
51.9health has discretion over the size, interest rate, and number of loans made. Nothing in
51.10this section shall require the commissioner to make a loan to an eligible borrower under
51.11subdivision 2.
51.12    (b) The commissioner of health may prescribe forms and establish an application
51.13process and, notwithstanding section 16A.1283, may impose a reasonable nonrefundable
51.14application fee to cover the cost of administering the loan program. Any application
51.15fees imposed and collected under the electronic health records system revolving account
51.16and loan program in this section are appropriated to the commissioner of health for the
51.17duration of the loan program. The commissioner may apply for and use all federal funds
51.18available through the HITECH Act to administer the loan program.
51.19    (c) For loans approved prior to July 1, 2009, the borrower must begin repaying the
51.20principal no later than two years from the date of the loan. Loans must be amortized no
51.21later than six years from the date of the loan.
51.22(d) For loans granted on January 1, 2010, or thereafter, the borrower must begin
51.23repaying the principle no later than one year from the date of the loan. Loans must be
51.24amortized no later than six years after the date of the loan.
51.25    (d) Repayments (e) All repayments and interest paid on each loan must be credited
51.26to the account.
51.27(f) The loan agreement shall include the assurances that borrower meets requirements
51.28included or developed pursuant to section 3014 of the HITECH Act. The requirements
51.29shall include, but are not limited to:
51.30(1) submitting reports on quality measures in compliance with regulations adopted
51.31by the federal government;
51.32(2) demonstrating that any certified electronic health record technology purchased,
51.33improved, or otherwise financially supported by this loan program is used to exchange
51.34health information in a manner that, in accordance with law and standards applicable to
51.35the exchange of information, improves the quality of health care;
52.1(3) including a plan on how the borrower intends to maintain and support the
52.2certified electronic health record technology over time and the resources expected to be
52.3used to maintain and support the technology purchased with the loan; and
52.4(4) complying with other requirements the secretary may require to use loans funds
52.5under the HITECH Act.
52.6    Subd. 4. Data classification. Data collected by the commissioner of health on the
52.7application to determine eligibility under subdivision 2 and to monitor borrowers' default
52.8risk or collect payments owed under subdivision 3 are (1) private data on individuals as
52.9defined in section 13.02, subdivision 12; and (2) nonpublic data as defined in section
52.1013.02, subdivision 9 . The names of borrowers and the amounts of the loans granted
52.11are public data.

52.12    Sec. 4. Minnesota Statutes 2008, section 62J.497, subdivision 1, is amended to read:
52.13    Subdivision 1. Definitions. For the purposes of this section, the following terms
52.14have the meanings given.
52.15(a) "Backward compatible" means that the newer version of a data transmission
52.16standard would retain, at a minimum, the full functionality of the versions previously
52.17adopted, and would permit the successful completion of the applicable transactions with
52.18entities that continue to use the older versions.
52.19    (a) (b) "Dispense" or "dispensing" has the meaning given in section 151.01,
52.20subdivision
30. Dispensing does not include the direct administering of a controlled
52.21substance to a patient by a licensed health care professional.
52.22    (b) (c) "Dispenser" means a person authorized by law to dispense a controlled
52.23substance, pursuant to a valid prescription.
52.24    (c) (d) "Electronic media" has the meaning given under Code of Federal Regulations,
52.25title 45, part 160.103.
52.26    (d) (e) "E-prescribing" means the transmission using electronic media of prescription
52.27or prescription-related information between a prescriber, dispenser, pharmacy benefit
52.28manager, or group purchaser, either directly or through an intermediary, including
52.29an e-prescribing network. E-prescribing includes, but is not limited to, two-way
52.30transmissions between the point of care and the dispenser and two-way transmissions
52.31related to eligibility, formulary, and medication history information.
52.32    (e) (f) "Electronic prescription drug program" means a program that provides for
52.33e-prescribing.
52.34    (f) (g) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.
53.1    (g) (h) "HL7 messages" means a standard approved by the standards development
53.2organization known as Health Level Seven.
53.3    (h) (i) "National Provider Identifier" or "NPI" means the identifier described under
53.4Code of Federal Regulations, title 45, part 162.406.
53.5    (i) (j) "NCPDP" means the National Council for Prescription Drug Programs, Inc.
53.6    (j) (k) "NCPDP Formulary and Benefits Standard" means the National Council for
53.7Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
53.8Version 1, Release 0, October 2005.
53.9    (k) (l) "NCPDP SCRIPT Standard" means the National Council for Prescription
53.10Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation
53.11Guide Version 8, Release 1 (Version 8.1), October 2005, or the most recent standard
53.12adopted by the Centers for Medicare and Medicaid Services for e-prescribing under
53.13Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and
53.14regulations adopted under it. The standards shall be implemented according to the Centers
53.15for Medicare and Medicaid Services schedule for compliance. Subsequently released
53.16versions of the NCPDP SCRIPT Standard may be used, provided that the new version
53.17of the standard is backward compatible to the current version adopted by the Centers for
53.18Medicare and Medicaid Services.
53.19    (l) (m) "Pharmacy" has the meaning given in section 151.01, subdivision 2.
53.20    (m) (n) "Prescriber" means a licensed health care professional who is authorized to
53.21prescribe a controlled substance under section 152.12, subdivision 1.
53.22    (n) (o) "Prescription-related information" means information regarding eligibility for
53.23drug benefits, medication history, or related health or drug information.
53.24    (o) (p) "Provider" or "health care provider" has the meaning given in section 62J.03,
53.25subdivision 8.

53.26    Sec. 5. Minnesota Statutes 2008, section 62J.497, subdivision 2, is amended to read:
53.27    Subd. 2. Requirements for electronic prescribing. (a) Effective January 1, 2011,
53.28all providers, group purchasers, prescribers, and dispensers must establish and, maintain,
53.29and use an electronic prescription drug program that complies. This program must comply
53.30with the applicable standards in this section for transmitting, directly or through an
53.31intermediary, prescriptions and prescription-related information using electronic media.
53.32    (b) Nothing in this section requires providers, group purchasers, prescribers, or
53.33dispensers to conduct the transactions described in this section. If transactions described in
53.34this section are conducted, they must be done electronically using the standards described
53.35in this section. Nothing in this section requires providers, group purchasers, prescribers,
54.1or dispensers to electronically conduct transactions that are expressly prohibited by other
54.2sections or federal law.
54.3    (c) Providers, group purchasers, prescribers, and dispensers must use either HL7
54.4messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related
54.5information internally when the sender and the recipient are part of the same legal entity. If
54.6an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard
54.7or other applicable standards required by this section. Any pharmacy within an entity
54.8must be able to receive electronic prescription transmittals from outside the entity using
54.9the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health
54.10Insurance Portability and Accountability Act (HIPAA) requirement that may require the
54.11use of a HIPAA transaction standard within an organization.
54.12    (d) Entities transmitting prescriptions or prescription-related information where the
54.13prescriber is required by law to issue a prescription for a patient to a nonprescribing
54.14provider that in turn forwards the prescription to a dispenser are exempt from the
54.15requirement to use the NCPDP SCRIPT Standard when transmitting prescriptions or
54.16prescription-related information.

54.17    Sec. 6. Minnesota Statutes 2008, section 62J.497, is amended by adding a subdivision
54.18to read:
54.19    Subd. 4. Development and use of prior authorization and uniform formulary
54.20exception form. (a) The commissioner of health, in consultation with the Minnesota
54.21Administrative Uniformity Committee, shall develop, by six weeks after enactment of
54.22this subdivision, a uniform prior authorization and formulary exception form that allows
54.23health care providers to request exceptions from group purchaser formularies, including
54.24Medicare Part D plans, using a uniform form. Upon development of the form, all health
54.25care providers must submit requests for prior authorization and formulary exceptions
54.26using the uniform form, or by telephone if the group purchaser provides this option, and
54.27all group purchasers must accept this form from health care providers.
54.28(b) Effective January 1, 2011, the uniform prior authorization and formulary
54.29exception form must be accessible by health care providers, and accepted and processed
54.30by group purchasers, electronically through a secure Internet site.

54.31    Sec. 7. [62Q.676] MEDICATION THERAPY MANAGEMENT.
54.32    A pharmacy benefit manager that provides prescription drug services must make
54.33available medication therapy management services for enrollees taking four or more
54.34prescriptions to treat or prevent two or more chronic medical conditions. For purposes
54.35of this section, "medication therapy management" means the provision of the following
55.1pharmaceutical care services by a licensed pharmacist to optimize the therapeutic
55.2outcomes of the patient's medications:
55.3    (1) performing a comprehensive medication review to identify, resolve, and prevent
55.4medication-related problems, including adverse drug events;
55.5    (2) communicating essential information to the patient's other primary care
55.6providers; and
55.7    (3) providing verbal education and training designed to enhance patient
55.8understanding and appropriate use of the patient's medications.
55.9    Nothing in this section shall be construed to expand or modify the scope of practice
55.10of the pharmacist as defined in section 151.01, subdivision 27.

55.11    Sec. 8. Minnesota Statutes 2008, section 144.122, is amended to read:
55.12144.122 LICENSE, PERMIT, AND SURVEY FEES.
55.13    (a) The state commissioner of health, by rule, may prescribe procedures and fees
55.14for filing with the commissioner as prescribed by statute and for the issuance of original
55.15and renewal permits, licenses, registrations, and certifications issued under authority of
55.16the commissioner. The expiration dates of the various licenses, permits, registrations,
55.17and certifications as prescribed by the rules shall be plainly marked thereon. Fees may
55.18include application and examination fees and a penalty fee for renewal applications
55.19submitted after the expiration date of the previously issued permit, license, registration,
55.20and certification. The commissioner may also prescribe, by rule, reduced fees for permits,
55.21licenses, registrations, and certifications when the application therefor is submitted
55.22during the last three months of the permit, license, registration, or certification period.
55.23Fees proposed to be prescribed in the rules shall be first approved by the Department of
55.24Finance. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be
55.25in an amount so that the total fees collected by the commissioner will, where practical,
55.26approximate the cost to the commissioner in administering the program. All fees collected
55.27shall be deposited in the state treasury and credited to the state government special revenue
55.28fund unless otherwise specifically appropriated by law for specific purposes.
55.29    (b) The commissioner may charge a fee for voluntary certification of medical
55.30laboratories and environmental laboratories, and for environmental and medical laboratory
55.31services provided by the department, without complying with paragraph (a) or chapter 14.
55.32Fees charged for environment and medical laboratory services provided by the department
55.33must be approximately equal to the costs of providing the services.
55.34    (c) The commissioner may develop a schedule of fees for diagnostic evaluations
55.35conducted at clinics held by the services for children with disabilities program. All
56.1receipts generated by the program are annually appropriated to the commissioner for use
56.2in the maternal and child health program.
56.3    (d) The commissioner shall set license fees for hospitals and nursing homes that are
56.4not boarding care homes at the following levels:
56.5
56.6
56.7
56.8
Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) and
American Osteopathic Association (AOA)
hospitals
$7,555$7,655 plus $13$16 per bed
56.9
Non-JCAHO and non-AOA hospitals
$5,180$5,280 plus $247$250 per bed
56.10
Nursing home
$183 plus $91 per bed
56.11    The commissioner shall set license fees for outpatient surgical centers, boarding care
56.12homes, and supervised living facilities at the following levels:
56.13
Outpatient surgical centers
$3,349$3,712
56.14
Boarding care homes
$183 plus $91 per bed
56.15
Supervised living facilities
$183 plus $91 per bed.
56.16    (e) Unless prohibited by federal law, the commissioner of health shall charge
56.17applicants the following fees to cover the cost of any initial certification surveys required
56.18to determine a provider's eligibility to participate in the Medicare or Medicaid program:
56.19
Prospective payment surveys for hospitals
$
900
56.20
Swing bed surveys for nursing homes
$
1,200
56.21
Psychiatric hospitals
$
1,400
56.22
Rural health facilities
$
1,100
56.23
Portable x-ray providers
$
500
56.24
Home health agencies
$
1,800
56.25
Outpatient therapy agencies
$
800
56.26
End stage renal dialysis providers
$
2,100
56.27
Independent therapists
$
800
56.28
Comprehensive rehabilitation outpatient facilities
$
1,200
56.29
Hospice providers
$
1,700
56.30
Ambulatory surgical providers
$
1,800
56.31
Hospitals
$
4,200
56.32
56.33
56.34
Other provider categories or additional
resurveys required to complete initial
certification
Actual surveyor costs: average
surveyor cost x number of hours
for the survey process.
56.35    These fees shall be submitted at the time of the application for federal certification
56.36and shall not be refunded. All fees collected after the date that the imposition of fees is not
56.37prohibited by federal law shall be deposited in the state treasury and credited to the state
56.38government special revenue fund.

56.39    Sec. 9. Minnesota Statutes 2008, section 144.218, subdivision 1, is amended to read:
57.1    Subdivision 1. Adoption. (a) Upon receipt of a certified copy of an order, decree,
57.2or certificate of adoption, the state registrar shall register a replacement vital record in
57.3the new name of the adopted person. Except as provided in paragraph (b), the original
57.4record of birth is confidential pursuant to private data on individuals, as defined in section
57.513.02, subdivision 3 12, and shall not be disclosed except pursuant to court order or
57.6section 144.2252 or 144.2253.
57.7(b) The information contained on the original birth record, except for the registration
57.8number, shall be provided on request to: (1) a parent who is named on the original birth
57.9record; or (2) the adopted person who is the subject of the record if the person is at least
57.1019 years of age, unless there is an affidavit of nondisclosure on file with the state registrar.
57.11Upon the receipt of a certified copy of a court order of annulment of adoption the state
57.12registrar shall restore the original vital record to its original place in the file.
57.13EFFECTIVE DATE.This section is effective August 1, 2010.

57.14    Sec. 10. Minnesota Statutes 2008, section 144.225, subdivision 2, is amended to read:
57.15    Subd. 2. Data about births. (a) Except as otherwise provided in this subdivision,
57.16data pertaining to the birth of a child to a woman who was not married to the child's father
57.17when the child was conceived nor when the child was born, including the original record
57.18of birth and the certified vital record, are confidential data. At the time of the birth of a
57.19child to a woman who was not married to the child's father when the child was conceived
57.20nor when the child was born, the mother may designate demographic data pertaining to
57.21the birth as public. Notwithstanding the designation of the data as confidential, it may
57.22be disclosed:
57.23(1) to a parent or guardian of the child;
57.24(2) to the child when the child is 16 years of age or older;
57.25(3) under paragraph (b) or (e); or
57.26(4) pursuant to a court order. For purposes of this section, a subpoena does not
57.27constitute a court order.
57.28(b) Unless the child is adopted, data pertaining to the birth of a child that are not
57.29accessible to the public become public data if 100 years have elapsed since the birth of
57.30the child who is the subject of the data, or as provided under section 13.10, whichever
57.31occurs first.
57.32(c) If a child is adopted, data pertaining to the child's birth are governed by the
57.33provisions relating to adoption records, including sections 13.10, subdivision 5; 144.218,
57.34subdivision 1
; 144.2252; 144.2253; and 259.89.
58.1(d) The name and address of a mother under paragraph (a) and the child's date of
58.2birth may be disclosed to the county social services or public health member of a family
58.3services collaborative for purposes of providing services under section 124D.23.
58.4(e) The commissioner of human services shall have access to birth records for:
58.5(1) the purposes of administering medical assistance, general assistance medical
58.6care, and the MinnesotaCare program;
58.7(2) child support enforcement purposes; and
58.8(3) other public health purposes as determined by the commissioner of health.
58.9EFFECTIVE DATE.This section is effective August 1, 2010.

58.10    Sec. 11. Minnesota Statutes 2008, section 144.2252, is amended to read:
58.11144.2252 ACCESS TO ORIGINAL BIRTH RECORD AFTER ADOPTION.
58.12(a) Whenever an adopted person requests the state registrar to disclose the
58.13information on the adopted person's original birth record, the state registrar shall act
58.14according to section 259.89 144.2253.
58.15(b) The state registrar shall provide a transcript of an adopted person's original birth
58.16record to an authorized representative of a federally recognized American Indian tribe
58.17for the sole purpose of determining the adopted person's eligibility for enrollment or
58.18membership. Information contained in the birth record may not be used to provide the
58.19adopted person information about the person's birth parents, except as provided in this
58.20section or section 259.83 144.2253.
58.21EFFECTIVE DATE.This section is effective August 1, 2010.

58.22    Sec. 12. [144.2253] ACCESS TO ORIGINAL BIRTH RECORDS BY ADOPTED
58.23PERSON; DEPARTMENT DUTIES.
58.24    Subdivision 1. Affidavits. The department shall prepare affidavit of disclosure and
58.25nondisclosure forms under which a birth parent may agree to or object to the release of the
58.26original birth record to the adopted person. The department shall make the forms readily
58.27accessible to birth parents on the department's Web site.
58.28    Subd. 2. Disclosure. Upon request, the state registrar shall provide a noncertified
58.29copy of the original birth record to an adopted person age 19 or older, unless there is
58.30an affidavit of nondisclosure on file. The state registrar must comply with the terms of
58.31affidavits of disclosure or affidavits of nondisclosure.
58.32    Subd. 3. Rescission of affidavit. A birth parent may rescind an affidavit of
58.33disclosure or an affidavit of nondisclosure at any time.
59.1    Subd. 4. Affidavit of nondisclosure; access to birth record. If an affidavit of
59.2nondisclosure is on file with the registrar, an adopted person age 19 or older may petition
59.3the appropriate court for disclosure of the original birth record pursuant to section 259.61.
59.4The court shall grant the petition if, after consideration of the interests of all known
59.5persons affected by the petition, the court determines that the benefits of disclosure of the
59.6information are greater than the benefits of nondisclosure.
59.7    Subd. 5. Information provided. (a) The department shall, in consultation with
59.8adoption agencies and adoption advocates, provide information and educational materials
59.9to adopted persons and birth parents about the changes in the law under this act affecting
59.10accessibility to birth records. For purposes of this subdivision, an adoption advocate is a
59.11nonprofit organization that works with adoption issues in Minnesota.
59.12    (b) The department shall include a notice on the department Web site about the
59.13change in the law under this act and direct individuals to private agencies and advocates
59.14for post-adoption resources.
59.15    (c) Adoption agencies may charge a fee for counseling and support services provided
59.16to adopted persons and birth parents.
59.17EFFECTIVE DATE.This section is effective August 1, 2010.

59.18    Sec. 13. Minnesota Statutes 2008, section 144.226, subdivision 1, is amended to read:
59.19    Subdivision 1. Which services are for fee. The fees for the following services shall
59.20be the following or an amount prescribed by rule of the commissioner:
59.21(a) The fee for the issuance of a certified vital record or a certification that the vital
59.22record cannot be found is $9. No fee shall be charged for a certified birth, stillbirth, or
59.23death record that is reissued within one year of the original issue, if an amendment is
59.24made to the vital record and if the previously issued vital record is surrendered. The
59.25fee is nonrefundable.
59.26(b) The fee for processing a request for the replacement of a birth record for
59.27all events, except when filing a recognition of parentage pursuant to section 257.73,
59.28subdivision 1
, is $40. The fee is payable at the time of application and is nonrefundable.
59.29(c) The fee for processing a request for the filing of a delayed registration of
59.30birth, stillbirth, or death is $40. The fee is payable at the time of application and is
59.31nonrefundable. This fee includes one subsequent review of the request if the request
59.32is not acceptable upon the initial receipt.
59.33(d) The fee for processing a request for the amendment of any vital record when
59.34requested more than 45 days after the filing of the vital record is $40. No fee shall be
59.35charged for an amendment requested within 45 days after the filing of the vital record.
60.1The fee is payable at the time of application and is nonrefundable. This fee includes one
60.2subsequent review of the request if the request is not acceptable upon the initial receipt.
60.3(e) The fee for processing a request for the verification of information from vital
60.4records is $9 when the applicant furnishes the specific information to locate the vital
60.5record. When the applicant does not furnish specific information, the fee is $20 per hour
60.6for staff time expended. Specific information includes the correct date of the event and
60.7the correct name of the registrant. Fees charged shall approximate the costs incurred in
60.8searching and copying the vital records. The fee is payable at the time of application
60.9and is nonrefundable.
60.10(f) The fee for processing a request for the issuance of a copy of any document on
60.11file pertaining to a vital record or statement that a related document cannot be found is $9.
60.12The fee is payable at the time of application and is nonrefundable.
60.13(g) The department shall charge a fee of $18 for noncertified copies of birth records
60.14provided to adopted persons age 19 or older to cover the cost of providing the birth record
60.15and any costs associated with the distribution of information to adopted persons and birth
60.16parents required under section 144.2253, subdivision 5.
60.17EFFECTIVE DATE.This section is effective August 1, 2010.

60.18    Sec. 14. Minnesota Statutes 2008, section 144.226, subdivision 4, is amended to read:
60.19    Subd. 4. Vital records surcharge. (a) In addition to any fee prescribed under
60.20subdivision 1, there is a nonrefundable surcharge of $2 for each certified and noncertified
60.21birth, stillbirth, or death record, and for a certification that the record cannot be found.
60.22The local or state registrar shall forward this amount to the commissioner of finance to
60.23be deposited into the state government special revenue fund. This surcharge shall not be
60.24charged under those circumstances in which no fee for a birth, stillbirth, or death record is
60.25permitted under subdivision 1, paragraph (a).
60.26(b) Effective August 1, 2005, to June 30, 2009, the surcharge in paragraph (a) shall
60.27be is $4.

60.28    Sec. 15. Minnesota Statutes 2008, section 148.6445, is amended by adding a
60.29subdivision to read:
60.30    Subd. 2a. Duplicate license fee. The fee for a duplicate license is $25.

60.31    Sec. 16. Minnesota Statutes 2008, section 259.89, subdivision 1, is amended to read:
60.32    Subdivision 1. Request. An adopted person who is 19 years of age or over may
60.33request the commissioner of health to disclose the information on the adopted person's
60.34original birth record. The commissioner of health shall, within five days of receipt of
61.1the request, notify the commissioner of human services' agent or licensed child-placing
61.2agency when known, or the commissioner of human services when the agency is not
61.3known in writing of the request by the adopted person.
61.4EFFECTIVE DATE.This section is effective August 1, 2010.

61.5    Sec. 17. Minnesota Statutes 2008, section 260C.317, subdivision 4, is amended to read:
61.6    Subd. 4. Rights of terminated parent. Upon entry of an order terminating the
61.7parental rights of any person who is identified as a parent on the original birth record of
61.8the child as to whom the parental rights are terminated, the court shall cause written
61.9notice to be made to that person setting forth:
61.10(1) the right of the person to file at any time with the state registrar of vital statistics
61.11a consent to disclosure, as defined in section 144.212, subdivision 11; and
61.12(2) the right of the person to file at any time with the state registrar of vital statistics
61.13an affidavit stating that the information on the original birth record shall not be disclosed
61.14as provided in section 144.2252 144.2253; and.
61.15(3) the effect of a failure to file either a consent to disclosure, as defined in section
61.16144.212, subdivision 11, or an affidavit stating that the information on the original birth
61.17record shall not be disclosed.
61.18EFFECTIVE DATE.This section is effective August 1, 2010.

61.19    Sec. 18. REPEALER.
61.20(a) Minnesota Statutes 2008, sections 259.83, subdivision 3; and 259.89,
61.21subdivisions 2, 3, and 4, are repealed effective retroactively from August 1, 2008.
61.22(b) Minnesota Statutes 2008, section 62U.08, is repealed.

61.23ARTICLE 6
61.24HEALTH CARE

61.25    Section 1. Minnesota Statutes 2008, section 62J.692, subdivision 7, is amended to read:
61.26    Subd. 7. Transfers from the commissioner of human services. (a) The amount
61.27transferred according to section 256B.69, subdivision 5c, paragraph (a), clause (1), shall
61.28be distributed by the commissioner annually to clinical medical education programs that
61.29meet the qualifications of subdivision 3 based on the formula in subdivision 4, paragraph
61.30(a). Of the amount transferred according to section 256B.69, subdivision 5c, paragraph
61.31(a), clauses (1) to (4), $21,714,000 must be distributed as follows:
61.32(1) $2,157,000 by the commissioner to the University of Minnesota Board of
61.33Regents for the purposes described in sections 137.38 to 137.40;
62.1(2) $1,035,360 by the commissioner to the Hennepin County Medical Center for
62.2clinical medical education;
62.3(3) $17,400,000 by the commissioner to the University of Minnesota Board of
62.4Regents for purposes of medical education;
62.5(4) $1,121,640 by the commissioner to clinical medical education dental innovation
62.6grants in accordance with subdivision 7a; and
62.7(5) the remainder of the amount transferred according to section 256B.69,
62.8subdivision 5c, paragraph (a), clauses (1) to (4), must be distributed by the commissioner
62.9annually to clinical medical education programs that meet the qualifications of subdivision
62.103 based on the formula in subdivision 4, paragraph (a).
62.11(b) Fifty percent of the amount transferred according to section 256B.69, subdivision
62.125c
, paragraph (a), clause (2), shall be distributed by the commissioner to the University of
62.13Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40. Of
62.14the remaining amount transferred according to section 256B.69, subdivision 5c, paragraph
62.15(a), clause (2), 24 percent of the amount shall be distributed by the commissioner to
62.16the Hennepin County Medical Center for clinical medical education. The remaining 26
62.17percent of the amount transferred shall be distributed by the commissioner in accordance
62.18with subdivision 7a. If the federal approval is not obtained for the matching funds under
62.19section 256B.69, subdivision 5c, paragraph (a), clause (2), 100 percent of the amount
62.20transferred under this paragraph shall be distributed by the commissioner to the University
62.21of Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40.
62.22(c) The amount transferred according to section 256B.69, subdivision 5c, paragraph
62.23(a), clauses (3) and (4), shall be distributed by the commissioner upon receipt to the
62.24University of Minnesota Board of Regents for the purposes of clinical graduate medical
62.25education.

62.26    Sec. 2. Minnesota Statutes 2008, section 125A.744, subdivision 3, is amended to read:
62.27    Subd. 3. Implementation. Consistent with section 256B.0625, subdivision 26,
62.28school districts may enroll as medical assistance providers or subcontractors and bill
62.29the Department of Human Services under the medical assistance fee for service claims
62.30processing system for special education services which are covered services under chapter
62.31256B, which are provided in the school setting for a medical assistance recipient, and for
62.32whom the district has secured informed consent consistent with section 13.05, subdivision
62.334
, paragraph (d), and section 256B.77, subdivision 2, paragraph (p), to bill for each type
62.34of covered service. School districts shall be reimbursed by the commissioner of human
62.35services for the federal share of individual education plan health-related services that
63.1qualify for reimbursement by medical assistance, minus up to five percent retained by the
63.2commissioner of human services for administrative costs, not to exceed $350,000 per
63.3fiscal year. The commissioner may withhold up to five percent of each payment to a
63.4school district. Following the end of each fiscal year, the commissioner shall settle up with
63.5each school district in order to ensure that collections from each district for departmental
63.6administrative costs are made on a pro rata basis according to federal earnings for these
63.7services in each district. A school district is not eligible to enroll as a home care provider
63.8or a personal care provider organization for purposes of billing home care services under
63.9sections 256B.0651 and 256B.0653 to 256B.0656 until the commissioner of human
63.10services issues a bulletin instructing county public health nurses on how to assess for the
63.11needs of eligible recipients during school hours. To use private duty nursing services or
63.12personal care services at school, the recipient or responsible party must provide written
63.13authorization in the care plan identifying the chosen provider and the daily amount
63.14of services to be used at school.

63.15    Sec. 3. Minnesota Statutes 2008, section 256.01, subdivision 2b, is amended to read:
63.16    Subd. 2b. Performance payments; performance measurement. (a) The
63.17commissioner shall develop and implement a pay-for-performance system to provide
63.18performance payments to eligible medical groups and clinics that demonstrate optimum
63.19care in serving individuals with chronic diseases who are enrolled in health care
63.20programs administered by the commissioner under chapters 256B, 256D, and 256L.
63.21The commissioner may receive any federal matching money that is made available
63.22through the medical assistance program for managed care oversight contracted through
63.23vendors, including consumer surveys, studies, and external quality reviews as required
63.24by the federal Balanced Budget Act of 1997, Code of Federal Regulations, title 42, part
63.25438-managed care, subpart E-external quality review. Any federal money received
63.26for managed care oversight is appropriated to the commissioner for this purpose. The
63.27commissioner may expend the federal money received in either year of the biennium.
63.28    (b) Effective July 1, 2008, or upon federal approval, whichever is later, the
63.29commissioner shall develop and implement a patient incentive health program to provide
63.30incentives and rewards to patients who are enrolled in health care programs administered
63.31by the commissioner under chapters 256B, 256D, and 256L, and who have agreed to and
63.32have met personal health goals established with the patients' primary care providers to
63.33manage a chronic disease or condition, including but not limited to diabetes, high blood
63.34pressure, and coronary artery disease. The commissioner, in consultation with the Health
63.35and Human Services Policy Committee, shall develop and provide to the legislature by
64.1December 15, 2009, a methodology and any draft legislation necessary to allow for the
64.2release, upon request, of summary data as defined in section 13.02, subdivision 19,
64.3on claims and utilization for medical assistance, general assistance medical care, and
64.4MinnesotaCare enrollees at no charge to the University of Minnesota Medical School, the
64.5Mayo Medical School, Northwestern Health Sciences University, the Institute for Clinical
64.6Systems Improvement, and other research institutions, to conduct analyses of health care
64.7outcomes and treatment effectiveness, provided the research institutions do not release
64.8private or nonpublic data, or data for which dissemination is prohibited by law.

64.9    Sec. 4. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
64.10to read:
64.11    Subd. 18a. Public Assistance Reporting Information System. (a) Effective July
64.121, 2009, the commissioner shall comply with the federal requirements in Public Law
64.13110-379 in implementing the Public Assistance Reporting Information System (PARIS) to
64.14determine eligibility for all individuals applying for:
64.15(1) health care benefits under chapters 256B, 256D, and 256L; and
64.16(2) public benefits under chapters 119B, 256D, 256I, and the supplemental nutrition
64.17assistance program.
64.18(b) The commissioner shall determine eligibility under paragraph (a) by performing
64.19data matches, including matching with medical assistance, cash, child care, and
64.20supplemental assistance programs operated by other states.
64.21EFFECTIVE DATE.This section is effective July 1, 2009.

64.22    Sec. 5. Minnesota Statutes 2008, section 256.962, subdivision 2, is amended to read:
64.23    Subd. 2. Outreach grants. (a) The commissioner shall award grants to public and
64.24private organizations, regional collaboratives, and regional health care outreach centers
64.25for outreach activities, including, but not limited to:
64.26    (1) providing information, applications, and assistance in obtaining coverage
64.27through Minnesota public health care programs;
64.28    (2) collaborating with public and private entities such as hospitals, providers, health
64.29plans, legal aid offices, pharmacies, insurance agencies, and faith-based organizations to
64.30develop outreach activities and partnerships to ensure the distribution of information
64.31and applications and provide assistance in obtaining coverage through Minnesota health
64.32care programs; and
65.1    (3) providing or collaborating with public and private entities to provide multilingual
65.2and culturally specific information and assistance to applicants in areas of high
65.3uninsurance in the state or populations with high rates of uninsurance; and
65.4(4) targeting families with incomes below 200 percent of the federal poverty
65.5guidelines or who belong to underserved populations.
65.6    (b) The commissioner shall ensure that all outreach materials are available in
65.7languages other than English.
65.8    (c) The commissioner shall establish an outreach trainer program to provide
65.9training to designated individuals from the community and public and private entities on
65.10application assistance in order for these individuals to provide training to others in the
65.11community on an as-needed basis.

65.12    Sec. 6. Minnesota Statutes 2008, section 256.962, subdivision 6, is amended to read:
65.13    Subd. 6. School districts and charter schools. (a) At the beginning of each school
65.14year, a school district or charter school shall provide information to each student on the
65.15availability of health care coverage through the Minnesota health care programs and how
65.16to obtain an application for the Minnesota health care programs.
65.17    (b) For each child who is determined to be eligible for the free and reduced-price
65.18school lunch program, the district shall provide the child's family with information on how
65.19to obtain an application for the Minnesota health care programs and application assistance.
65.20    (c) A school district or charter school shall also ensure that applications and
65.21information on application assistance are available at early childhood education sites and
65.22public schools located within the district's jurisdiction.
65.23    (d) (c) Each district shall designate an enrollment specialist to provide application
65.24assistance and follow-up services with families who have indicated an interest in receiving
65.25information or an application for the Minnesota health care program. A district is eligible
65.26for the application assistance bonus described in subdivision 5.
65.27    (e) Each (d) If a school district or charter school maintains a district Web site, the
65.28school district or charter school shall provide on their its Web site a link to information on
65.29how to obtain an application and application assistance.

65.30    Sec. 7. Minnesota Statutes 2008, section 256.963, is amended by adding a subdivision
65.31to read:
65.32    Subd. 3. Urgent dental care services. The commissioner of human services shall
65.33authorize pilot projects to reduce the total costs to the state for dental services provided
65.34to persons enrolled in Minnesota health care programs by reducing hospital emergency
65.35room costs for preventable and nonemergency dental services. The commissioner may
66.1provide start-up funding and establish special payment rates for urgent dental care services
66.2provided as an alternative to emergency room services and may change or waive existing
66.3payment policies in order to adequately reimburse providers for providing cost-effective
66.4alternative services in outpatient or urgent care settings. The commissioner may establish
66.5a project in conjunction with the initiative authorized under subdivisions 1 and 2, or
66.6establish new initiatives, or may implement both approaches.

66.7    Sec. 8. Minnesota Statutes 2008, section 256.969, subdivision 3a, is amended to read:
66.8    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
66.9assistance program must not be submitted until the recipient is discharged. However,
66.10the commissioner shall establish monthly interim payments for inpatient hospitals that
66.11have individual patient lengths of stay over 30 days regardless of diagnostic category.
66.12Except as provided in section 256.9693, medical assistance reimbursement for treatment
66.13of mental illness shall be reimbursed based on diagnostic classifications. Individual
66.14hospital payments established under this section and sections 256.9685, 256.9686, and
66.15256.9695 , in addition to third party and recipient liability, for discharges occurring during
66.16the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
66.17inpatient services paid for the same period of time to the hospital. This payment limitation
66.18shall be calculated separately for medical assistance and general assistance medical
66.19care services. The limitation on general assistance medical care shall be effective for
66.20admissions occurring on or after July 1, 1991. Services that have rates established under
66.21subdivision 11 or 12, must be limited separately from other services. After consulting with
66.22the affected hospitals, the commissioner may consider related hospitals one entity and
66.23may merge the payment rates while maintaining separate provider numbers. The operating
66.24and property base rates per admission or per day shall be derived from the best Medicare
66.25and claims data available when rates are established. The commissioner shall determine
66.26the best Medicare and claims data, taking into consideration variables of recency of the
66.27data, audit disposition, settlement status, and the ability to set rates in a timely manner.
66.28The commissioner shall notify hospitals of payment rates by December 1 of the year
66.29preceding the rate year. The rate setting data must reflect the admissions data used to
66.30establish relative values. Base year changes from 1981 to the base year established for the
66.31rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
66.32to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
66.331. The commissioner may adjust base year cost, relative value, and case mix index data
66.34to exclude the costs of services that have been discontinued by the October 1 of the year
66.35preceding the rate year or that are paid separately from inpatient services. Inpatient stays
67.1that encompass portions of two or more rate years shall have payments established based
67.2on payment rates in effect at the time of admission unless the date of admission preceded
67.3the rate year in effect by six months or more. In this case, operating payment rates for
67.4services rendered during the rate year in effect and established based on the date of
67.5admission shall be adjusted to the rate year in effect by the hospital cost index.
67.6    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
67.7payment, before third-party liability and spenddown, made to hospitals for inpatient
67.8services is reduced by .5 percent from the current statutory rates.
67.9    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
67.10admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
67.11before third-party liability and spenddown, is reduced five percent from the current
67.12statutory rates. Mental health services within diagnosis related groups 424 to 432, and
67.13facilities defined under subdivision 16 are excluded from this paragraph.
67.14    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
67.15fee-for-service admissions occurring on or after July 1, 2005, made to hospitals for
67.16inpatient services before third-party liability and spenddown, is reduced 6.0 percent
67.17from the current statutory rates. Mental health services within diagnosis related groups
67.18424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
67.19Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
67.20assistance does not include general assistance medical care. Payments made to managed
67.21care plans shall be reduced for services provided on or after January 1, 2006, to reflect
67.22this reduction.
67.23    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
67.24fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
67.25to hospitals for inpatient services before third-party liability and spenddown, is reduced
67.263.46 percent from the current statutory rates. Mental health services with diagnosis related
67.27groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
67.28paragraph. Payments made to managed care plans shall be reduced for services provided
67.29on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
67.30    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
67.31fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2010, made
67.32to hospitals for inpatient services before third-party liability and spenddown, is reduced
67.331.9 percent from the current statutory rates. Mental health services with diagnosis related
67.34groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
67.35paragraph. Payments made to managed care plans shall be reduced for services provided
67.36on or after July 1, 2009, through June 30, 2010, to reflect this reduction.
68.1    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
68.2for fee-for-service admissions occurring on or after July 1, 2010, made to hospitals for
68.3inpatient services before third-party liability and spenddown, is reduced 1.79 percent
68.4from the current statutory rates. Mental health services with diagnosis related groups
68.5424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
68.6Payments made to managed care plans shall be reduced for services provided on or after
68.7July 1, 2010, to reflect this reduction.
68.8(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
68.9payment for fee-for-service admissions occurring on or after July 1, 2009, made to
68.10hospitals for inpatient services before third-party liability and spenddown, is reduced
68.113.0 percent from the current statutory rates. Facilities defined under subdivision 16 are
68.12excluded from this paragraph. Payments made to managed care plans shall be reduced for
68.13services provided on or after January 1, 2010, to reflect this reduction.
68.14(i) In addition to the reductions in paragraphs (b) and (h), the total payment for
68.15fee-for-service admissions occurring on or after July 1, 2009, made to hospitals for mental
68.16health services within diagnosis-related groups 424 to 432 before third-party liability and
68.17spenddown, is reduced 5.2 percent from the current statutory rates. Facilities defined under
68.18subdivision 16 are excluded from this paragraph. Payments made to managed care plans
68.19shall be reduced for services provided on or after January 1, 2010, to reflect this reduction.

68.20    Sec. 9. Minnesota Statutes 2008, section 256B.056, subdivision 3, is amended to read:
68.21    Subd. 3. Asset limitations for individuals and families. To be eligible for medical
68.22assistance, a person must not individually own more than $3,000 in assets, or if a member
68.23of a household with two family members, husband and wife, or parent and child, the
68.24household must not own more than $6,000 in assets, plus $200 for each additional legal
68.25dependent. In addition to these maximum amounts, an eligible individual or family may
68.26accrue interest on these amounts, but they must be reduced to the maximum at the time
68.27of an eligibility redetermination. The accumulation of the clothing and personal needs
68.28allowance according to section 256B.35 must also be reduced to the maximum at the
68.29time of the eligibility redetermination. The value of assets that are not considered in
68.30determining eligibility for medical assistance is the value of those assets excluded under
68.31the supplemental security income program for aged, blind, and disabled persons, with
68.32the following exceptions:
68.33(1) household goods and personal effects are not considered;
68.34(2) capital and operating assets of a trade or business that the local agency determines
68.35are necessary to the person's ability to earn an income are not considered. A bank account
69.1that contains income or assets, or is used to pay personal expenses, is not considered a
69.2capital or operating asset of a trade or business;
69.3(3) motor vehicles are excluded to the same extent excluded by the supplemental
69.4security income program;
69.5(4) assets designated as burial expenses are excluded to the same extent excluded by
69.6the supplemental security income program. Burial expenses funded by annuity contracts
69.7or life insurance policies must irrevocably designate the individual's estate as contingent
69.8beneficiary to the extent proceeds are not used for payment of selected burial expenses; and
69.9(5) effective upon federal approval, for a person who no longer qualifies as an
69.10employed person with a disability due to loss of earnings, assets allowed while eligible
69.11for medical assistance under section 256B.057, subdivision 9, are not considered for 12
69.12months, beginning with the first month of ineligibility as an employed person with a
69.13disability, to the extent that the person's total assets remain within the allowed limits of
69.14section 256B.057, subdivision 9, paragraph (c).
69.15The assets specified in clauses (1) to (4) must be disclosed to the local agency at the
69.16time of application and at the time of an eligibility redetermination, and must be verified
69.17upon request of the local agency.

69.18    Sec. 10. Minnesota Statutes 2008, section 256B.056, subdivision 3b, is amended to
69.19read:
69.20    Subd. 3b. Treatment of trusts. (a) A "medical assistance qualifying trust" is a
69.21revocable or irrevocable trust, or similar legal device, established on or before August
69.2210, 1993, by a person or the person's spouse under the terms of which the person
69.23receives or could receive payments from the trust principal or income and the trustee
69.24has discretion in making payments to the person from the trust principal or income.
69.25Notwithstanding that definition, a medical assistance qualifying trust does not include:
69.26(1) a trust set up by will; (2) a trust set up before April 7, 1986, solely to benefit a person
69.27with a developmental disability living in an intermediate care facility for persons with
69.28developmental disabilities; or (3) a trust set up by a person with payments made by the
69.29Social Security Administration pursuant to the United States Supreme Court decision in
69.30Sullivan v. Zebley, 110 S. Ct. 885 (1990). The maximum amount of payments that a
69.31trustee of a medical assistance qualifying trust may make to a person under the terms of
69.32the trust is considered to be available assets to the person, without regard to whether the
69.33trustee actually makes the maximum payments to the person and without regard to the
69.34purpose for which the medical assistance qualifying trust was established.
70.1(b) Except as provided in paragraphs (c) and (d), trusts established after August 10,
70.21993, are treated according to section 13611(b) of the Omnibus Budget Reconciliation
70.3Act of 1993 (OBRA), Public Law 103-66.
70.4(c) For purposes of paragraph (d), a pooled trust means a trust established under
70.5United States Code, title 42, section 1396p(d)(4)(C).
70.6(d) A beneficiary's interest in a pooled trust is considered an available asset unless
70.7the trust provides that upon the death of the beneficiary or termination of the trust during
70.8the beneficiary's lifetime, whichever is sooner, the department receives any amount in
70.9excess of reasonable administrative fees remaining in the beneficiary's trust account up to
70.10the amount of medical assistance benefits paid on behalf of the beneficiary.
70.11EFFECTIVE DATE.This section is effective for pooled trust accounts established
70.12on or after July 1, 2009.

70.13    Sec. 11. Minnesota Statutes 2008, section 256B.056, subdivision 3c, is amended to
70.14read:
70.15    Subd. 3c. Asset limitations for families and children. A household of two or more
70.16persons must not own more than $20,000 in total net assets, and a household of one
70.17person must not own more than $10,000 in total net assets. In addition to these maximum
70.18amounts, an eligible individual or family may accrue interest on these amounts, but they
70.19must be reduced to the maximum at the time of an eligibility redetermination. The value of
70.20assets that are not considered in determining eligibility for medical assistance for families
70.21and children is the value of those assets excluded under the AFDC state plan as of July 16,
70.221996, as required by the Personal Responsibility and Work Opportunity Reconciliation
70.23Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:
70.24(1) household goods and personal effects are not considered;
70.25(2) capital and operating assets of a trade or business up to $200,000 are not
70.26considered, except that a bank account that contains personal income or assets, or is used to
70.27pay personal expenses, is not considered a capital or operating asset of a trade or business;
70.28(3) one motor vehicle is excluded for each person of legal driving age who is
70.29employed or seeking employment;
70.30(4) one burial plot and all other burial expenses equal to the supplemental security
70.31income program asset limit are not considered for each individual;
70.32(5) court-ordered settlements up to $10,000 are not considered;
70.33(6) individual retirement accounts and funds are not considered; and
70.34(7) assets owned by children are not considered.
71.1The assets specified in clauses (1) to (7) must be disclosed to the local agency at the
71.2time of application and at the time of an eligibility redetermination, and must be verified
71.3upon request of the local agency.

71.4    Sec. 12. Minnesota Statutes 2008, section 256B.056, is amended by adding a
71.5subdivision to read:
71.6    Subd. 10a. Delayed verification. On the basis of information provided on the
71.7completed application, a child whose family gross income is less than 90 percent of the
71.8applicable income standard and who meets all other eligibility requirements, including
71.9compliance at the time of application with citizenship or nationality documentation
71.10requirements, shall be determined eligible beginning in the month of application. The
71.11child must provide all required verifications within 60 days' notice of the eligibility
71.12determination or eligibility shall be terminated. Applicants who are terminated for failure
71.13to provide all required verifications are not eligible to apply for coverage using the delayed
71.14verification procedures specified in this subdivision for 12 months.
71.15EFFECTIVE DATE.This section is effective January 1, 2010, or upon federal
71.16approval, whichever is later.

71.17    Sec. 13. Minnesota Statutes 2008, section 256B.057, subdivision 3, is amended to read:
71.18    Subd. 3. Qualified Medicare beneficiaries. A person who is entitled to Part A
71.19Medicare benefits, whose income is equal to or less than 100 percent of the federal
71.20poverty guidelines, and whose assets are no more than $10,000 for a single individual
71.21and $18,000 for a married couple or family of two or more the maximum resource
71.22level applied for the year for an individual or an individual and the individual's spouse
71.23according to United States Code, title 42, section 1396d(p)(1)(C), is eligible for medical
71.24assistance reimbursement of Part A and Part B premiums, Part A and Part B coinsurance
71.25and deductibles, and cost-effective premiums for enrollment with a health maintenance
71.26organization or a competitive medical plan under section 1876 of the Social Security Act.
71.27Reimbursement of the Medicare coinsurance and deductibles, when added to the amount
71.28paid by Medicare, must not exceed the total rate the provider would have received for the
71.29same service or services if the person were a medical assistance recipient with Medicare
71.30coverage. Increases in benefits under Title II of the Social Security Act shall not be
71.31counted as income for purposes of this subdivision until July 1 of each year.
71.32EFFECTIVE DATE.This section is effective January 1, 2012.

71.33    Sec. 14. Minnesota Statutes 2008, section 256B.057, subdivision 9, is amended to read:
72.1    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid
72.2for a person who is employed and who:
72.3(1) meets the definition of disabled under the supplemental security income program;
72.4(2) is at least 16 but less than 65 years of age;
72.5(3) meets the asset limits in paragraph (c); and
72.6(4) effective November 1, 2003, pays a premium and other obligations under
72.7paragraph (e).
72.8Any spousal income or assets shall be disregarded for purposes of eligibility and premium
72.9determinations.
72.10(b) After the month of enrollment, a person enrolled in medical assistance under
72.11this subdivision who:
72.12(1) is temporarily unable to work and without receipt of earned income due to a
72.13medical condition, as verified by a physician, may retain eligibility for up to four calendar
72.14months; or
72.15(2) effective January 1, 2004, loses employment for reasons not attributable to the
72.16enrollee, may retain eligibility for up to four consecutive months after the month of job
72.17loss. To receive a four-month extension, enrollees must verify the medical condition or
72.18provide notification of job loss. All other eligibility requirements must be met and the
72.19enrollee must pay all calculated premium costs for continued eligibility.
72.20(c) For purposes of determining eligibility under this subdivision, a person's assets
72.21must not exceed $20,000, excluding:
72.22(1) all assets excluded under section 256B.056;
72.23(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
72.24Keogh plans, and pension plans; and
72.25(3) medical expense accounts set up through the person's employer.
72.26(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65
72.27earned income disregard. To be eligible, a person applying for medical assistance under
72.28this subdivision must have earned income above the disregard level.
72.29(2) Effective January 1, 2004, to be considered earned income, Medicare, Social
72.30Security, and applicable state and federal income taxes must be withheld. To be eligible,
72.31a person must document earned income tax withholding.
72.32(e)(1) A person whose earned and unearned income is equal to or greater than 100
72.33percent of federal poverty guidelines for the applicable family size must pay a premium
72.34to be eligible for medical assistance under this subdivision. The premium shall be based
72.35on the person's gross earned and unearned income and the applicable family size using a
72.36sliding fee scale established by the commissioner, which begins at one percent of income
73.1at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income
73.2for those with incomes at or above 300 percent of the federal poverty guidelines. Annual
73.3adjustments in the premium schedule based upon changes in the federal poverty guidelines
73.4shall be effective for premiums due in July of each year.
73.5(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for
73.6medical assistance under this subdivision. An enrollee shall pay the greater of a $35 $50
73.7premium or the premium calculated in clause (1).
73.8(3) Effective November 1, 2003, all enrollees who receive unearned income must
73.9pay one-half of one 2.5 percent of unearned income in addition to the premium amount.
73.10(4) Effective November 1, 2003, for enrollees whose income does not exceed 200
73.11percent of the federal poverty guidelines and who are also enrolled in Medicare, the
73.12commissioner must reimburse the enrollee for Medicare Part B premiums under section
73.13256B.0625, subdivision 15 , paragraph (a).
73.14(5) Increases in benefits under title II of the Social Security Act shall not be counted
73.15as income for purposes of this subdivision until July 1 of each year.
73.16(f) A person's eligibility and premium shall be determined by the local county
73.17agency. Premiums must be paid to the commissioner. All premiums are dedicated to
73.18the commissioner.
73.19(g) Any required premium shall be determined at application and redetermined at
73.20the enrollee's six-month income review or when a change in income or household size is
73.21reported. Enrollees must report any change in income or household size within ten days
73.22of when the change occurs. A decreased premium resulting from a reported change in
73.23income or household size shall be effective the first day of the next available billing month
73.24after the change is reported. Except for changes occurring from annual cost-of-living
73.25increases, a change resulting in an increased premium shall not affect the premium amount
73.26until the next six-month review.
73.27(h) Premium payment is due upon notification from the commissioner of the
73.28premium amount required. Premiums may be paid in installments at the discretion of
73.29the commissioner.
73.30(i) Nonpayment of the premium shall result in denial or termination of medical
73.31assistance unless the person demonstrates good cause for nonpayment. Good cause exists
73.32if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
73.33D, are met. Except when an installment agreement is accepted by the commissioner,
73.34all persons disenrolled for nonpayment of a premium must pay any past due premiums
73.35as well as current premiums due prior to being reenrolled. Nonpayment shall include
73.36payment with a returned, refused, or dishonored instrument. The commissioner may
74.1require a guaranteed form of payment as the only means to replace a returned, refused,
74.2or dishonored instrument.
74.3EFFECTIVE DATE.This section is effective January 1, 2011.

74.4    Sec. 15. Minnesota Statutes 2008, section 256B.057, is amended by adding a
74.5subdivision to read:
74.6    Subd. 11. Treatment for colorectal cancer. (a) State-only funded medical
74.7assistance may be paid for an individual who:
74.8(1) has been screened for colorectal cancer by the colorectal cancer prevention
74.9demonstration project;
74.10(2) according to the individual's treating health professional, needs treatment for
74.11colorectal cancer;
74.12(3) meets income eligibility guidelines for the colorectal cancer prevention
74.13demonstration project;
74.14(4) is under the age of 65; and
74.15(5) is not otherwise eligible for federally funded medical assistance or other
74.16creditable coverage as defined under United States Code, title 42, section 1396a(aa).
74.17(b) Medical assistance provided under this subdivision shall be limited to services
74.18provided during the period that the individual receives treatment for colorectal cancer.
74.19(c) An individual meeting the criteria in paragraph (a) is eligible for state-only
74.20funded medical assistance without meeting the eligibility criteria relating to income and
74.21assets in section 256B.056, subdivisions 1a to 5b.

74.22    Sec. 16. Minnesota Statutes 2008, section 256B.0575, is amended to read:
74.23256B.0575 AVAILABILITY OF INCOME FOR INSTITUTIONALIZED
74.24PERSONS.
74.25    Subdivision 1. Income deductions. When an institutionalized person is determined
74.26eligible for medical assistance, the income that exceeds the deductions in paragraphs (a)
74.27and (b) must be applied to the cost of institutional care.
74.28(a) The following amounts must be deducted from the institutionalized person's
74.29income in the following order:
74.30(1) the personal needs allowance under section 256B.35 or, for a veteran who
74.31does not have a spouse or child, or a surviving spouse of a veteran having no child, the
74.32amount of an improved pension received from the veteran's administration not exceeding
74.33$90 per month;
74.34(2) the personal allowance for disabled individuals under section 256B.36;
75.1(3) if the institutionalized person has a legally appointed guardian or conservator,
75.2five percent of the recipient's gross monthly income up to $100 as reimbursement for
75.3guardianship or conservatorship services;
75.4(4) a monthly income allowance determined under section 256B.058, subdivision
75.52
, but only to the extent income of the institutionalized spouse is made available to the
75.6community spouse;
75.7(5) a monthly allowance for children under age 18 which, together with the net
75.8income of the children, would provide income equal to the medical assistance standard
75.9for families and children according to section 256B.056, subdivision 4, for a family size
75.10that includes only the minor children. This deduction applies only if the children do not
75.11live with the community spouse and only to the extent that the deduction is not included
75.12in the personal needs allowance under section 256B.35, subdivision 1, as child support
75.13garnished under a court order;
75.14(6) a monthly family allowance for other family members, equal to one-third of the
75.15difference between 122 percent of the federal poverty guidelines and the monthly income
75.16for that family member;
75.17(7) reparations payments made by the Federal Republic of Germany and reparations
75.18payments made by the Netherlands for victims of Nazi persecution between 1940 and
75.191945;
75.20(8) all other exclusions from income for institutionalized persons as mandated by
75.21federal law; and
75.22(9) amounts for reasonable expenses, as specified in subdivision 2, incurred for
75.23necessary medical or remedial care for the institutionalized person that are recognized
75.24under state law, not medical assistance covered expenses, and that are not subject to
75.25payment by a third party.
75.26Reasonable expenses are limited to expenses that have not been previously used as a
75.27deduction from income and are incurred during the enrollee's current period of eligibility,
75.28including retroactive months associated with the current period of eligibility, for medical
75.29assistance payment of long-term care services.
75.30For purposes of clause (6), "other family member" means a person who resides
75.31with the community spouse and who is a minor or dependent child, dependent parent, or
75.32dependent sibling of either spouse. "Dependent" means a person who could be claimed as
75.33a dependent for federal income tax purposes under the Internal Revenue Code.
75.34(b) Income shall be allocated to an institutionalized person for a period of up to three
75.35calendar months, in an amount equal to the medical assistance standard for a family
75.36size of one if:
76.1(1) a physician certifies that the person is expected to reside in the long-term care
76.2facility for three calendar months or less;
76.3(2) if the person has expenses of maintaining a residence in the community; and
76.4(3) if one of the following circumstances apply:
76.5(i) the person was not living together with a spouse or a family member as defined in
76.6paragraph (a) when the person entered a long-term care facility; or
76.7(ii) the person and the person's spouse become institutionalized on the same date, in
76.8which case the allocation shall be applied to the income of one of the spouses.
76.9For purposes of this paragraph, a person is determined to be residing in a licensed nursing
76.10home, regional treatment center, or medical institution if the person is expected to remain
76.11for a period of one full calendar month or more.
76.12    Subd. 2. Reasonable expenses. (a) For the purposes of subdivision 1, paragraph
76.13(a), clause (9), reasonable expenses are limited to expenses that have not been previously
76.14used as a deduction from income and were not:
76.15    (1) for long-term care expenses incurred during a period of ineligibility as defined in
76.16section 256B.0595, subdivision 2;
76.17    (2) incurred more than three months before the month of application associated with
76.18the current period of eligibility;
76.19    (3) for expenses incurred by a recipient that are duplicative of services that are
76.20covered under chapter 256B; or
76.21    (4) nursing facility expenses incurred without a timely assessment as required under
76.22section 256B.0911.

76.23    Sec. 17. Minnesota Statutes 2008, section 256B.0595, subdivision 1, is amended to
76.24read:
76.25    Subdivision 1. Prohibited transfers. (a) For transfers of assets made on or before
76.26August 10, 1993, if an institutionalized person or the institutionalized person's spouse has
76.27given away, sold, or disposed of, for less than fair market value, any asset or interest
76.28therein, except assets other than the homestead that are excluded under the supplemental
76.29security program, within 30 months before or any time after the date of institutionalization
76.30if the person has been determined eligible for medical assistance, or within 30 months
76.31before or any time after the date of the first approved application for medical assistance
76.32if the person has not yet been determined eligible for medical assistance, the person is
76.33ineligible for long-term care services for the period of time determined under subdivision
76.342.
77.1    (b) Effective for transfers made after August 10, 1993, an institutionalized person, an
77.2institutionalized person's spouse, or any person, court, or administrative body with legal
77.3authority to act in place of, on behalf of, at the direction of, or upon the request of the
77.4institutionalized person or institutionalized person's spouse, may not give away, sell, or
77.5dispose of, for less than fair market value, any asset or interest therein, except assets other
77.6than the homestead that are excluded under the Supplemental Security Income program,
77.7for the purpose of establishing or maintaining medical assistance eligibility. This applies
77.8to all transfers, including those made by a community spouse after the month in which
77.9the institutionalized spouse is determined eligible for medical assistance. For purposes of
77.10determining eligibility for long-term care services, any transfer of such assets within 36
77.11months before or any time after an institutionalized person requests medical assistance
77.12payment of long-term care services, or 36 months before or any time after a medical
77.13assistance recipient becomes an institutionalized person, for less than fair market value
77.14may be considered. Any such transfer is presumed to have been made for the purpose
77.15of establishing or maintaining medical assistance eligibility and the institutionalized
77.16person is ineligible for long-term care services for the period of time determined under
77.17subdivision 2, unless the institutionalized person furnishes convincing evidence to
77.18establish that the transaction was exclusively for another purpose, or unless the transfer is
77.19permitted under subdivision 3 or 4. In the case of payments from a trust or portions of a
77.20trust that are considered transfers of assets under federal law, or in the case of any other
77.21disposal of assets made on or after February 8, 2006, any transfers made within 60 months
77.22before or any time after an institutionalized person requests medical assistance payment of
77.23long-term care services and within 60 months before or any time after a medical assistance
77.24recipient becomes an institutionalized person, may be considered.
77.25    (c) This section applies to transfers, for less than fair market value, of income
77.26or assets, including assets that are considered income in the month received, such as
77.27inheritances, court settlements, and retroactive benefit payments or income to which the
77.28institutionalized person or the institutionalized person's spouse is entitled but does not
77.29receive due to action by the institutionalized person, the institutionalized person's spouse,
77.30or any person, court, or administrative body with legal authority to act in place of, on
77.31behalf of, at the direction of, or upon the request of the institutionalized person or the
77.32institutionalized person's spouse.
77.33    (d) This section applies to payments for care or personal services provided by a
77.34relative, unless the compensation was stipulated in a notarized, written agreement which
77.35was in existence when the service was performed, the care or services directly benefited
77.36the person, and the payments made represented reasonable compensation for the care
78.1or services provided. A notarized written agreement is not required if payment for the
78.2services was made within 60 days after the service was provided.
78.3    (e) This section applies to the portion of any asset or interest that an institutionalized
78.4person, an institutionalized person's spouse, or any person, court, or administrative body
78.5with legal authority to act in place of, on behalf of, at the direction of, or upon the request
78.6of the institutionalized person or the institutionalized person's spouse, transfers to any
78.7annuity that exceeds the value of the benefit likely to be returned to the institutionalized
78.8person or institutionalized person's spouse while alive, based on estimated life expectancy
78.9as determined according to the current actuarial tables published by the Office of the
78.10Chief Actuary of the Social Security Administration. The commissioner may adopt rules
78.11reducing life expectancies based on the need for long-term care. This section applies to an
78.12annuity purchased on or after March 1, 2002, that:
78.13    (1) is not purchased from an insurance company or financial institution that is
78.14subject to licensing or regulation by the Minnesota Department of Commerce or a similar
78.15regulatory agency of another state;
78.16    (2) does not pay out principal and interest in equal monthly installments; or
78.17    (3) does not begin payment at the earliest possible date after annuitization.
78.18    (f) Effective for transactions, including the purchase of an annuity, occurring on or
78.19after February 8, 2006, by or on behalf of an institutionalized person who has applied for
78.20or is receiving long-term care services or the institutionalized person's spouse shall be
78.21treated as the disposal of an asset for less than fair market value unless the department is
78.22named a preferred remainder beneficiary as described in section 256B.056, subdivision
78.2311
. Any subsequent change to the designation of the department as a preferred remainder
78.24beneficiary shall result in the annuity being treated as a disposal of assets for less than
78.25fair market value. The amount of such transfer shall be the maximum amount the
78.26institutionalized person or the institutionalized person's spouse could receive from the
78.27annuity or similar financial instrument. Any change in the amount of the income or
78.28principal being withdrawn from the annuity or other similar financial instrument at the
78.29time of the most recent disclosure shall be deemed to be a transfer of assets for less than
78.30fair market value unless the institutionalized person or the institutionalized person's spouse
78.31demonstrates that the transaction was for fair market value. In the event a distribution
78.32of income or principal has been improperly distributed or disbursed from an annuity or
78.33other retirement planning instrument of an institutionalized person or the institutionalized
78.34person's spouse, a cause of action exists against the individual receiving the improper
78.35distribution for the cost of medical assistance services provided or the amount of the
78.36improper distribution, whichever is less.
79.1    (g) Effective for transactions, including the purchase of an annuity, occurring on
79.2or after February 8, 2006, by or on behalf of an institutionalized person applying for or
79.3receiving long-term care services shall be treated as a disposal of assets for less than fair
79.4market value unless it is:
79.5    (i) an annuity described in subsection (b) or (q) of section 408 of the Internal
79.6Revenue Code of 1986; or
79.7    (ii) purchased with proceeds from:
79.8    (A) an account or trust described in subsection (a), (c), or (p) of section 408 of the
79.9Internal Revenue Code;
79.10    (B) a simplified employee pension within the meaning of section 408(k) of the
79.11Internal Revenue Code; or
79.12    (C) a Roth IRA described in section 408A of the Internal Revenue Code; or
79.13    (iii) an annuity that is irrevocable and nonassignable; is actuarially sound as
79.14determined in accordance with actuarial publications of the Office of the Chief Actuary of
79.15the Social Security Administration; and provides for payments in equal amounts during
79.16the term of the annuity, with no deferral and no balloon payments made.
79.17     (h) For purposes of this section, long-term care services include services in a nursing
79.18facility, services that are eligible for payment according to section 256B.0625, subdivision
79.192
, because they are provided in a swing bed, intermediate care facility for persons with
79.20developmental disabilities, and home and community-based services provided pursuant
79.21to sections 256B.0915, 256B.092, and 256B.49. For purposes of this subdivision and
79.22subdivisions 2, 3, and 4, "institutionalized person" includes a person who is an inpatient
79.23in a nursing facility or in a swing bed, or intermediate care facility for persons with
79.24developmental disabilities or who is receiving home and community-based services under
79.25sections 256B.0915, 256B.092, and 256B.49.
79.26    (i) This section applies to funds used to purchase a promissory note, loan, or
79.27mortgage unless the note, loan, or mortgage:
79.28    (1) has a repayment term that is actuarially sound;
79.29    (2) provides for payments to be made in equal amounts during the term of the loan,
79.30with no deferral and no balloon payments made; and
79.31    (3) prohibits the cancellation of the balance upon the death of the lender.
79.32    In the case of a promissory note, loan, or mortgage that does not meet an exception
79.33in clauses (1) to (3), the value of such note, loan, or mortgage shall be the outstanding
79.34balance due as of the date of the institutionalized person's request for medical assistance
79.35payment of long-term care services.
80.1    (j) This section applies to the purchase of a life estate interest in another person's
80.2home unless the purchaser resides in the home for a period of at least one year after the
80.3date of purchase.
80.4(k) This section applies to transfers into a pooled trust that qualifies under United
80.5States Code, title 42, section 1396p(d)(4)(C), by:
80.6(1) a person age 65 or older or the person's spouse; or
80.7(2) any person, court, or administrative body with legal authority to act in place
80.8of, on behalf of, at the direction of, or upon the request of a person age 65 or older or
80.9the person's spouse.

80.10    Sec. 18. Minnesota Statutes 2008, section 256B.06, subdivision 4, is amended to read:
80.11    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
80.12to citizens of the United States, qualified noncitizens as defined in this subdivision, and
80.13other persons residing lawfully in the United States. Citizens or nationals of the United
80.14States must cooperate in obtaining satisfactory documentary evidence of citizenship or
80.15nationality according to the requirements of the federal Deficit Reduction Act of 2005,
80.16Public Law 109-171.
80.17(b) "Qualified noncitizen" means a person who meets one of the following
80.18immigration criteria:
80.19(1) admitted for lawful permanent residence according to United States Code, title 8;
80.20(2) admitted to the United States as a refugee according to United States Code,
80.21title 8, section 1157;
80.22(3) granted asylum according to United States Code, title 8, section 1158;
80.23(4) granted withholding of deportation according to United States Code, title 8,
80.24section 1253(h);
80.25(5) paroled for a period of at least one year according to United States Code, title 8,
80.26section 1182(d)(5);
80.27(6) granted conditional entrant status according to United States Code, title 8,
80.28section 1153(a)(7);
80.29(7) determined to be a battered noncitizen by the United States Attorney General
80.30according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
80.31title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
80.32(8) is a child of a noncitizen determined to be a battered noncitizen by the United
80.33States Attorney General according to the Illegal Immigration Reform and Immigrant
80.34Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
80.35Public Law 104-200; or
81.1(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
81.2Law 96-422, the Refugee Education Assistance Act of 1980.
81.3(c) All qualified noncitizens who were residing in the United States before August
81.422, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
81.5medical assistance with federal financial participation.
81.6(d) All qualified noncitizens who entered the United States on or after August 22,
81.71996, and who otherwise meet the eligibility requirements of this chapter, are eligible for
81.8medical assistance with federal financial participation through November 30, 1996.
81.9Beginning December 1, 1996, qualified noncitizens who entered the United States
81.10on or after August 22, 1996, and who otherwise meet the eligibility requirements of this
81.11chapter are eligible for medical assistance with federal participation for five years if they
81.12meet one of the following criteria:
81.13(i) refugees admitted to the United States according to United States Code, title 8,
81.14section 1157;
81.15(ii) persons granted asylum according to United States Code, title 8, section 1158;
81.16(iii) persons granted withholding of deportation according to United States Code,
81.17title 8, section 1253(h);
81.18(iv) veterans of the United States armed forces with an honorable discharge for
81.19a reason other than noncitizen status, their spouses and unmarried minor dependent
81.20children; or
81.21(v) persons on active duty in the United States armed forces, other than for training,
81.22their spouses and unmarried minor dependent children.
81.23Beginning December 1, 1996, qualified noncitizens who do not meet one of the
81.24criteria in items (i) to (v) are eligible for medical assistance without federal financial
81.25participation as described in paragraph (j).
81.26Notwithstanding paragraph (j), beginning July 1, 2010, children and pregnant
81.27women who are qualified noncitizens, as described in paragraph (b), are eligible for
81.28medical assistance with federal financial participation as provided by the federal Children's
81.29Health Insurance Program Reauthorization Act of 2009, Public Law 11-3.
81.30(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b), who
81.31are lawfully present in the United States, as defined in Code of Federal Regulations, title
81.328, section 103.12, and who otherwise meet the eligibility requirements of this chapter, are
81.33eligible for medical assistance under clauses (1) to (3). These individuals must cooperate
81.34with the United States Citizenship and Immigration Services to pursue any applicable
81.35immigration status, including citizenship, that would qualify them for medical assistance
81.36with federal financial participation.
82.1(1) Persons who were medical assistance recipients on August 22, 1996, are eligible
82.2for medical assistance with federal financial participation through December 31, 1996.
82.3(2) Beginning January 1, 1997, persons described in clause (1) are eligible for
82.4medical assistance without federal financial participation as described in paragraph (j).
82.5(3) Beginning December 1, 1996, persons residing in the United States prior to
82.6August 22, 1996, who were not receiving medical assistance and persons who arrived on
82.7or after August 22, 1996, are eligible for medical assistance without federal financial
82.8participation as described in paragraph (j).
82.9(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
82.10are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this
82.11subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
82.12Code, title 8, section 1101(a)(15).
82.13(g) Payment shall also be made for care and services that are furnished to noncitizens,
82.14regardless of immigration status, who otherwise meet the eligibility requirements of
82.15this chapter, if such care and services are necessary for the treatment of an emergency
82.16medical condition, except for organ transplants and related care and services and routine
82.17prenatal care.
82.18(h) For purposes of this subdivision, the term "emergency medical condition" means
82.19a medical condition that meets the requirements of United States Code, title 42, section
82.201396b(v).
82.21(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
82.22nonimmigrants, or eligible for medical assistance as described in paragraph (j), and who
82.23are not covered by a group health plan or health insurance coverage according to Code of
82.24Federal Regulations, title 42, section 457.310, lawfully present as designated in paragraph
82.25(e), and who otherwise meet the eligibility requirements of this chapter, are eligible for
82.26medical assistance through the period of pregnancy, including labor and delivery, and 60
82.27days post partum, to the extent federal funds are available under title XXI of the Social
82.28Security Act, and the state children's health insurance program, followed by 60 days
82.29postpartum without federal financial participation.
82.30(j) Qualified noncitizens as described in paragraph (d), and all other noncitizens
82.31lawfully residing in the United States as described in paragraph (e), who are ineligible
82.32for medical assistance with federal financial participation and who otherwise meet the
82.33eligibility requirements of chapter 256B and of this paragraph, are eligible for medical
82.34assistance without federal financial participation. Qualified noncitizens as described
82.35in paragraph (d) are only eligible for medical assistance without federal financial
82.36participation for five years from their date of entry into the United States.
83.1(k) Beginning October 1, 2003, persons who are receiving care and rehabilitation
83.2services from a nonprofit center established to serve victims of torture and are otherwise
83.3ineligible for medical assistance under this chapter are eligible for medical assistance
83.4without federal financial participation. These individuals are eligible only for the period
83.5during which they are receiving services from the center. Individuals eligible under this
83.6paragraph shall not be required to participate in prepaid medical assistance.
83.7EFFECTIVE DATE.This section is effective July 1, 2009.

83.8    Sec. 19. Minnesota Statutes 2008, section 256B.06, subdivision 5, is amended to read:
83.9    Subd. 5. Deeming of sponsor income and resources. When determining eligibility
83.10for any federal or state funded medical assistance under this section, the income
83.11and resources of all noncitizens shall be deemed to include their sponsors' income
83.12and resources as required under the Personal Responsibility and Work Opportunity
83.13Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
83.14subsequently set out in federal rules. This section is effective May 1, 1997. Beginning
83.15July 1, 2010, sponsor deeming does not apply to pregnant women and children who are
83.16qualified noncitizens, as described in section 256B.06, subdivision 4, paragraph (b).
83.17EFFECTIVE DATE.This section is effective July 1, 2009.

83.18    Sec. 20. Minnesota Statutes 2008, section 256B.0625, subdivision 3c, is amended to
83.19read:
83.20    Subd. 3c. Health Services Policy Committee. (a) The commissioner, after
83.21receiving recommendations from professional physician associations, professional
83.22associations representing licensed nonphysician health care professionals, and consumer
83.23groups, shall establish a 13-member Health Services Policy Committee, which consists of
83.2412 voting members and one nonvoting member. The Health Services Policy Committee
83.25shall advise the commissioner regarding health services pertaining to the administration
83.26of health care benefits covered under the medical assistance, general assistance medical
83.27care, and MinnesotaCare programs. The Health Services Policy Committee shall meet at
83.28least quarterly. The Health Services Policy Committee shall annually elect a physician
83.29chair from among its members, who shall work directly with the commissioner's medical
83.30director, to establish the agenda for each meeting. The Health Services Policy Committee
83.31shall also recommend criteria for verifying centers of excellence for specific aspects of
83.32medical care where a specific set of combined services, a volume of patients necessary to
83.33maintain a high level of competency, or a specific level of technical capacity is associated
83.34with improved health outcomes.
84.1(b) The commissioner shall establish a dental subcommittee to operate under the
84.2Health Services Policy Committee. The dental subcommittee consists of general dentists,
84.3dental specialists, safety net providers, dental hygienists, health plan company and county
84.4and public health representatives, health researchers, consumers, and the Minnesota
84.5Department of Health oral health director. The dental subcommittee shall advise the
84.6commissioner regarding:
84.7(1) the critical access dental program under section 256B.76, subdivision 4;
84.8(2) any changes to the critical access dental provider program necessary to comply
84.9with program expenditure limits;
84.10(3) dental coverage policy based on evidence, quality, continuity of care, and best
84.11practices;
84.12(4) the development of dental delivery models; and
84.13(5) dental services to be added or eliminated from subdivision 9, paragraph (b).
84.14(c) The Health Services Policy Committee shall study approaches to making
84.15provider reimbursement under the medical assistance, MinnesotaCare, and general
84.16assistance medical care programs contingent on patient participation in a patient-centered
84.17decision-making process, and shall evaluate the impact of these approaches on health
84.18care quality, patient satisfaction, and health care costs. The committee shall present
84.19findings and recommendations to the commissioner and the legislative committees with
84.20jurisdiction over health care by January 15, 2010.

84.21    Sec. 21. Minnesota Statutes 2008, section 256B.0625, subdivision 9, is amended to
84.22read:
84.23    Subd. 9. Dental services. (a) Medical assistance covers dental services. Dental
84.24services include, with prior authorization, fixed bridges that are cost-effective for persons
84.25who cannot use removable dentures because of their medical condition.
84.26(b) Medical assistance dental coverage for nonpregnant adults is limited to the
84.27following services:
84.28(1) comprehensive exams, limited to once every five years;
84.29(2) periodic exams, limited to one per year;
84.30(3) limited exams;
84.31(4) bitewing x-rays, limited to one per year;
84.32(5) periapical x-rays;
84.33(6) panoramic x-rays, limited to one every five years, and only if provided in
84.34conjunction with a posterior extraction or scheduled outpatient facility procedure, or as
84.35medically necessary for the diagnosis and follow-up of oral and maxillofacial pathology
85.1and trauma. Panoramic x-rays may be taken once every two years for patients who cannot
85.2cooperate for intraoral film due to a developmental disability or medical condition that
85.3does not allow for intraoral film placement;
85.4(7) prophylaxis, limited to one per year;
85.5(8) application of fluoride varnish, limited to one per year;
85.6(9) posterior fillings, all at the amalgam rate;
85.7(10) anterior fillings;
85.8(11) endodontics, limited to root canals on the anterior and premolars only;
85.9(12) removable prostheses, each dental arch limited to one every six years;
85.10(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
85.11abscesses;
85.12(14) palliative treatment and sedative fillings for relief of pain; and
85.13(15) full-mouth debridement, limited to one every five years.
85.14(c) In addition to the services specified in paragraph (b), medical assistance
85.15covers the following services for adults, if provided in an outpatient hospital setting or
85.16freestanding ambulatory surgical center as part of outpatient dental surgery:
85.17(1) periodontics, limited to periodontal scaling and root planing once every two
85.18years;
85.19(2) general anesthesia; and
85.20(3) full-mouth survey once every five years.
85.21(d) Medical assistance covers dental services for children that are medically
85.22necessary. The following guidelines apply:
85.23(1) posterior fillings are paid at the amalgam rate;
85.24(2) application of sealants once every five years per permanent molar; and
85.25(3) application of fluoride varnish once every six months.
85.26EFFECTIVE DATE.This section is effective January 1, 2010.

85.27    Sec. 22. Minnesota Statutes 2008, section 256B.0625, subdivision 13e, is amended to
85.28read:
85.29    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment
85.30shall be the lower of the actual acquisition costs of the drugs plus a fixed dispensing fee;
85.31the maximum allowable cost set by the federal government or by the commissioner plus
85.32the fixed dispensing fee; or the usual and customary price charged to the public. The
85.33amount of payment basis must be reduced to reflect all discount amounts applied to the
85.34charge by any provider/insurer agreement or contract for submitted charges to medical
85.35assistance programs. The net submitted charge may not be greater than the patient liability
86.1for the service. The pharmacy dispensing fee shall be $3.65, except that the dispensing fee
86.2for intravenous solutions which must be compounded by the pharmacist shall be $8 per
86.3bag, $14 per bag for cancer chemotherapy products, and $30 per bag for total parenteral
86.4nutritional products dispensed in one liter quantities, or $44 per bag for total parenteral
86.5nutritional products dispensed in quantities greater than one liter. Actual acquisition
86.6cost includes quantity and other special discounts except time and cash discounts.
86.7Effective July 1, 2008, the actual acquisition cost of a drug shall be estimated by the
86.8commissioner, at average wholesale price minus 14 15 percent. The actual acquisition
86.9cost of antihemophilic factor drugs shall be estimated at the average wholesale price
86.10minus 30 percent. The maximum allowable cost of a multisource drug may be set by the
86.11commissioner and it shall be comparable to, but no higher than, the maximum amount
86.12paid by other third-party payors in this state who have maximum allowable cost programs.
86.13Establishment of the amount of payment for drugs shall not be subject to the requirements
86.14of the Administrative Procedure Act.
86.15    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
86.16to pharmacists for legend drug prescriptions dispensed to residents of long-term care
86.17facilities when a unit dose blister card system, approved by the department, is used. Under
86.18this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.
86.19The National Drug Code (NDC) from the drug container used to fill the blister card must
86.20be identified on the claim to the department. The unit dose blister card containing the
86.21drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700,
86.22that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider
86.23will be required to credit the department for the actual acquisition cost of all unused
86.24drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
86.25manufacturer's unopened package. The commissioner may permit the drug clozapine to be
86.26dispensed in a quantity that is less than a 30-day supply.
86.27    (c) Whenever a generically equivalent product is available, payment shall be on the
86.28basis of the actual acquisition cost of the generic drug, or on the maximum allowable cost
86.29established by the commissioner.
86.30    (d) The basis for determining the amount of payment for drugs administered in an
86.31outpatient setting shall be the lower of the usual and customary cost submitted by the
86.32provider or the amount established for Medicare by the United States Department of
86.33Health and Human Services pursuant to title XVIII, section 1847a of the federal Social
86.34Security Act.
86.35    (e) The commissioner may negotiate lower reimbursement rates for specialty
86.36pharmacy products than the rates specified in paragraph (a). The commissioner may
87.1require individuals enrolled in the health care programs administered by the department
87.2to obtain specialty pharmacy products from providers with whom the commissioner has
87.3negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
87.4used by a small number of recipients or recipients with complex and chronic diseases
87.5that require expensive and challenging drug regimens. Examples of these conditions
87.6include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
87.7C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
87.8of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
87.9biotechnology drugs, high-cost therapies, and therapies that require complex care. The
87.10commissioner shall consult with the formulary committee to develop a list of specialty
87.11pharmacy products subject to this paragraph. In consulting with the formulary committee
87.12in developing this list, the commissioner shall take into consideration the population
87.13served by specialty pharmacy products, the current delivery system and standard of care in
87.14the state, and access to care issues. The commissioner shall have the discretion to adjust
87.15the reimbursement rate to prevent access to care issues.
87.16EFFECTIVE DATE.This section is effective retroactively from July 1, 2008.

87.17    Sec. 23. Minnesota Statutes 2008, section 256B.0625, subdivision 17, is amended to
87.18read:
87.19    Subd. 17. Transportation costs. (a) Medical assistance covers transportation costs
87.20incurred solely for obtaining emergency medical care or transportation costs incurred
87.21by eligible persons in obtaining emergency or nonemergency medical care when paid
87.22directly to an ambulance company, common carrier, or other recognized providers of
87.23transportation services.
87.24(b) Medical assistance covers special transportation, as defined in Minnesota Rules,
87.25part 9505.0315, subpart 1, item F, if the recipient has a physical or mental impairment that
87.26would prohibit the recipient from safely accessing and using a bus, taxi, other commercial
87.27transportation, or private automobile.
87.28The commissioner may use an order by the recipient's attending physician to certify that
87.29the recipient requires special transportation services. Special transportation includes
87.30driver-assisted service to eligible individuals. Driver-assisted service includes passenger
87.31pickup at and return to the individual's residence or place of business, assistance with
87.32admittance of the individual to the medical facility, and assistance in passenger securement
87.33or in securing of wheelchairs or stretchers in the vehicle. Special transportation providers
87.34must obtain written documentation from the health care service provider who is serving
87.35the recipient being transported, identifying the time that the recipient arrived. Special
88.1transportation providers may not bill for separate base rates for the continuation of a trip
88.2beyond the original destination. Special transportation providers must take recipients to
88.3the nearest appropriate health care provider, using the most direct route available. The
88.4maximum medical assistance reimbursement rates for special transportation services are:
88.5(1) $17 for the base rate and $1.35 $1.65 per mile for services to eligible persons
88.6who need a wheelchair-accessible van;
88.7(2) $11.50 $8.50 for the base rate and $1.30 per mile for services to eligible persons
88.8who do not need a wheelchair-accessible van; and
88.9(3) $60 for the base rate and $2.40 per mile, and an attendant rate of $9 per trip, for
88.10services to eligible persons who need a stretcher-accessible vehicle.

88.11    Sec. 24. Minnesota Statutes 2008, section 256B.0625, subdivision 26, is amended to
88.12read:
88.13    Subd. 26. Special education services. (a) Medical assistance covers medical
88.14services identified in a recipient's individualized education plan and covered under the
88.15medical assistance state plan. Covered services include occupational therapy, physical
88.16therapy, speech-language therapy, clinical psychological services, nursing services,
88.17school psychological services, school social work services, personal care assistants
88.18serving as management aides, assistive technology devices, transportation services,
88.19health assessments, and other services covered under the medical assistance state plan.
88.20Mental health services eligible for medical assistance reimbursement must be provided or
88.21coordinated through a children's mental health collaborative where a collaborative exists if
88.22the child is included in the collaborative operational target population. The provision or
88.23coordination of services does not require that the individual education plan be developed
88.24by the collaborative.
88.25The services may be provided by a Minnesota school district that is enrolled as a
88.26medical assistance provider or its subcontractor, and only if the services meet all the
88.27requirements otherwise applicable if the service had been provided by a provider other
88.28than a school district, in the following areas: medical necessity, physician's orders,
88.29documentation, personnel qualifications, and prior authorization requirements. The
88.30nonfederal share of costs for services provided under this subdivision is the responsibility
88.31of the local school district as provided in section 125A.74. Services listed in a child's
88.32individual education plan are eligible for medical assistance reimbursement only if those
88.33services meet criteria for federal financial participation under the Medicaid program.
88.34(b) Approval of health-related services for inclusion in the individual education plan
88.35does not require prior authorization for purposes of reimbursement under this chapter.
89.1The commissioner may require physician review and approval of the plan not more than
89.2once annually or upon any modification of the individual education plan that reflects a
89.3change in health-related services.
89.4(c) Services of a speech-language pathologist provided under this section are covered
89.5notwithstanding Minnesota Rules, part 9505.0390, subpart 1, item L, if the person:
89.6(1) holds a masters degree in speech-language pathology;
89.7(2) is licensed by the Minnesota Board of Teaching as an educational
89.8speech-language pathologist; and
89.9(3) either has a certificate of clinical competence from the American Speech and
89.10Hearing Association, has completed the equivalent educational requirements and work
89.11experience necessary for the certificate or has completed the academic program and is
89.12acquiring supervised work experience to qualify for the certificate.
89.13(d) Medical assistance coverage for medically necessary services provided under
89.14other subdivisions in this section may not be denied solely on the basis that the same or
89.15similar services are covered under this subdivision.
89.16(e) The commissioner shall develop and implement package rates, bundled rates, or
89.17per diem rates for special education services under which separately covered services are
89.18grouped together and billed as a unit in order to reduce administrative complexity.
89.19(f) The commissioner shall develop a cost-based payment structure for payment
89.20of these services. The commissioner shall reimburse claims submitted based on an
89.21interim rate, and shall settle at a final rate once the department has determined it. The
89.22commissioner shall notify the school district of the final rate. The school district has 60
89.23days to appeal the final rate. To appeal the final rate, the school district shall file a written
89.24appeal request to the commissioner within 60 days of the date the final rate determination
89.25was mailed. The appeal request shall specify (1) the disputed items and (2) the name and
89.26address of the person to contact regarding the appeal.
89.27(g) Effective July 1, 2000, medical assistance services provided under an individual
89.28education plan or an individual family service plan by local school districts shall not count
89.29against medical assistance authorization thresholds for that child.
89.30(h) Nursing services as defined in section 148.171, subdivision 15, and provided
89.31as an individual education plan health-related service, are eligible for medical assistance
89.32payment if they are otherwise a covered service under the medical assistance program.
89.33Medical assistance covers the administration of prescription medications by a licensed
89.34nurse who is employed by or under contract with a school district when the administration
89.35of medications is identified in the child's individualized education plan. The simple
89.36administration of medications alone is not covered under medical assistance when
90.1administered by a provider other than a school district or when it is not identified in the
90.2child's individualized education plan.

90.3    Sec. 25. Minnesota Statutes 2008, section 256B.0631, subdivision 1, is amended to
90.4read:
90.5    Subdivision 1. Co-payments. (a) Except as provided in subdivision 2, the medical
90.6assistance benefit plan shall include the following co-payments for all recipients, effective
90.7for services provided on or after October 1, 2003, and before January 1, 2009 July 1, 2009:
90.8    (1) $3 per nonpreventive visit. For purposes of this subdivision, a visit means an
90.9episode of service which is required because of a recipient's symptoms, diagnosis, or
90.10established illness, and which is delivered in an ambulatory setting by a physician or
90.11physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
90.12audiologist, optician, or optometrist;
90.13    (2) $3 for eyeglasses;
90.14    (3) $6 for nonemergency visits to a hospital-based emergency room; and
90.15    (4) $3 per brand-name drug prescription and $1 per generic drug prescription,
90.16subject to a $12 per month maximum for prescription drug co-payments. No co-payments
90.17shall apply to antipsychotic drugs when used for the treatment of mental illness.
90.18    (b) Except as provided in subdivision 2, the medical assistance benefit plan shall
90.19include the following co-payments for all recipients, effective for services provided on
90.20or after January 1, 2009:
90.21    (1) $6 for nonemergency visits to a hospital-based emergency room;
90.22    (2) (4) $3 per brand-name drug prescription and $1 per generic drug prescription,
90.23subject to a $7 per month maximum for prescription drug co-payments. No co-payments
90.24shall apply to antipsychotic drugs when used for the treatment of mental illness; and
90.25    (3) (5) for individuals identified by the commissioner with income at or below 100
90.26percent of the federal poverty guidelines, total monthly co-payments must not exceed five
90.27percent of family income. For purposes of this paragraph, family income is the total
90.28earned and unearned income of the individual and the individual's spouse, if the spouse is
90.29enrolled in medical assistance and also subject to the five percent limit on co-payments.
90.30    (c) (b) Recipients of medical assistance are responsible for all co-payments in this
90.31subdivision.

90.32    Sec. 26. [256B.0755] PAYMENT REFORM DEMONSTRATION PROJECT FOR
90.33SPECIAL PATIENT POPULATIONS.
90.34    Subdivision 1. Demonstration project. (a) The commissioner of human services,
90.35in consultation with the commissioner of health, shall establish a payment reform
91.1demonstration project implementing an alternative payment system for health care
91.2providers serving an identified group of patients who are enrolled in a state health
91.3care program, and are either high utilizers of high-cost health care services or have
91.4characteristics that put them at high risk of becoming high utilizers. The purpose of the
91.5demonstration project is to implement and evaluate methods of reducing hospitalizations,
91.6emergency room use, high-cost medications and specialty services, admissions to nursing
91.7facilities, or use of long-term home and community-based services, in order to reduce the
91.8total cost of care and services for the patients.
91.9(b) The commissioner shall give the highest priority to projects that will serve
91.10patients who have chronic medical conditions or complex medical needs that are
91.11complicated by a physical disability, serious mental illness, or serious socioeconomic
91.12factors such as poverty, homelessness, or language or cultural barriers. The commissioner
91.13shall also give the highest priority to providers or groups of providers who have the
91.14highest concentrations of patients with these characteristics.
91.15(c) The commissioner must implement this payment reform demonstration project
91.16in a manner consistent with the payment reform initiative provided in sections 62U.02
91.17to 62U.04.
91.18(d) For purposes of this section, "state health care program" means the medical
91.19assistance, MinnesotaCare, and general assistance medical care programs.
91.20    Subd. 2. Participation. (a) The commissioner shall request eligible providers or
91.21groups of providers to submit a proposal to participate in the demonstration project by
91.22September 1, 2009. The providers who are interested in participating shall negotiate with
91.23the commissioner to determine:
91.24(1) the identified group of patients who are to be enrolled in the program;
91.25(2) the services that are to be included in the total cost of care calculation;
91.26(3) the methodology for calculating the total cost of care, which may take into
91.27consideration the impact on costs to other state or local government programs including,
91.28but not limited to, social services and income maintenance programs;
91.29(4) the time period to be covered under the bid;
91.30(5) the implementation of a risk adjustment mechanism to adjust for factors that are
91.31beyond the control of the provider including nonclinical factors that will affect the cost
91.32or outcomes of treatment;
91.33(6) the payment reforms and payment methods to be used under the project, which
91.34may include but are not limited to adjustments in fee-for-service payments, payment of
91.35care coordination fees, payments for start-up and implementation costs to be recovered or
91.36repaid later in the project, payments adjusted based on a provider's proportion of patients
92.1who are enrolled in state health care programs; payments adjusted for the clinical or
92.2socioeconomic complexity of the patients served, payment incentives tied to use of
92.3inpatient and emergency room services, and periodic settle-up adjustments;
92.4(7) methods of sharing financial risk and benefit between the commissioner and
92.5the provider or groups of providers, which may include but are not limited to stop-loss
92.6arrangements to cover high-cost outlier cases or costs that are beyond the control of the
92.7provider, and risk-sharing and benefit-sharing corridors; and
92.8(8) performance and outcome benchmarks to be used to measure performance,
92.9achievement of cost-savings targets, and quality of care provided.
92.10(b) A provider or group of providers may submit a proposal for a demonstration
92.11project in partnership with a health maintenance organization or county-based purchasing
92.12plan for the purposes of sharing risk, claims processing, or administration of the project,
92.13or to extend participation in the project to persons who are enrolled in prepaid health
92.14care programs.
92.15    Subd. 3. Total cost of care agreement. Based on negotiations, the commissioner
92.16must enter into an agreement with interested and eligible providers or groups of providers
92.17to implement projects that are designed to reduce the total cost of care for the identified
92.18patients. To the extent possible, the projects shall begin implementation on January 1,
92.192010, or upon federal approval, whichever is later.
92.20    Subd. 4. Eligibility. To be eligible to participate, providers or groups of providers
92.21must meet certification standards for health care homes established by the Department of
92.22Health and the Department of Human Services under section 256B.0751.
92.23    Subd. 5. Alternative payments. The commissioner shall seek all federal waivers
92.24and approvals necessary to implement this section and to obtain federal matching funds. To
92.25the extent authorized by federal law, the commissioner may waive existing fee-for-service
92.26payment rates, provider contract or performance requirements, consumer incentive
92.27policies, or other requirements in statute or rule in order to allow the providers or groups
92.28of providers to utilize alternative payment and financing methods that will appropriately
92.29fund necessary and cost-effective primary care and care coordination services; establish
92.30appropriate incentives for prevention, health promotion, and care coordination; and
92.31mitigate financial harm to participating providers caused by the successful reduction in
92.32preventable hospitalization, emergency room use, and other costly services.
92.33    Subd. 6. Cost neutrality. The total cost, including administrative costs, of this
92.34demonstration project must not exceed the costs that would otherwise be incurred by
92.35the state had services to the state health care program enrollees participating in the
93.1demonstration project been provided, as applicable for the enrollee, under fee-for-service
93.2or through managed care or county-based purchasing plans.

93.3    Sec. 27. Minnesota Statutes 2008, section 256B.15, subdivision 1a, is amended to read:
93.4    Subd. 1a. Estates subject to claims. (a) If a person receives any medical assistance
93.5hereunder, on the person's death, if single, or on the death of the survivor of a married
93.6couple, either or both of whom received medical assistance, or as otherwise provided
93.7for in this section, the total amount paid for medical assistance rendered for the person
93.8and spouse shall be filed as a claim against the estate of the person or the estate of the
93.9surviving spouse in the court having jurisdiction to probate the estate or to issue a decree
93.10of descent according to sections 525.31 to 525.313.
93.11(b) For the purposes of this section, the person's estate must consist of:
93.12(1) the person's probate estate;
93.13(2) all of the person's interests or proceeds of those interests in real property the
93.14person owned as a life tenant or as a joint tenant with a right of survivorship at the time of
93.15the person's death;
93.16(3) all of the person's interests or proceeds of those interests in securities the person
93.17owned in beneficiary form as provided under sections 524.6-301 to 524.6-311 at the time
93.18of the person's death, to the extent the interests or proceeds of those interests become part
93.19of the probate estate under section 524.6-307;
93.20(4) all of the person's interests in joint accounts, multiple-party accounts, and
93.21pay-on-death accounts, brokerage accounts, investment accounts, or the proceeds of
93.22those accounts, as provided under sections 524.6-201 to 524.6-214 at the time of the
93.23person's death to the extent the interests become part of the probate estate under section
93.24524.6-207; and
93.25(5) assets conveyed to a survivor, heir, or assign of the person through survivorship,
93.26living trust, or other arrangements.
93.27(c) For the purpose of this section and recovery in a surviving spouse's estate for
93.28medical assistance paid for a predeceased spouse, the estate must consist of all of the legal
93.29title and interests the deceased individual's predeceased spouse had in jointly owned or
93.30marital property at the time of the spouse's death, as defined in subdivision 2b, and the
93.31proceeds of those interests, that passed to the deceased individual or another individual, a
93.32survivor, an heir, or an assign of the predeceased spouse through a joint tenancy, tenancy
93.33in common, survivorship, life estate, living trust, or other arrangement. A deceased
93.34recipient who, at death, owned the property jointly with the surviving spouse shall have
93.35an interest in the entire property.
94.1(d) For the purpose of recovery in a single person's estate or the estate of a survivor
94.2of a married couple, "other arrangement" includes any other means by which title to all or
94.3any part of the jointly owned or marital property or interest passed from the predeceased
94.4spouse to another including, but not limited to, transfers between spouses which are
94.5permitted, prohibited, or penalized for purposes of medical assistance.
94.6(e) A claim shall be filed if medical assistance was rendered for either or both
94.7persons under one of the following circumstances:
94.8(a) (1) the person was over 55 years of age, and received services under this chapter;
94.9(b) (2) the person resided in a medical institution for six months or longer, received
94.10services under this chapter, and, at the time of institutionalization or application for
94.11medical assistance, whichever is later, the person could not have reasonably been expected
94.12to be discharged and returned home, as certified in writing by the person's treating
94.13physician. For purposes of this section only, a "medical institution" means a skilled
94.14nursing facility, intermediate care facility, intermediate care facility for persons with
94.15developmental disabilities, nursing facility, or inpatient hospital; or
94.16(c) (3) the person received general assistance medical care services under chapter
94.17256D.
94.18(f) The claim shall be considered an expense of the last illness of the decedent for the
94.19purpose of section 524.3-805. Notwithstanding any law or rule to the contrary, a state or
94.20county agency with a claim under this section must be a creditor under section 524.6-307.
94.21Any statute of limitations that purports to limit any county agency or the state agency,
94.22or both, to recover for medical assistance granted hereunder shall not apply to any claim
94.23made hereunder for reimbursement for any medical assistance granted hereunder. Notice
94.24of the claim shall be given to all heirs and devisees of the decedent whose identity can be
94.25ascertained with reasonable diligence. The notice must include procedures and instructions
94.26for making an application for a hardship waiver under subdivision 5; time frames for
94.27submitting an application and determination; and information regarding appeal rights and
94.28procedures. Counties are entitled to one-half of the nonfederal share of medical assistance
94.29collections from estates that are directly attributable to county effort. Counties are entitled
94.30to ten percent of the collections for alternative care directly attributable to county effort.

94.31    Sec. 28. Minnesota Statutes 2008, section 256B.15, subdivision 1h, is amended to read:
94.32    Subd. 1h. Estates of specific persons receiving medical assistance. (a) For
94.33purposes of this section, paragraphs (b) to (k) (j) apply if a person received medical
94.34assistance for which a claim may be filed under this section and died single, or the
95.1surviving spouse of the couple and was not survived by any of the persons described
95.2in subdivisions 3 and 4.
95.3    (b) For purposes of this section, the person's estate consists of: (1) the person's
95.4probate estate; (2) all of the person's interests or proceeds of those interests in real property
95.5the person owned as a life tenant or as a joint tenant with a right of survivorship at the
95.6time of the person's death; (3) all of the person's interests or proceeds of those interests in
95.7securities the person owned in beneficiary form as provided under sections 524.6-301 to
95.8524.6-311 at the time of the person's death, to the extent they become part of the probate
95.9estate under section 524.6-307; (4) all of the person's interests in joint accounts, multiple
95.10party accounts, and pay on death accounts, or the proceeds of those accounts, as provided
95.11under sections 524.6-201 to 524.6-214 at the time of the person's death to the extent
95.12they become part of the probate estate under section 524.6-207; and (5) the person's
95.13legal title or interest at the time of the person's death in real property transferred under
95.14a transfer on death deed under section 507.071, or in the proceeds from the subsequent
95.15sale of the person's interest in the real property. Notwithstanding any law or rule to the
95.16contrary, a state or county agency with a claim under this section shall be a creditor under
95.17section 524.6-307.
95.18    (c) (b) Notwithstanding any law or rule to the contrary, the person's life estate or joint
95.19tenancy interest in real property not subject to a medical assistance lien under sections
95.20514.980 to 514.985 on the date of the person's death shall not end upon the person's death
95.21and shall continue as provided in this subdivision. The life estate in the person's estate
95.22shall be that portion of the interest in the real property subject to the life estate that is equal
95.23to the life estate percentage factor for the life estate as listed in the Life Estate Mortality
95.24Table of the health care program's manual for a person who was the age of the medical
95.25assistance recipient on the date of the person's death. The joint tenancy interest in real
95.26property in the estate shall be equal to the fractional interest the person would have owned
95.27in the jointly held interest in the property had they and the other owners held title to the
95.28property as tenants in common on the date the person died.
95.29    (d) (c) The court upon its own motion, or upon motion by the personal representative
95.30or any interested party, may enter an order directing the remaindermen or surviving joint
95.31tenants and their spouses, if any, to sign all documents, take all actions, and otherwise
95.32fully cooperate with the personal representative and the court to liquidate the decedent's
95.33life estate or joint tenancy interests in the estate and deliver the cash or the proceeds of
95.34those interests to the personal representative and provide for any legal and equitable
95.35sanctions as the court deems appropriate to enforce and carry out the order, including an
95.36award of reasonable attorney fees.
96.1    (e) (d) The personal representative may make, execute, and deliver any conveyances
96.2or other documents necessary to convey the decedent's life estate or joint tenancy interest
96.3in the estate that are necessary to liquidate and reduce to cash the decedent's interest or
96.4for any other purposes.
96.5    (f) (e) Subject to administration, all costs, including reasonable attorney fees,
96.6directly and immediately related to liquidating the decedent's life estate or joint tenancy
96.7interest in the decedent's estate, shall be paid from the gross proceeds of the liquidation
96.8allocable to the decedent's interest and the net proceeds shall be turned over to the personal
96.9representative and applied to payment of the claim presented under this section.
96.10    (g) (f) The personal representative shall bring a motion in the district court in which
96.11the estate is being probated to compel the remaindermen or surviving joint tenants to
96.12account for and deliver to the personal representative all or any part of the proceeds of any
96.13sale, mortgage, transfer, conveyance, or any disposition of real property allocable to the
96.14decedent's life estate or joint tenancy interest in the decedent's estate, and do everything
96.15necessary to liquidate and reduce to cash the decedent's interest and turn the proceeds of
96.16the sale or other disposition over to the personal representative. The court may grant any
96.17legal or equitable relief including, but not limited to, ordering a partition of real estate
96.18under chapter 558 necessary to make the value of the decedent's life estate or joint tenancy
96.19interest available to the estate for payment of a claim under this section.
96.20    (h) (g) Subject to administration, the personal representative shall use all of the cash
96.21or proceeds of interests to pay an allowable claim under this section. The remaindermen
96.22or surviving joint tenants and their spouses, if any, may enter into a written agreement
96.23with the personal representative or the claimant to settle and satisfy obligations imposed at
96.24any time before or after a claim is filed.
96.25    (i) (h) The personal representative may, at their discretion, provide any or all of the
96.26other owners, remaindermen, or surviving joint tenants with an affidavit terminating the
96.27decedent's estate's interest in real property the decedent owned as a life tenant or as a joint
96.28tenant with others, if the personal representative determines in good faith that neither the
96.29decedent nor any of the decedent's predeceased spouses received any medical assistance
96.30for which a claim could be filed under this section, or if the personal representative has
96.31filed an affidavit with the court that the estate has other assets sufficient to pay a claim, as
96.32presented, or if there is a written agreement under paragraph (h) (g), or if the claim, as
96.33allowed, has been paid in full or to the full extent of the assets the estate has available
96.34to pay it. The affidavit may be recorded in the office of the county recorder or filed in
96.35the Office of the Registrar of Titles for the county in which the real property is located.
96.36Except as provided in section 514.981, subdivision 6, when recorded or filed, the affidavit
97.1shall terminate the decedent's interest in real estate the decedent owned as a life tenant or a
97.2joint tenant with others. The affidavit shall:
97.3(1) be signed by the personal representative;
97.4(2) identify the decedent and the interest being terminated;
97.5(3) give recording information sufficient to identify the instrument that created the
97.6interest in real property being terminated;
97.7(4) legally describe the affected real property;
97.8(5) state that the personal representative has determined that neither the decedent
97.9nor any of the decedent's predeceased spouses received any medical assistance for which
97.10a claim could be filed under this section;
97.11(6) state that the decedent's estate has other assets sufficient to pay the claim, as
97.12presented, or that there is a written agreement between the personal representative and
97.13the claimant and the other owners or remaindermen or other joint tenants to satisfy the
97.14obligations imposed under this subdivision; and
97.15(7) state that the affidavit is being given to terminate the estate's interest under this
97.16subdivision, and any other contents as may be appropriate.
97.17The recorder or registrar of titles shall accept the affidavit for recording or filing. The
97.18affidavit shall be effective as provided in this section and shall constitute notice even if it
97.19does not include recording information sufficient to identify the instrument creating the
97.20interest it terminates. The affidavit shall be conclusive evidence of the stated facts.
97.21    (j) (i) The holder of a lien arising under subdivision 1c shall release the lien at
97.22the holder's expense against an interest terminated under paragraph (h) (g) to the extent
97.23of the termination.
97.24    (k) (j) If a lien arising under subdivision 1c is not released under paragraph (j) (i),
97.25prior to closing the estate, the personal representative shall deed the interest subject to the
97.26lien to the remaindermen or surviving joint tenants as their interests may appear. Upon
97.27recording or filing, the deed shall work a merger of the recipient's life estate or joint
97.28tenancy interest, subject to the lien, into the remainder interest or interest the decedent and
97.29others owned jointly. The lien shall attach to and run with the property to the extent of
97.30the decedent's interest at the time of the decedent's death.

97.31    Sec. 29. Minnesota Statutes 2008, section 256B.15, subdivision 2, is amended to read:
97.32    Subd. 2. Limitations on claims. The claim shall include only the total amount
97.33of medical assistance rendered after age 55 or during a period of institutionalization
97.34described in subdivision 1a, clause (b) paragraph (e), and the total amount of general
97.35assistance medical care rendered, and shall not include interest. Claims that have been
98.1allowed but not paid shall bear interest according to section 524.3-806, paragraph (d). A
98.2claim against the estate of a surviving spouse who did not receive medical assistance, for
98.3medical assistance rendered for the predeceased spouse, shall be payable from the full
98.4value of all of the predeceased spouse's assets and interests which are part of the surviving
98.5spouse's estate under subdivisions 1a and 2b. Recovery of medical assistance expenses in
98.6the nonrecipient surviving spouse's estate is limited to the value of the assets of the estate
98.7that were marital property or jointly owned property at any time during the marriage. The
98.8claim is not payable from the value of assets or proceeds of assets in the estate attributable
98.9to a predeceased spouse whom the individual married after the death of the predeceased
98.10recipient spouse for whom the claim is filed or from assets and the proceeds of assets in the
98.11estate which the nonrecipient decedent spouse acquired with assets which were not marital
98.12property or jointly owned property after the death of the predeceased recipient spouse.
98.13Claims for alternative care shall be net of all premiums paid under section 256B.0913,
98.14subdivision 12
, on or after July 1, 2003, and shall be limited to services provided on or
98.15after July 1, 2003. Claims against marital property shall be limited to claims against
98.16recipients who died on or after July 1, 2009.

98.17    Sec. 30. Minnesota Statutes 2008, section 256B.15, is amended by adding a
98.18subdivision to read:
98.19    Subd. 2b. Controlling provisions. (a) For purposes of this subdivision and
98.20subdivisions 1a and 2, paragraphs (b) to (d) apply.
98.21(b) At the time of death of a recipient spouse and solely for purpose of recovery of
98.22medical assistance benefits received, a predeceased recipient spouse shall have a legal
98.23title or interest in the undivided whole of all of the property which the recipient and the
98.24recipient's surviving spouse owned jointly or which was marital property at any time
98.25during their marriage regardless of the form of ownership and regardless of whether
98.26it was owned or titled in the names of one or both the recipient and the recipient's
98.27spouse. Title and interest in the property of a predeceased recipient spouse shall not end
98.28or extinguish upon the person's death and shall continue for the purpose of allowing
98.29recovery of medical assistance in the estate of the surviving spouse. Upon the death of
98.30the predeceased recipient spouse, title and interest in the predeceased spouse's property
98.31shall vest in the surviving spouse by operation of law and without the necessity for any
98.32probate or decree of descent proceedings and shall continue to exist after the death of the
98.33predeceased spouse and the surviving spouse to permit recovery of medical assistance.
98.34The recipient spouse and the surviving spouse of a deceased recipient spouse shall not
99.1encumber, disclaim, transfer, alienate, hypothecate, or otherwise divest themselves of
99.2these interests before or upon death.
99.3(c) For purposes of this section, "marital property" includes any and all real or
99.4personal property of any kind or interests in such property the predeceased recipient
99.5spouse and their spouse, or either of them, owned at the time of their marriage to each
99.6other or acquired during their marriage regardless of whether it was owned or titled in
99.7the names of one or both of them. If either or both spouses of a married couple received
99.8medical assistance, all property owned during the marriage or which either or both spouses
99.9acquired during their marriage shall be presumed to be marital property for purposes of
99.10recovering medical assistance unless there is clear and convincing evidence to the contrary.
99.11(d) The agency responsible for the claim for medical assistance for a recipient spouse
99.12may, at its discretion, release specific real and personal property from the provisions of
99.13this section. The release shall extinguish the interest created under paragraph (b) in the
99.14land it describes upon filing or recording. The release need not be attested, certified, or
99.15acknowledged as a condition of filing or recording and shall be filed or recorded in the
99.16office of the county recorder or registrar of titles, as appropriate, in the county where the
99.17real property is located. The party to whom the release is given shall be responsible for
99.18paying all fees and costs necessary to record and file the release. If the property described
99.19in the release is registered property, the registrar of titles shall accept it for recording and
99.20shall record it on the certificate of title for each parcel of property described in the release.
99.21If the property described in the release is abstract property, the recorder shall accept it
99.22for filing and file it in the county's grantor-grantee indexes and any tract index the county
99.23maintains for each parcel of property described in the release.

99.24    Sec. 31. Minnesota Statutes 2008, section 256B.15, is amended by adding a
99.25subdivision to read:
99.26    Subd. 9. Commissioner's intervention. The commissioner shall be permitted to
99.27intervene as a party in any proceeding involving recovery of medical assistance upon
99.28filing a notice of intervention and serving such notice on the other parties.

99.29    Sec. 32. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:
99.30    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
99.31and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
99.32basis beginning January 1, 1996. Managed care contracts which were in effect on June
99.3330, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
99.34through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
100.1commissioner may issue separate contracts with requirements specific to services to
100.2medical assistance recipients age 65 and older.
100.3    (b) A prepaid health plan providing covered health services for eligible persons
100.4pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
100.5of its contract with the commissioner. Requirements applicable to managed care programs
100.6under chapters 256B, 256D, and 256L, established after the effective date of a contract
100.7with the commissioner take effect when the contract is next issued or renewed.
100.8    (c) Effective for services rendered on or after January 1, 2003, the commissioner shall
100.9withhold five percent of managed care plan payments under this section and county-based
100.10purchasing plan's payment rate under section 256B.692 for the prepaid medical assistance
100.11and general assistance medical care programs pending completion of performance targets.
100.12Each performance target must be quantifiable, objective, measurable, and reasonably
100.13attainable, except in the case of a performance target based on a federal or state law or rule.
100.14Criteria for assessment of each performance target must be outlined in writing prior to the
100.15contract effective date. The managed care plan must demonstrate, to the commissioner's
100.16satisfaction, that the data submitted regarding attainment of the performance target is
100.17accurate. The commissioner shall periodically change the administrative measures used
100.18as performance targets in order to improve plan performance across a broader range of
100.19administrative services. The performance targets must include measurement of plan
100.20efforts to contain spending on health care services and administrative activities. The
100.21commissioner may adopt plan-specific performance targets that take into account factors
100.22affecting only one plan, including characteristics of the plan's enrollee population. The
100.23withheld funds must be returned no sooner than July of the following year if performance
100.24targets in the contract are achieved. The commissioner may exclude special demonstration
100.25projects under subdivision 23. A managed care plan or a county-based purchasing plan
100.26under section 256B.692 may include as admitted assets under section 62D.044 any amount
100.27withheld under this paragraph that is reasonably expected to be returned.
100.28    (d)(1) Effective for services rendered on or after January 1, 2009, the commissioner
100.29shall withhold three percent of managed care plan payments under this section and
100.30county-based purchasing plan payments under section 256B.692 for the prepaid medical
100.31assistance and general assistance medical care programs. The withheld funds must be
100.32returned no sooner than July 1 and no later than July 31 of the following year. The
100.33commissioner may exclude special demonstration projects under subdivision 23.
100.34    (2) A managed care plan or a county-based purchasing plan under section 256B.692
100.35
may include as admitted assets under section 62D.044 any amount withheld under
101.1this paragraph. The return of the withhold under this paragraph is not subject to the
101.2requirements of paragraph (c).
101.3(e) Effective for services rendered on or after January 1, 2010, the commissioner
101.4shall include as part of the performance targets described in paragraph (a) a reduction in
101.5the health plan's emergency room utilization rate for state health care program enrollees
101.6by a measurable rate of five percent from the plan's utilization rate for state health care
101.7program enrollees for the previous calendar year.
101.8The withheld funds must be returned no sooner than July 1 and no later than July
101.931 of the following calendar year if the managed care plan or county-based purchasing
101.10plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
101.11rate was achieved.
101.12The withhold described in this paragraph shall continue for each consecutive
101.13contract period until the health plan's emergency room utilization rate for state health care
101.14program enrollees is reduced by 25 percent of the health plan's emergency room utilization
101.15rate for state health care program enrollees for calendar year 2008.
101.16(f) A managed care plan or a county-based purchasing plan under section 256B.692
101.17may include as admitted assets under section 62D.044 any amount withheld under this
101.18section that is reasonably expected to be returned.

101.19    Sec. 33. Minnesota Statutes 2008, section 256B.69, subdivision 5c, is amended to read:
101.20    Subd. 5c. Medical education and research fund. (a) Except as provided in
101.21paragraph (c), the commissioner of human services shall transfer each year to the medical
101.22education and research fund established under section 62J.692, the following:
101.23(1) an amount equal to the reduction in the prepaid medical assistance and prepaid
101.24general assistance medical care payments as specified in this clause. Until January 1,
101.252002, the county medical assistance and general assistance medical care capitation base
101.26rate prior to plan specific adjustments and after the regional rate adjustments under section
101.27256B.69, subdivision 5b , is reduced 6.3 percent for Hennepin County, two percent for
101.28the remaining metropolitan counties, and no reduction for nonmetropolitan Minnesota
101.29counties; and after January 1, 2002, the county medical assistance and general assistance
101.30medical care capitation base rate prior to plan specific adjustments is reduced 6.3 percent
101.31for Hennepin County, two percent for the remaining metropolitan counties, and 1.6 percent
101.32for nonmetropolitan Minnesota counties. Nursing facility and elderly waiver payments
101.33and demonstration project payments operating under subdivision 23 are excluded from
101.34this reduction. The amount calculated under this clause shall not be adjusted for periods
101.35already paid due to subsequent changes to the capitation payments;
102.1(2) beginning July 1, 2003, $2,157,000 $4,314,000 from the capitation rates paid
102.2under this section plus any federal matching funds on this amount;
102.3(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
102.4paid under this section; and
102.5(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
102.6under this section.
102.7(b) This subdivision shall be effective upon approval of a federal waiver which
102.8allows federal financial participation in the medical education and research fund. Effective
102.9July 1, 2009, and thereafter, the transfers required by paragraph (a), clauses (1) to (4),
102.10shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first
102.11reduce the amounts otherwise required to be transferred under paragraph (a), clauses (2),
102.12(3), and (4). Any excess following this reduction shall proportionally reduce the transfers
102.13under paragraph (a), clause (1).
102.14(c) Effective July 1, 2003, the amount reduced from the prepaid general assistance
102.15medical care payments under paragraph (a), clause (1), shall be transferred to the general
102.16fund.
102.17(d) Beginning July 1, 2009, of the amounts in paragraph (a), the commissioner shall
102.18transfer $21,714,000 each fiscal year to the medical education and research fund. The
102.19balance of the transfers under paragraph (a) shall be transferred to the medical education
102.20and research fund no earlier than July 1 of the following fiscal year.

102.21    Sec. 34. Minnesota Statutes 2008, section 256B.69, subdivision 5f, is amended to read:
102.22    Subd. 5f. Capitation rates. (a) Beginning July 1, 2002, the capitation rates paid
102.23under this section are increased by $12,700,000 per year. Beginning July 1, 2003, the
102.24capitation rates paid under this section are increased by $4,700,000 per year.
102.25(b) Beginning July 1, 2009, the capitation rates paid under this section are increased
102.26each year by the lesser of $21,714,000 or an amount equal to the difference between the
102.27estimated value of the reductions described in subdivision 5c, paragraph (a), clause (1),
102.28and the amount of the limit described in subdivision 5c, paragraph (b).

102.29    Sec. 35. [256B.695] PAYMENT FOR BASIC CARE SERVICES.
102.30Effective service date July 1, 2009, total payments for basic care services, except
102.31prescription drugs, medical supplies, prosthetics, lab, radiology, medical transportation,
102.32and services subject to or specifically exempted from section 256B.76, subdivision 1,
102.33paragraph (c), shall be reduced by 3.0 percent, prior to third-party liability and spenddown
102.34calculation. Payments made to managed care and county-based purchasing plans shall be
102.35reduced for services provided on or after January 1, 2010, to reflect this reduction.

103.1    Sec. 36. Minnesota Statutes 2008, section 256B.76, subdivision 1, is amended to read:
103.2    Subdivision 1. Physician reimbursement. (a) Effective for services rendered on
103.3or after October 1, 1992, the commissioner shall make payments for physician services
103.4as follows:
103.5    (1) payment for level one Centers for Medicare and Medicaid Services' common
103.6procedural coding system codes titled "office and other outpatient services," "preventive
103.7medicine new and established patient," "delivery, antepartum, and postpartum care,"
103.8"critical care," cesarean delivery and pharmacologic management provided to psychiatric
103.9patients, and level three codes for enhanced services for prenatal high risk, shall be paid
103.10at the lower of (i) submitted charges, or (ii) 25 percent above the rate in effect on June
103.1130, 1992. If the rate on any procedure code within these categories is different than the
103.12rate that would have been paid under the methodology in section 256B.74, subdivision 2,
103.13then the larger rate shall be paid;
103.14    (2) payments for all other services shall be paid at the lower of (i) submitted charges,
103.15or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
103.16    (3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
103.17percentile of 1989, less the percent in aggregate necessary to equal the above increases
103.18except that payment rates for home health agency services shall be the rates in effect
103.19on September 30, 1992.
103.20    (b) Effective for services rendered on or after January 1, 2000, payment rates for
103.21physician and professional services shall be increased by three percent over the rates
103.22in effect on December 31, 1999, except for home health agency and family planning
103.23agency services. The increases in this paragraph shall be implemented January 1, 2000,
103.24for managed care.
103.25(c) Effective for services rendered on or after July 1, 2009, payment rates for
103.26physician and professional services shall be reduced by three percent over the rates in effect
103.27on June 30, 2009, except for office or other outpatient services (procedure codes 99201
103.28to 99215) and preventive medicine services (procedure codes 99381 to 99412) billed by
103.29the following primary care specialties: general practitioner, internal medicine, pediatrics,
103.30geriatric nurse practitioner, pediatric nurse practitioner, family practice nurse practitioner,
103.31adult nurse practitioner, geriatrics, and family practice. The commissioner, effective
103.32January 1, 2010, shall reduce capitation rates paid to managed care and county-based
103.33purchasing plans under sections 256B.69 and 256B.692 to reflect this payment reduction.

103.34    Sec. 37. Minnesota Statutes 2008, section 256B.76, subdivision 4, is amended to read:
104.1    Subd. 4. Critical access dental providers. Effective for dental services rendered
104.2on or after January 1, 2002, the commissioner shall increase reimbursements to dentists
104.3and dental clinics deemed by the commissioner to be critical access dental providers.
104.4For dental services rendered on or after July 1, 2007, the commissioner shall increase
104.5reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to
104.6the critical access dental provider. The commissioner shall pay the health plan companies
104.7in amounts sufficient to reflect increased reimbursements to critical access dental providers
104.8as approved by the commissioner. In determining which dentists and dental clinics shall
104.9be deemed critical access dental providers, the commissioner shall review:
104.10    (1) the utilization rate in the service area in which the dentist or dental clinic operates
104.11for dental services to patients covered by medical assistance, general assistance medical
104.12care, or MinnesotaCare as their primary source of coverage;
104.13    (2) the level of services provided by the dentist or dental clinic to patients covered
104.14by medical assistance, general assistance medical care, or MinnesotaCare as their primary
104.15source of coverage; and
104.16    (3) whether the level of services provided by the dentist or dental clinic is critical to
104.17maintaining adequate levels of patient access within the service area.
104.18In the absence of a critical access dental provider in a service area, the commissioner may
104.19designate a dentist or dental clinic as a critical access dental provider if the dentist or
104.20dental clinic is willing to provide care to patients covered by medical assistance, general
104.21assistance medical care, or MinnesotaCare at a level which significantly increases access
104.22to dental care in the service area. The commissioner shall administer this subdivision
104.23within the limits of available appropriations.

104.24    Sec. 38. Minnesota Statutes 2008, section 256B.76, is amended by adding a
104.25subdivision to read:
104.26    Subd. 4a. Designation and termination of critical access dental providers. (a)
104.27The commissioner shall not designate an individual dentist or clinic as a critical access
104.28dental provider under subdivision 4 or section 256L.11, subdivision 7, when the owner or
104.29any dentist employed by or under contract with the practice:
104.30(1) has been subject to a corrective or disciplinary action by the Minnesota Board of
104.31Dentistry within the past five years or is currently subject to a corrective or disciplinary
104.32action by the board. Designation shall not be made until the provider is no longer subject
104.33to a corrective or disciplinary action;
104.34(2) does not bill on a clinic-specific location basis;
105.1(3) has been subject, within the past five years, to a postinvestigation action by the
105.2commissioner of human services or contracted health plan when investigating services
105.3provided to Minnesota health care program enrollees, including administrative sanctions,
105.4monetary recovery, referral to state regulatory agency, referral to the state attorney general
105.5or county attorney general, or issuance of a warning as specified in Minnesota Rules, parts
105.69505.2160 to 9505.2245. Designation shall not be considered until the January of the
105.7year following documentation that the activity that resulted in postinvestigative action
105.8has stopped; or
105.9(4) has not completed the application for critical access dental provider designation,
105.10has submitted the application after the due date, provided incorrect information, or has
105.11knowingly and willfully submitted a fraudulent designation form.
105.12(b) The commissioner shall terminate a critical access designation of an individual
105.13dentist or clinic, if the owner or any dentist employed by or under contract with the
105.14practice:
105.15(1) becomes subject to a disciplinary or corrective action by the Minnesota Board of
105.16Dentistry. The provider shall not be considered for critical access designation until the
105.17January following the year in which the action has ended; or
105.18(2) becomes subject to a postinvestigation action by the commissioner of human
105.19services or contracted health plan including administrative sanctions, monetary recovery,
105.20referral to state regulatory agency, referral to the state attorney general or county attorney
105.21general, or issuance of a warning as specified in Minnesota Rules, parts 9505.2160 to
105.229505.2245. Designation shall not be considered until the January of the year following
105.23documentation that the activity that resulted in postinvestigative action has stopped.
105.24(c) Any termination is retroactive to the date of the:
105.25(1) postinvestigative action; or
105.26(2) disciplinary or corrective action by the Minnesota Board of Dentistry.
105.27(d) A provider who has been terminated or not designated may appeal only through
105.28the contested hearing process as defined in section 14.02, subdivision 3, by filing with the
105.29commissioner a written request of appeal. The appeal request must be received by the
105.30commissioner no later than 30 days after notification of termination or nondesignation.
105.31(e) The commissioner may make an exception to paragraph (a), clauses (1) and (3),
105.32and paragraph (b), if an action taken by the Minnesota Board of Dentistry, commissioner
105.33of human services, or contracted health plan is the result of a onetime event by an
105.34individual employed or contracted by a group practice.
105.35EFFECTIVE DATE.This section is effective the day following final enactment.

106.1    Sec. 39. Minnesota Statutes 2008, section 256D.03, subdivision 4, is amended to read:
106.2    Subd. 4. General assistance medical care; services. (a)(i) For a person who is
106.3eligible under subdivision 3, paragraph (a), clause (2), item (i), general assistance medical
106.4care covers, except as provided in paragraph (c):
106.5    (1) inpatient hospital services;
106.6    (2) outpatient hospital services;
106.7    (3) services provided by Medicare certified rehabilitation agencies;
106.8    (4) prescription drugs and other products recommended through the process
106.9established in section 256B.0625, subdivision 13;
106.10    (5) equipment necessary to administer insulin and diagnostic supplies and equipment
106.11for diabetics to monitor blood sugar level;
106.12    (6) eyeglasses and eye examinations provided by a physician or optometrist;
106.13    (7) hearing aids;
106.14    (8) prosthetic devices;
106.15    (9) laboratory and X-ray services;
106.16    (10) physician's services;
106.17    (11) medical transportation except special transportation;
106.18    (12) chiropractic services as covered under the medical assistance program;
106.19    (13) podiatric services;
106.20    (14) dental services as covered under the medical assistance program;
106.21    (15) mental health services covered under chapter 256B;
106.22    (16) prescribed medications for persons who have been diagnosed as mentally ill as
106.23necessary to prevent more restrictive institutionalization;
106.24    (17) medical supplies and equipment, and Medicare premiums, coinsurance and
106.25deductible payments;
106.26    (18) medical equipment not specifically listed in this paragraph when the use of
106.27the equipment will prevent the need for costlier services that are reimbursable under
106.28this subdivision;
106.29    (19) services performed by a certified pediatric nurse practitioner, a certified family
106.30nurse practitioner, a certified adult nurse practitioner, a certified obstetric/gynecological
106.31nurse practitioner, a certified neonatal nurse practitioner, or a certified geriatric nurse
106.32practitioner in independent practice, if (1) the service is otherwise covered under this
106.33chapter as a physician service, (2) the service provided on an inpatient basis is not included
106.34as part of the cost for inpatient services included in the operating payment rate, and (3) the
106.35service is within the scope of practice of the nurse practitioner's license as a registered
106.36nurse, as defined in section 148.171;
107.1    (20) services of a certified public health nurse or a registered nurse practicing in
107.2a public health nursing clinic that is a department of, or that operates under the direct
107.3authority of, a unit of government, if the service is within the scope of practice of the
107.4public health nurse's license as a registered nurse, as defined in section 148.171;
107.5    (21) telemedicine consultations, to the extent they are covered under section
107.6256B.0625, subdivision 3b ;
107.7    (22) care coordination and patient education services provided by a community
107.8health worker according to section 256B.0625, subdivision 49; and
107.9    (23) regardless of the number of employees that an enrolled health care provider
107.10may have, sign language interpreter services when provided by an enrolled health care
107.11provider during the course of providing a direct, person-to-person covered health care
107.12service to an enrolled recipient who has a hearing loss and uses interpreting services.
107.13    (ii) Effective October 1, 2003, for a person who is eligible under subdivision 3,
107.14paragraph (a), clause (2), item (ii), general assistance medical care coverage is limited
107.15to inpatient hospital services, including physician services provided during the inpatient
107.16hospital stay. A $1,000 deductible is required for each inpatient hospitalization.
107.17    (b) Effective August 1, 2005, sex reassignment surgery is not covered under this
107.18subdivision.
107.19    (c) In order to contain costs, the commissioner of human services shall select
107.20vendors of medical care who can provide the most economical care consistent with high
107.21medical standards and shall where possible contract with organizations on a prepaid
107.22capitation basis to provide these services. The commissioner shall consider proposals by
107.23counties and vendors for prepaid health plans, competitive bidding programs, block grants,
107.24or other vendor payment mechanisms designed to provide services in an economical
107.25manner or to control utilization, with safeguards to ensure that necessary services are
107.26provided. Before implementing prepaid programs in counties with a county operated or
107.27affiliated public teaching hospital or a hospital or clinic operated by the University of
107.28Minnesota, the commissioner shall consider the risks the prepaid program creates for the
107.29hospital and allow the county or hospital the opportunity to participate in the program in a
107.30manner that reflects the risk of adverse selection and the nature of the patients served by
107.31the hospital, provided the terms of participation in the program are competitive with the
107.32terms of other participants considering the nature of the population served. Payment for
107.33services provided pursuant to this subdivision shall be as provided to medical assistance
107.34vendors of these services under sections 256B.02, subdivision 8, and 256B.0625. For
107.35payments made during fiscal year 1990 and later years, the commissioner shall consult
108.1with an independent actuary in establishing prepayment rates, but shall retain final control
108.2over the rate methodology.
108.3    (d) Effective January 1, 2008, drug coverage under general assistance medical
108.4care is limited to prescription drugs that:
108.5    (i) are covered under the medical assistance program as described in section
108.6256B.0625, subdivisions 13 and 13d; and
108.7    (ii) are provided by manufacturers that have fully executed general assistance
108.8medical care rebate agreements with the commissioner and comply with the agreements.
108.9Prescription drug coverage under general assistance medical care must conform to
108.10coverage under the medical assistance program according to section 256B.0625,
108.11subdivisions 13 to 13g.
108.12     (e) Recipients eligible under subdivision 3, paragraph (a), shall pay the following
108.13co-payments for services provided on or after October 1, 2003, and before January 1, 2009:
108.14    (1) $25 for eyeglasses;
108.15    (2) $25 for nonemergency visits to a hospital-based emergency room;
108.16    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
108.17subject to a $12 per month maximum for prescription drug co-payments. No co-payments
108.18shall apply to antipsychotic drugs when used for the treatment of mental illness; and
108.19    (4) 50 percent coinsurance on restorative dental services.
108.20    (f) Recipients eligible under subdivision 3, paragraph (a), shall include the following
108.21co-payments for services provided on or after January 1, 2009:
108.22    (1) $25 for nonemergency visits to a hospital-based emergency room; and
108.23    (2) $3 per brand-name drug prescription and $1 per generic drug prescription,
108.24subject to a $7 per month maximum for prescription drug co-payments. No co-payments
108.25shall apply to antipsychotic drugs when used for the treatment of mental illness.
108.26    (g) MS 2007 Supp [Expired]
108.27    (h) Effective January 1, 2009, co-payments shall be limited to one per day per
108.28provider for nonemergency visits to a hospital-based emergency room. Recipients of
108.29general assistance medical care are responsible for all co-payments in this subdivision.
108.30The general assistance medical care reimbursement to the provider shall be reduced by the
108.31amount of the co-payment, except that reimbursement for prescription drugs shall not be
108.32reduced once a recipient has reached the $7 per month maximum for prescription drug
108.33co-payments. The provider collects the co-payment from the recipient. Providers may not
108.34deny services to recipients who are unable to pay the co-payment.
109.1    (i) General assistance medical care reimbursement to fee-for-service providers
109.2and payments to managed care plans shall not be increased as a result of the removal of
109.3the co-payments effective January 1, 2009.
109.4    (j) Any county may, from its own resources, provide medical payments for which
109.5state payments are not made.
109.6    (k) Chemical dependency services that are reimbursed under chapter 254B must not
109.7be reimbursed under general assistance medical care.
109.8    (l) The maximum payment for new vendors enrolled in the general assistance
109.9medical care program after the base year shall be determined from the average usual and
109.10customary charge of the same vendor type enrolled in the base year.
109.11    (m) The conditions of payment for services under this subdivision are the same
109.12as the conditions specified in rules adopted under chapter 256B governing the medical
109.13assistance program, unless otherwise provided by statute or rule.
109.14     (n) Inpatient and outpatient payments shall be reduced by five percent, effective July
109.151, 2003. This reduction is in addition to the five percent reduction effective July 1, 2003,
109.16and incorporated by reference in paragraph (l).
109.17    (o) Payments for all other health services except inpatient, outpatient, and pharmacy
109.18services shall be reduced by five percent, effective July 1, 2003.
109.19    (p) Payments to managed care plans shall be reduced by five percent for services
109.20provided on or after October 1, 2003.
109.21    (q) A hospital receiving a reduced payment as a result of this section may apply the
109.22unpaid balance toward satisfaction of the hospital's bad debts.
109.23    (r) Fee-for-service payments for nonpreventive visits shall be reduced by $3 for
109.24services provided on or after January 1, 2006. For purposes of this subdivision, a visit
109.25means an episode of service which is required because of a recipient's symptoms,
109.26diagnosis, or established illness, and which is delivered in an ambulatory setting by
109.27a physician or physician ancillary, chiropractor, podiatrist, advance practice nurse,
109.28audiologist, optician, or optometrist.
109.29    (s) Payments to managed care plans shall not be increased as a result of the removal
109.30of the $3 nonpreventive visit co-payment effective January 1, 2006.
109.31    (t) Payments for mental health services added as covered benefits after December
109.3231, 2007, are not subject to the reductions in paragraphs (l), (n), (o), and (p).
109.33(u) In addition to the reductions in paragraphs (k) and (l), effective service date
109.34July 1, 2009, total payments for basic care services, except prescription drugs, medical
109.35supplies, prosthetics, lab, radiology, medical transportation, and services subject to or
109.36specifically exempted from paragraph (v), shall be reduced by 3.0 percent, prior to
110.1third-party liability and spenddown calculation. Payments made to managed care and
110.2county-based purchasing plans shall be reduced for services provided on or after January
110.31, 2010, to reflect this reduction.
110.4(v) Effective for services rendered on or after July 1, 2009, payment rates for
110.5physician and professional services shall be reduced by three percent over the rates in
110.6effect on June 30, 2009, except for office or other outpatient services (procedure codes
110.799201 to 99215) and preventive medicine services (procedure codes 99381 to 99412)
110.8billed by the following primary care specialties: general practitioner, internal medicine,
110.9pediatrics, geriatric nurse practitioner, pediatric nurse practitioner, family practice nurse
110.10practitioner, adult nurse practitioner, geriatrics, and family practice. The commissioner,
110.11effective January 1, 2010, shall reduce capitation rates paid to managed care and
110.12county-based purchasing plans under paragraph (c) to reflect this payment reduction.

110.13    Sec. 40. Minnesota Statutes 2008, section 256J.575, subdivision 6, is amended to read:
110.14    Subd. 6. Cooperation with services requirements. (a) To be eligible, A participant
110.15who is eligible for family stabilization services under this section shall comply with
110.16paragraphs (b) to (d).
110.17    (b) Participants shall engage in family stabilization plan services for the appropriate
110.18number of hours per week that the activities are scheduled and available, unless good
110.19cause exists for not doing so, as defined in section 256J.57, subdivision 1. The appropriate
110.20number of hours must be based on the participant's plan.
110.21    (c) The case manager shall review the participant's progress toward the goals in the
110.22family stabilization plan every six months to determine whether conditions have changed,
110.23including whether revisions to the plan are needed.
110.24    (d) A participant's requirement to comply with any or all family stabilization plan
110.25requirements under this subdivision is excused when the case management services,
110.26training and educational services, or family support services identified in the participant's
110.27family stabilization plan are unavailable for reasons beyond the control of the participant,
110.28including when money appropriated is not sufficient to provide the services.

110.29    Sec. 41. Minnesota Statutes 2008, section 256J.575, subdivision 7, is amended to read:
110.30    Subd. 7. Sanctions. (a) The county agency or employment services provider must
110.31follow the requirements of this subdivision at the time the county agency or employment
110.32services provider has information that an MFIP recipient may meet the eligibility criteria
110.33in subdivision 3.
110.34(b) The financial assistance grant of a participating family is reduced according to
110.35section 256J.46, if a participating adult fails without good cause to comply or continue
111.1to comply with the family stabilization plan requirements in this subdivision, unless
111.2compliance has been excused under subdivision 6, paragraph (d).
111.3    (b) (c) Given the purpose of the family stabilization services in this section and the
111.4nature of the underlying family circumstances that act as barriers to both employment and
111.5full compliance with program requirements, there must be a review by the county agency
111.6prior to imposing a sanction to determine whether the plan was appropriated to the needs
111.7of the participant and family, and. There must be a current assessment by a behavioral
111.8health or medical professional confirming that the participant in all ways had the ability to
111.9comply with the plan, as confirmed by a behavioral health or medical professional.
111.10    (c) (d) Prior to the imposition of a sanction, the county agency or employment
111.11services provider shall review the participant's case to determine if the family stabilization
111.12plan is still appropriate and meet with the participant face-to-face. The participant may
111.13bring an advocate The county agency or employment services provider must inform the
111.14participant of the right to bring an advocate to the face-to-face meeting.
111.15    During the face-to-face meeting, the county agency shall:
111.16    (1) determine whether the continued noncompliance can be explained and mitigated
111.17by providing a needed family stabilization service, as defined in subdivision 2, paragraph
111.18(d);
111.19    (2) determine whether the participant qualifies for a good cause exception under
111.20section 256J.57, or if the sanction is for noncooperation with child support requirements,
111.21determine if the participant qualifies for a good cause exemption under section 256.741,
111.22subdivision 10;
111.23    (3) determine whether activities in the family stabilization plan are appropriate
111.24based on the family's circumstances;
111.25    (4) explain the consequences of continuing noncompliance;
111.26    (5) identify other resources that may be available to the participant to meet the
111.27needs of the family; and
111.28    (6) inform the participant of the right to appeal under section 256J.40.
111.29    If the lack of an identified activity or service can explain the noncompliance, the
111.30county shall work with the participant to provide the identified activity.
111.31    (d) If the participant fails to come to the face-to-face meeting, the case manager or a
111.32designee shall attempt at least one home visit. If a face-to-face meeting is not conducted,
111.33the county agency shall send the participant a written notice that includes the information
111.34under paragraph (c).
111.35    (e) After the requirements of paragraphs (c) and (d) are met and prior to imposition
111.36of a sanction, the county agency shall provide a notice of intent to sanction under section
112.1256J.57, subdivision 2 , and, when applicable, a notice of adverse action under section
112.2256J.31 .
112.3    (f) Section 256J.57 applies to this section except to the extent that it is modified
112.4by this subdivision.

112.5    Sec. 42. Minnesota Statutes 2008, section 256L.04, subdivision 10a, is amended to
112.6read:
112.7    Subd. 10a. Sponsor's income and resources deemed available; documentation.
112.8When determining eligibility for any federal or state benefits under sections 256L.01 to
112.9256L.18 , the income and resources of all noncitizens whose sponsor signed an affidavit of
112.10support as defined under United States Code, title 8, section 1183a, shall be deemed to
112.11include their sponsors' income and resources as defined in the Personal Responsibility
112.12and Work Opportunity Reconciliation Act of 1996, title IV, Public Law 104-193, sections
112.13421 and 422, and subsequently set out in federal rules. To be eligible for the program,
112.14noncitizens must provide documentation of their immigration status. Beginning July
112.151, 2010, or upon federal approval, whichever is later, sponsor deeming does not apply
112.16to pregnant women and children who are qualified noncitizens, as described in section
112.17256B.06, subdivision 4, paragraph (b).
112.18EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal
112.19approval, whichever is later. The commissioner shall notify the revisor of statutes when
112.20federal approval has been obtained.

112.21    Sec. 43. Minnesota Statutes 2008, section 256L.05, subdivision 1, is amended to read:
112.22    Subdivision 1. Application assistance and information availability. (a)
112.23Applications and application assistance must be made available at provider offices, local
112.24human services agencies, school districts, public and private elementary schools in which
112.2525 percent or more of the students receive free or reduced price lunches, community health
112.26offices, Women, Infants and Children (WIC) program sites, Head Start program sites,
112.27public housing councils, crisis nurseries, child care centers, early childhood education
112.28and preschool program sites, legal aid offices, and libraries. These sites may accept
112.29applications and forward the forms to the commissioner or local county human services
112.30agencies that choose to participate as an enrollment site. Otherwise, applicants may apply
112.31directly to the commissioner or to participating local county human services agencies.
112.32(b) Application assistance must be available for applicants choosing to file an
112.33online application.
113.1(c) The commissioner and local agencies shall assist enrollees in choosing a
113.2managed care organization by:
113.3(1) establishing a Web site to provide information about managed care organizations
113.4and to allow online enrollment;
113.5(2) making applications and information on managed care organizations available
113.6to applicants and enrollees according to Title VI of the Civil Rights Act and federal
113.7regulations adopted under that law, or any guidance from the United States Department of
113.8Health and Human Services; and
113.9(3) making benefit educators available to assist applicants in choosing a managed
113.10care organization.

113.11    Sec. 44. Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision
113.12to read:
113.13    Subd. 1c. Open enrollment and streamlined application and enrollment
113.14process. (a) The commissioner and local agencies working in partnership must develop
113.15a streamlined and efficient application and enrollment process that meets the criteria
113.16specified in this subdivision.
113.17(b) The commissioners of human services and education shall provide
113.18recommendations to the legislature by January 15, 2010, on the creation of an open
113.19enrollment process for MinnesotaCare that is tied to the public education system, including
113.20prekindergarten programs. The recommendations must:
113.21(1) be developed in consultation with MinnesotaCare enrollees and representatives
113.22from organizations that advocate on behalf of children and families, low-income persons
113.23and minority populations, counties, school administrators and nurses, health plans, and
113.24health care providers;
113.25(2) be based on enrollment and renewal procedures best practices, including express
113.26lane eligibility as required under subdivision 1d;
113.27(3) simplify the enrollment and renewal processes wherever possible; and
113.28(4) establish a process to:
113.29(i) disseminate information on MinnesotaCare to all children in the public education
113.30system, including prekindergarten programs; and
113.31(ii) enroll children and other household members who are eligible.
113.32The commissioners of human services and education shall implement an open
113.33enrollment process by August 1, 2010, to be effective beginning with the 2010-2011
113.34school year.
114.1(c) The commissioner and local agencies shall develop an online application process
114.2for MinnesotaCare.
114.3(d) The commissioner shall develop an application that is easily understandable
114.4and does not exceed four pages in length.
114.5(e) The commissioner of human services shall present to the legislature, by January
114.615, 2010, an implementation plan for the open enrollment period and online application
114.7process.
114.8EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal
114.9approval, which must be requested by the commissioner, whichever is later.

114.10    Sec. 45. Minnesota Statutes 2008, section 256L.05, is amended by adding a subdivision
114.11to read:
114.12    Subd. 1d. Express lane eligibility. (a) Children who complete an application
114.13for educational benefits and indicate an interest in enrolling in MinnesotaCare on the
114.14application form shall have the form considered an application for MinnesotaCare.
114.15(b) The commissioner of education shall modify the application for educational
114.16benefits to:
114.17(1) include a separate section for MinnesotaCare;
114.18(2) include a check box to allow all of the children included on the application for
114.19educational benefits to apply for MinnesotaCare; and
114.20(3) specify that if the MinnesotaCare application box is checked, the information on
114.21the application will be shared with the commissioner of human services.
114.22    (c) The commissioner shall accept an applicant's declaration of citizenship and
114.23provide the applicant a reasonable opportunity to provide acceptable documentation
114.24without delaying eligibility.
114.25(d) The commissioner of education shall forward electronically the information for
114.26families who apply for MinnesotaCare to the commissioner of human services within five
114.27business days of determining an applicant's eligibility for the free and reduced-price
114.28school lunch program.
114.29(e) The commissioner of human services shall accept the income determination
114.30made by the commissioner of education in administering the free and reduced-price school
114.31lunch program as proof of income for MinnesotaCare eligibility until renewal. Within 30
114.32days of receipt of information provided by the commissioner of education under paragraph
114.33(d), the commissioner of human services shall:
114.34(1) enroll all eligible children in the MinnesotaCare program;
115.1    (2) notify children who are required to pay a premium under section 256L.15
115.2that they may qualify for lower premiums if they complete the regular MinnesotaCare
115.3application process, and provide instructions on how to apply and how to obtain
115.4application assistance;
115.5    (3) notify children who are ineligible for MinnesotaCare based on the income
115.6determination made by the commissioner of education that they may reapply for
115.7MinnesotaCare, and provide instructions on how to apply and how to obtain application
115.8assistance; and
115.9(4) provide information about Minnesota health care programs for other household
115.10members.
115.11The date of application for the MinnesotaCare program is the date on the signed
115.12application for educational benefits.
115.13EFFECTIVE DATE.This section is effective July 1, 2010, or upon federal
115.14approval, which must be requested by the commissioner, whichever is later.

115.15    Sec. 46. Minnesota Statutes 2008, section 256L.11, subdivision 1, is amended to read:
115.16    Subdivision 1. Medical assistance rate to be used. (a) Payment to providers under
115.17sections 256L.01 to 256L.11 shall be at the same rates and conditions established for
115.18medical assistance, except as provided in subdivisions 2 to 6.
115.19(b) Effective service date July 1, 2009, total payments for basic care services, except
115.20prescription drugs, medical supplies, prosthetics, lab, radiology, medical transportation,
115.21and services subject to or specifically exempted from paragraph (c), shall be reduced by
115.223.0 percent, prior to third-party liability and spenddown calculation. Payments made to
115.23managed care and county-based purchasing plans shall be reduced for services provided
115.24on or after January 1, 2010, to reflect this reduction.
115.25(c) Effective for services rendered on or after July 1, 2009, payment rates for
115.26physician and professional services shall be reduced by three percent over the rates in
115.27effect on June 30, 2009, except for office or other outpatient services (procedure codes
115.2899201 to 99215) and preventive medicine services (procedure codes 99381 to 99412)
115.29billed by the following primary care specialties: general practitioner, internal medicine,
115.30pediatrics, geriatric nurse practitioner, pediatric nurse practitioner, family practice nurse
115.31practitioner, adult nurse practitioner, geriatrics, and family practice. The commissioner,
115.32effective January 1, 2010, shall reduce capitation rates paid to managed care and
115.33county-based purchasing plans under section 256L.12 to reflect this payment reduction.

115.34    Sec. 47. Minnesota Statutes 2008, section 256L.11, subdivision 7, is amended to read:
116.1    Subd. 7. Critical access dental providers. Effective for dental services provided
116.2to MinnesotaCare enrollees on or after January 1, 2007 2010, the commissioner shall
116.3increase payment rates to dentists and dental clinics deemed by the commissioner to be
116.4critical access providers under section 256B.76, subdivision 4 subdivisions 4 and 4a, by
116.550 30 percent above the payment rate that would otherwise be paid to the provider. The
116.6commissioner shall pay the prepaid health plans under contract with the commissioner
116.7amounts sufficient to reflect this rate increase. The prepaid health plan must pass this rate
116.8increase to providers who have been identified by the commissioner as critical access
116.9dental providers under section 256B.76, subdivision 4. The commissioner shall administer
116.10this subdivision within the limits of available appropriations.

116.11    Sec. 48. Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:
116.12    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective,
116.13per capita, where possible. The commissioner may allow health plans to arrange for
116.14inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
116.15an independent actuary to determine appropriate rates.
116.16    (b) For services rendered on or after January 1, 2003, to December 31, 2003, the
116.17commissioner shall withhold .5 percent of managed care plan payments under this section
116.18pending completion of performance targets. The withheld funds must be returned no
116.19sooner than July 1 and no later than July 31 of the following year if performance targets
116.20in the contract are achieved. A managed care plan may include as admitted assets under
116.21section 62D.044 any amount withheld under this paragraph that is reasonably expected
116.22to be returned.
116.23    (c) (b) For services rendered on or after January 1, 2004, the commissioner shall
116.24withhold five percent of managed care plan payments and county-based purchasing
116.25plan payments under this section pending completion of performance targets. Each
116.26performance target must be quantifiable, objective, measurable, and reasonably attainable,
116.27except in the case of a performance target based on a federal or state law or rule. Criteria
116.28for assessment of each performance target must be outlined in writing prior to the
116.29contract effective date. The managed care plan must demonstrate, to the commissioner's
116.30satisfaction, that the data submitted regarding attainment of the performance target is
116.31accurate. The commissioner shall periodically change the administrative measures used
116.32as performance targets in order to improve plan performance across a broader range of
116.33administrative services. The performance targets must include measurement of plan
116.34efforts to contain spending on health care services and administrative activities. The
116.35commissioner may adopt plan-specific performance targets that take into account factors
117.1affecting only one plan, such as characteristics of the plan's enrollee population. The
117.2withheld funds must be returned no sooner than July 1 and no later than July 31 of the
117.3following calendar year if performance targets in the contract are achieved. A managed
117.4care plan or a county-based purchasing plan under section 256B.692 may include as
117.5admitted assets under section 62D.044 any amount withheld under this paragraph that is
117.6reasonably expected to be returned.
117.7(c) Effective for services rendered on or after January 1, 2010, the commissioner
117.8shall include as part of the performance targets described in paragraph (b) a reduction in
117.9the plan's emergency room utilization rate for state health care program enrollees by a
117.10measurable rate of five percent from the plan's utilization rate for the previous calendar
117.11year.
117.12The withheld funds must be returned no sooner than July 1 and no later than July
117.1331 of the following calendar year if the managed care plan or county-based purchasing
117.14plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization
117.15rate was achieved.
117.16The withhold described in this paragraph shall continue for each consecutive
117.17contract period until the health plan's emergency room utilization rate for state health care
117.18program enrollees is reduced by 25 percent of the health plan's emergency room utilization
117.19rate for state health care program enrollees for calendar year 2008.
117.20(d) A managed care plan or a county-based purchasing plan under section 256B.692
117.21may include as admitted assets under section 62D.044 any amount withheld under this
117.22section that is reasonably expected to be returned.

117.23    Sec. 49. Minnesota Statutes 2008, section 256L.17, subdivision 3, is amended to read:
117.24    Subd. 3. Documentation. (a) The commissioner of human services shall require
117.25individuals and families, at the time of application or renewal, to indicate on a checkoff
117.26form developed by the commissioner whether they satisfy the MinnesotaCare asset
117.27requirement.
117.28    (b) The commissioner may require individuals and families to provide any
117.29information the commissioner determines necessary to verify compliance with the asset
117.30requirement, if the commissioner determines that there is reason to believe that an
117.31individual or family has assets that exceed the program limit.

117.32    Sec. 50. Minnesota Statutes 2008, section 501B.89, is amended by adding a
117.33subdivision to read:
117.34    Subd. 4. Annual filing requirement for supplemental needs trusts. (a) A trustee
117.35of a trust under subdivision 3 and United States Code, title 42, section 1396p(d)(4)(A) or
118.1(C), shall submit to the commissioner of human services, at the time of a beneficiary's
118.2request for medical assistance, the following information about the trust:
118.3(1) a copy of the trust instrument; and
118.4(2) an inventory of the beneficiary's trust account assets and the value of those assets.
118.5(b) A trustee of a trust under subdivision 3 and United States Code, title 42, section
118.61396p(d)(4)(A) or (C), shall submit an accounting of the beneficiary's trust account to the
118.7commissioner of human services at least annually until the trust, or the beneficiary's
118.8interest in the trust, terminates. Accountings are due on the anniversary of the execution
118.9date of the trust unless another annual date is established by the terms of the trust. The
118.10accounting must include the following information for the accounting period:
118.11(1) an inventory of trust assets and the value of those assets at the beginning of the
118.12accounting period;
118.13(2) additions to the trust during the accounting period and the source of those
118.14additions;
118.15(3) itemized distributions from the trust during the accounting period, including the
118.16purpose of the distributions and to whom the distributions were made;
118.17(4) an inventory of trust assets and the value of those assets at the end of the
118.18accounting period; and
118.19(5) changes to the trust instrument during the accounting period.
118.20(c) For the purpose of paragraph (b), an accounting period is 12 months unless an
118.21accounting period of a different length is permitted by the commissioner.
118.22EFFECTIVE DATE.This section is effective for applications for medical
118.23assistance and renewals of medical assistance submitted on or after July 1, 2009.

118.24    Sec. 51. Minnesota Statutes 2008, section 519.05, is amended to read:
118.25519.05 LIABILITY OF HUSBAND AND WIFE.
118.26(a) A spouse is not liable to a creditor for any debts of the other spouse. Where
118.27husband and wife are living together, they shall be jointly and severally liable for
118.28necessary medical services that have been furnished to either spouse, including any claims
118.29arising under section 246.53, 256B.15, 256D.16, or 261.04, and necessary household
118.30articles and supplies furnished to and used by the family. Notwithstanding this paragraph,
118.31in a proceeding under chapter 518 the court may apportion such debt between the spouses.
118.32(b) Either spouse may close a credit card account or other unsecured consumer line
118.33of credit on which both spouses are contractually liable, by giving written notice to the
118.34creditor.

119.1    Sec. 52. Laws 2003, First Special Session chapter 14, article 13C, section 2, subdivision
119.21, as amended by Laws 2004, chapter 272, article 2, section 2, is amended to read:
119.3
Subdivision 1.Total Appropriation
$
3,848,049,000
$
4,135,780,000
119.4
Summary by Fund
119.5
General
3,301,811,000
3,561,055,000
119.6
119.7
State Government
Special Revenue
534,000
534,000
119.8
Health Care Access
273,723,000
302,272,000
119.9
Federal TANF
270,425,000
270,363,000
119.10
Lottery Cash Flow
1,556,000
1,556,000
119.11Federal Contingency Appropriation. (a)
119.12Federal Medicaid funds made available
119.13under title IV of the federal Jobs and Growth
119.14Tax Relief Reconciliation Act of 2003
119.15are appropriated to the commissioner of
119.16human services for use in the state's medical
119.17assistance and MinnesotaCare programs.
119.18The commissioners of human services and
119.19finance shall report to the legislative advisory
119.20committee on the additional federal Medicaid
119.21matching funds that will be available to the
119.22state.
119.23(b) Because of the availability of these funds,
119.24the following policies shall become effective:
119.25(1) medical assistance and MinnesotaCare
119.26eligibility and local financial participation
119.27changes provided for in this act may be
119.28implemented prior to September 2, 2003, or
119.29may be delayed as necessary to maximize
119.30the use of federal funds received under
119.31title IV of the Jobs and Growth Tax Relief
119.32Reconciliation Act of 2003;
119.33(2) the aggregate cap on the services
119.34identified in Minnesota Statutes, section
119.35256L.035 , paragraph (a), clause (3), shall
119.36be increased from $2,000 to $5,000. This
120.1increase shall expire at the end of fiscal year
120.22007. Funds may be transferred from the
120.3general fund to the health care access fund as
120.4necessary to implement this provision; and
120.5(3) the following payment shifts shall not be
120.6implemented:
120.7(i) MFIP payment shift found in subdivision
120.811;
120.9(ii) the county payment shift found in
120.10subdivision 1; and
120.11(iii) the delay in medical assistance
120.12and general assistance medical care
120.13fee-for-service payments found in
120.14subdivision 6.
120.15(c) Notwithstanding section 14, paragraphs
120.16(a) and (b) shall expire June 30, 2007.
120.17Receipts for Systems Projects.
120.18Appropriations and federal receipts for
120.19information system projects for MAXIS,
120.20PRISM, MMIS, and SSIS must be deposited
120.21in the state system account authorized in
120.22Minnesota Statutes, section 256.014. Money
120.23appropriated for computer projects approved
120.24by the Minnesota office of technology,
120.25funded by the legislature, and approved
120.26by the commissioner of finance may be
120.27transferred from one project to another
120.28and from development to operations as the
120.29commissioner of human services considers
120.30necessary. Any unexpended balance in
120.31the appropriation for these projects does
120.32not cancel but is available for ongoing
120.33development and operations.
121.1Gifts. Notwithstanding Minnesota Statutes,
121.2chapter 7, the commissioner may accept
121.3on behalf of the state additional funding
121.4from sources other than state funds for the
121.5purpose of financing the cost of assistance
121.6program grants or nongrant administration.
121.7All additional funding is appropriated to the
121.8commissioner for use as designated by the
121.9grantor of funding.
121.10Systems Continuity. In the event of
121.11disruption of technical systems or computer
121.12operations, the commissioner may use
121.13available grant appropriations to ensure
121.14continuity of payments for maintaining the
121.15health, safety, and well-being of clients
121.16served by programs administered by the
121.17department of human services. Grant funds
121.18must be used in a manner consistent with the
121.19original intent of the appropriation.
121.20Nonfederal Share Transfers. The
121.21nonfederal share of activities for which
121.22federal administrative reimbursement is
121.23appropriated to the commissioner may be
121.24transferred to the special revenue fund.
121.25TANF Funds Appropriated to Other
121.26Entities. Any expenditures from the TANF
121.27block grant shall be expended in accordance
121.28with the requirements and limitations of part
121.29A of title IV of the Social Security Act, as
121.30amended, and any other applicable federal
121.31requirement or limitation. Prior to any
121.32expenditure of these funds, the commissioner
121.33shall assure that funds are expended in
121.34compliance with the requirements and
121.35limitations of federal law and that any
122.1reporting requirements of federal law are
122.2met. It shall be the responsibility of any entity
122.3to which these funds are appropriated to
122.4implement a memorandum of understanding
122.5with the commissioner that provides the
122.6necessary assurance of compliance prior to
122.7any expenditure of funds. The commissioner
122.8shall receipt TANF funds appropriated
122.9to other state agencies and coordinate all
122.10related interagency accounting transactions
122.11necessary to implement these appropriations.
122.12Unexpended TANF funds appropriated to
122.13any state, local, or nonprofit entity cancel
122.14at the end of the state fiscal year unless
122.15appropriating language permits otherwise.
122.16TANF Funds Transferred to Other Federal
122.17Grants. The commissioner must authorize
122.18transfers from TANF to other federal block
122.19grants so that funds are available to meet the
122.20annual expenditure needs as appropriated.
122.21Transfers may be authorized prior to the
122.22expenditure year with the agreement of the
122.23receiving entity. Transferred funds must be
122.24expended in the year for which the funds
122.25were appropriated unless appropriation
122.26language permits otherwise. In accelerating
122.27transfer authorizations, the commissioner
122.28must aim to preserve the future potential
122.29transfer capacity from TANF to other block
122.30grants.
122.31TANF Maintenance of Effort. (a) In
122.32order to meet the basic maintenance of
122.33effort (MOE) requirements of the TANF
122.34block grant specified under Code of Federal
122.35Regulations, title 45, section 263.1, the
122.36commissioner may only report nonfederal
123.1money expended for allowable activities
123.2listed in the following clauses as TANF/MOE
123.3expenditures:
123.4(1) MFIP cash, diversionary work program,
123.5and food assistance benefits under Minnesota
123.6Statutes, chapter 256J;
123.7(2) the child care assistance programs
123.8under Minnesota Statutes, sections 119B.03
123.9and 119B.05, and county child care
123.10administrative costs under Minnesota
123.11Statutes, section 119B.15;
123.12(3) state and county MFIP administrative
123.13costs under Minnesota Statutes, chapters
123.14256J and 256K;
123.15(4) state, county, and tribal MFIP
123.16employment services under Minnesota
123.17Statutes, chapters 256J and 256K;
123.18(5) expenditures made on behalf of
123.19noncitizen MFIP recipients who qualify
123.20for the medical assistance without federal
123.21financial participation program under
123.22Minnesota Statutes, section 256B.06,
123.23subdivision 4
, paragraphs (d), (e), and (j);
123.24and
123.25(6) qualifying working family credit
123.26expenditures under Minnesota Statutes,
123.27section 290.0671.
123.28(b) The commissioner shall ensure that
123.29sufficient qualified nonfederal expenditures
123.30are made each year to meet the state's
123.31TANF/MOE requirements. For the activities
123.32listed in paragraph (a), clauses (2) to
123.33(6), the commissioner may only report
123.34expenditures that are excluded from the
124.1definition of assistance under Code of
124.2Federal Regulations, title 45, section 260.31.
124.3(c) By August 31 of each year, the
124.4commissioner shall make a preliminary
124.5calculation to determine the likelihood
124.6that the state will meet its annual federal
124.7work participation requirement under Code
124.8of Federal Regulations, title 45, sections
124.9261.21 and 261.23, after adjustment for any
124.10caseload reduction credit under Code of
124.11Federal Regulations, title 45, section 261.41.
124.12If the commissioner determines that the
124.13state will meet its federal work participation
124.14rate for the federal fiscal year ending that
124.15September, the commissioner may reduce the
124.16expenditure under paragraph (a), clause (1),
124.17to the extent allowed under Code of Federal
124.18Regulations, title 45, section 263.1(a)(2).
124.19(d) For fiscal years beginning with state
124.20fiscal year 2003, the commissioner shall
124.21assure that the maintenance of effort used
124.22by the commissioner of finance for the
124.23February and November forecasts required
124.24under Minnesota Statutes, section 16A.103,
124.25contains expenditures under paragraph (a),
124.26clause (1), equal to at least 25 percent of
124.27the total required under Code of Federal
124.28Regulations, title 45, section 263.1.
124.29(e) If nonfederal expenditures for the
124.30programs and purposes listed in paragraph
124.31(a) are insufficient to meet the state's
124.32TANF/MOE requirements, the commissioner
124.33shall recommend additional allowable
124.34sources of nonfederal expenditures to the
124.35legislature, if the legislature is or will be in
125.1session to take action to specify additional
125.2sources of nonfederal expenditures for
125.3TANF/MOE before a federal penalty is
125.4imposed. The commissioner shall otherwise
125.5provide notice to the legislative commission
125.6on planning and fiscal policy under paragraph
125.7(g).
125.8(f) If the commissioner uses authority
125.9granted under section 11, or similar authority
125.10granted by a subsequent legislature, to
125.11meet the state's TANF/MOE requirement
125.12in a reporting period, the commissioner
125.13shall inform the chairs of the appropriate
125.14legislative committees about all transfers
125.15made under that authority for this purpose.
125.16(g) If the commissioner determines that
125.17nonfederal expenditures under paragraph
125.18(a) are insufficient to meet TANF/MOE
125.19expenditure requirements, and if the
125.20legislature is not or will not be in
125.21session to take timely action to avoid a
125.22federal penalty, the commissioner may
125.23report nonfederal expenditures from
125.24other allowable sources as TANF/MOE
125.25expenditures after the requirements of this
125.26paragraph are met. The commissioner
125.27may report nonfederal expenditures
125.28in addition to those specified under
125.29paragraph (a) as nonfederal TANF/MOE
125.30expenditures, but only ten days after the
125.31commissioner of finance has first submitted
125.32the commissioner's recommendations for
125.33additional allowable sources of nonfederal
125.34TANF/MOE expenditures to the members of
125.35the legislative commission on planning and
125.36fiscal policy for their review.
126.1(h) The commissioner of finance shall not
126.2incorporate any changes in federal TANF
126.3expenditures or nonfederal expenditures for
126.4TANF/MOE that may result from reporting
126.5additional allowable sources of nonfederal
126.6TANF/MOE expenditures under the interim
126.7procedures in paragraph (g) into the February
126.8or November forecasts required under
126.9Minnesota Statutes, section 16A.103, unless
126.10the commissioner of finance has approved
126.11the additional sources of expenditures under
126.12paragraph (g).
126.13(i) Minnesota Statutes, section 256.011,
126.14subdivision 3
, which requires that federal
126.15grants or aids secured or obtained under that
126.16subdivision be used to reduce any direct
126.17appropriations provided by law, do not apply
126.18if the grants or aids are federal TANF funds.
126.19(j) Notwithstanding section 14, paragraph
126.20(a), clauses (1) to (6), and paragraphs (b) to
126.21(j) expire June 30, 2007.
126.22Working Family Credit Expenditures as
126.23TANF MOE. The commissioner may claim
126.24as TANF maintenance of effort up to the
126.25following amounts of working family credit
126.26expenditures for the following fiscal years:
126.27(1) fiscal year 2004, $7,013,000;
126.28(2) fiscal year 2005, $25,133,000;
126.29(3) fiscal year 2006, $6,942,000; and
126.30(4) fiscal year 2007, $6,707,000.
126.31Fiscal Year 2003 Appropriations
126.32Carryforward. Effective the day following
126.33final enactment, notwithstanding Minnesota
126.34Statutes, section 16A.28, or any other law to
127.1the contrary, state agencies and constitutional
127.2offices may carry forward unexpended
127.3and unencumbered nongrant operating
127.4balances from fiscal year 2003 general fund
127.5appropriations into fiscal year 2004 to offset
127.6general budget reductions.
127.7Transfer of Grant Balances. Effective
127.8the day following final enactment, the
127.9commissioner of human services, with
127.10the approval of the commissioner of
127.11finance and after notification of the chair
127.12of the senate health, human services and
127.13corrections budget division and the chair
127.14of the house of representatives health
127.15and human services finance committee,
127.16may transfer unencumbered appropriation
127.17balances for the biennium ending June 30,
127.182003, in fiscal year 2003 among the MFIP,
127.19MFIP child care assistance under Minnesota
127.20Statutes, section 119B.05, general assistance,
127.21general assistance medical care, medical
127.22assistance, Minnesota supplemental aid,
127.23and group residential housing programs,
127.24and the entitlement portion of the chemical
127.25dependency consolidated treatment fund, and
127.26between fiscal years of the biennium.
127.27TANF Appropriation Cancellation.
127.28Notwithstanding the provisions of Laws
127.292000, chapter 488, article 1, section 16,
127.30any prior appropriations of TANF funds
127.31to the department of trade and economic
127.32development or to the job skills partnership
127.33board or any transfers of TANF funds from
127.34another agency to the department of trade
127.35and economic development or to the job
127.36skills partnership board are not available
128.1until expended, and if unobligated as of June
128.230, 2003, these appropriations or transfers
128.3shall cancel to the TANF fund.
128.4Shift County Payment. The commissioner
128.5shall make up to 100 percent of the
128.6calendar year 2005 payments to counties for
128.7developmental disabilities semi-independent
128.8living services grants, developmental
128.9disabilities family support grants, and
128.10adult mental health grants from fiscal year
128.112006 appropriations. This is a onetime
128.12payment shift. Calendar year 2006 and future
128.13payments for these grants are not affected by
128.14this shift. This provision expires June 30,
128.152006.
128.16Capitation Rate Increase. Of the health care
128.17access fund appropriations to the University
128.18of Minnesota in the higher education
128.19omnibus appropriation bill, $2,157,000 in
128.20fiscal year 2004 and $2,157,000 in fiscal year
128.212005 are to be used to increase the capitation
128.22payments under for fiscal years beginning
128.23July 1, 2003, and thereafter, $2,157,000 each
128.24year shall be transferred to the commissioner
128.25for purposes of Minnesota Statutes, section
128.26256B.69 . Notwithstanding the provisions of
128.27section 14, this provision shall not expire.

128.28    Sec. 53. INCOME METHODOLOGY.
128.29The commissioner of human services shall study approaches toward adopting a
128.30uniform income methodology for families and children under medical assistance and
128.31MinnesotaCare. The approaches to be examined by the commissioner must include, but
128.32are not limited to: (1) replacing the MinnesotaCare gross income standard with a net
128.33income standard based on the medical assistance families with children methodology; and
128.34(2) replacing the medical assistance net income standard for families with children with
128.35the MinnesotaCare gross income standard. The commissioner must evaluate the impact of
129.1each approach on the number of potential MinnesotaCare and medical assistance enrolles
129.2who are families and children and on administrative, health care, and other costs to the
129.3state. The commissioner shall present findings and recommendations to the legislative
129.4committees with jurisdiction over health care by January 15, 2010.

129.5    Sec. 54. ADMINISTRATION OF MINNESOTACARE.
129.6The commissioner of human services, in cooperation with representatives of
129.7county human services agencies, shall develop a plan to administer the MinnesotaCare
129.8program. The plan must require county agencies to administer MinnesotaCare in their
129.9respective counties under the supervision of the state agency and the commissioner
129.10of human services. The plan, to the extent feasible, must incorporate procedures and
129.11requirements that are identical to or consistent with those procedures and requirements
129.12that apply to county administration of the medical assistance program. The commissioner
129.13shall present recommendations to the legislative committees with jurisdiction over health
129.14care by January 15, 2010.

129.15    Sec. 55. EXPENDITURE LIMIT.
129.16For calendar years beginning on or after January 1, 2010, the commissioner of
129.17human services shall limit annual expenditures for the critical access dental provider
129.18program under Minnesota Statutes, sections 256B.76, subdivisions 4 and 4a, and 256L.11,
129.19subdivision 7, to 75 percent of the expenditure level for the calendar year ending
129.20December 31, 2008.

129.21    Sec. 56. FEDERAL APPROVAL.
129.22The commissioner of human services shall resubmit for federal approval the
129.23elimination of depreciation for self-employed farmers in determining income eligibility
129.24for MinnesotaCare passed in Laws 2007, chapter 147, article 5, section 33.

129.25    Sec. 57. APPROPRIATION; MEDICAL EDUCATION RESEARCH COSTS
129.26(MERC).
129.27In fiscal year 2010, $38,000,000 is appropriated from the general fund to the
129.28commissioner of human services to restore the fiscal year 2009 unallotment of the transfers
129.29under Minnesota Statutes, section 256B.69, subdivision 5c, paragraph (a), for the July 1,
129.302008, through June 30, 2009, period. The commissioner of human services shall transfer
129.31$38,000,000 in fiscal year 2010 to the medical education research fund.

129.32    Sec. 58. REPEALER.
129.33Minnesota Statutes 2008, section 256.962, subdivision 7, is repealed.

130.1ARTICLE 7
130.2TECHNICAL

130.3    Section 1. Minnesota Statutes 2008, section 125A.744, subdivision 3, is amended to
130.4read:
130.5    Subd. 3. Implementation. Consistent with section 256B.0625, subdivision 26,
130.6school districts may enroll as medical assistance providers or subcontractors and bill
130.7the Department of Human Services under the medical assistance fee for service claims
130.8processing system for special education services which are covered services under chapter
130.9256B, which are provided in the school setting for a medical assistance recipient, and for
130.10whom the district has secured informed consent consistent with section 13.05, subdivision
130.114
, paragraph (d), and section 256B.77, subdivision 2, paragraph (p), to bill for each type
130.12of covered service. School districts shall be reimbursed by the commissioner of human
130.13services for the federal share of individual education plan health-related services that
130.14qualify for reimbursement by medical assistance, minus up to five percent retained by the
130.15commissioner of human services for administrative costs, not to exceed $350,000 per
130.16fiscal year. The commissioner may withhold up to five percent of each payment to a
130.17school district. Following the end of each fiscal year, the commissioner shall settle up with
130.18each school district in order to ensure that collections from each district for departmental
130.19administrative costs are made on a pro rata basis according to federal earnings for these
130.20services in each district. A school district is not eligible to enroll as a home care provider
130.21or a personal care provider organization for purposes of billing home care services under
130.22sections 256B.0651 and 256B.0653 to 256B.0656 and 256B.0659 until the commissioner
130.23of human services issues a bulletin instructing county public health nurses on how to
130.24assess for the needs of eligible recipients during school hours. To use private duty nursing
130.25services or personal care services at school, the recipient or responsible party must provide
130.26written authorization in the care plan identifying the chosen provider and the daily amount
130.27of services to be used at school.

130.28    Sec. 2. Minnesota Statutes 2008, section 144A.46, subdivision 1, is amended to read:
130.29    Subdivision 1. License required. (a) A home care provider may not operate in the
130.30state without a current license issued by the commissioner of health. A home care provider
130.31may hold a separate license for each class of home care licensure.
130.32    (b) Within ten days after receiving an application for a license, the commissioner
130.33shall acknowledge receipt of the application in writing. The acknowledgment must
130.34indicate whether the application appears to be complete or whether additional information
130.35is required before the application will be considered complete. Within 90 days after
131.1receiving a complete application, the commissioner shall either grant or deny the license.
131.2If an applicant is not granted or denied a license within 90 days after submitting a
131.3complete application, the license must be deemed granted. An applicant whose license has
131.4been deemed granted must provide written notice to the commissioner before providing a
131.5home care service.
131.6    (c) Each application for a home care provider license, or for a renewal of a license,
131.7shall be accompanied by a fee to be set by the commissioner under section 144.122.
131.8    (d) The commissioner of health, in consultation with the commissioner of human
131.9services, shall provide recommendations to the legislature by February 15, 2009, for
131.10provider standards for personal care assistant services as described in section 256B.0655
131.11256B.0659.

131.12    Sec. 3. Minnesota Statutes 2008, section 176.011, subdivision 9, is amended to read:
131.13    Subd. 9. Employee. "Employee" means any person who performs services for
131.14another for hire including the following:
131.15(1) an alien;
131.16(2) a minor;
131.17(3) a sheriff, deputy sheriff, police officer, firefighter, county highway engineer, and
131.18peace officer while engaged in the enforcement of peace or in the pursuit or capture of a
131.19person charged with or suspected of crime;
131.20(4) a person requested or commanded to aid an officer in arresting or retaking a
131.21person who has escaped from lawful custody, or in executing legal process, in which
131.22cases, for purposes of calculating compensation under this chapter, the daily wage of the
131.23person shall be the prevailing wage for similar services performed by paid employees;
131.24(5) a county assessor;
131.25(6) an elected or appointed official of the state, or of a county, city, town, school
131.26district, or governmental subdivision in the state. An officer of a political subdivision
131.27elected or appointed for a regular term of office, or to complete the unexpired portion of a
131.28regular term, shall be included only after the governing body of the political subdivision
131.29has adopted an ordinance or resolution to that effect;
131.30(7) an executive officer of a corporation, except those executive officers excluded
131.31by section 176.041;
131.32(8) a voluntary uncompensated worker, other than an inmate, rendering services in
131.33state institutions under the commissioners of human services and corrections similar to
131.34those of officers and employees of the institutions, and whose services have been accepted
131.35or contracted for by the commissioner of human services or corrections as authorized by
132.1law. In the event of injury or death of the worker, the daily wage of the worker, for the
132.2purpose of calculating compensation under this chapter, shall be the usual wage paid at
132.3the time of the injury or death for similar services in institutions where the services are
132.4performed by paid employees;
132.5(9) a voluntary uncompensated worker engaged in emergency management as
132.6defined in section 12.03, subdivision 4, who is:
132.7(i) registered with the state or any political subdivision of it, according to the
132.8procedures set forth in the state or political subdivision emergency operations plan; and
132.9(ii) acting under the direction and control of, and within the scope of duties approved
132.10by, the state or political subdivision.
132.11The daily wage of the worker, for the purpose of calculating compensation under this
132.12chapter, shall be the usual wage paid at the time of the injury or death for similar services
132.13performed by paid employees;
132.14(10) a voluntary uncompensated worker participating in a program established by a
132.15local social services agency. For purposes of this clause, "local social services agency"
132.16means any agency established under section 393.01. In the event of injury or death of the
132.17worker, the wage of the worker, for the purpose of calculating compensation under this
132.18chapter, shall be the usual wage paid in the county at the time of the injury or death for
132.19similar services performed by paid employees working a normal day and week;
132.20(11) a voluntary uncompensated worker accepted by the commissioner of natural
132.21resources who is rendering services as a volunteer pursuant to section 84.089. The daily
132.22wage of the worker for the purpose of calculating compensation under this chapter, shall
132.23be the usual wage paid at the time of injury or death for similar services performed by
132.24paid employees;
132.25(12) a voluntary uncompensated worker in the building and construction industry
132.26who renders services for joint labor-management nonprofit community service projects.
132.27The daily wage of the worker for the purpose of calculating compensation under this
132.28chapter shall be the usual wage paid at the time of injury or death for similar services
132.29performed by paid employees;
132.30(13) a member of the military forces, as defined in section 190.05, while in state
132.31active service, as defined in section 190.05, subdivision 5a. The daily wage of the member
132.32for the purpose of calculating compensation under this chapter shall be based on the
132.33member's usual earnings in civil life. If there is no evidence of previous occupation or
132.34earning, the trier of fact shall consider the member's earnings as a member of the military
132.35forces;
133.1(14) a voluntary uncompensated worker, accepted by the director of the Minnesota
133.2Historical Society, rendering services as a volunteer, pursuant to chapter 138. The daily
133.3wage of the worker, for the purposes of calculating compensation under this chapter,
133.4shall be the usual wage paid at the time of injury or death for similar services performed
133.5by paid employees;
133.6(15) a voluntary uncompensated worker, other than a student, who renders services
133.7at the Minnesota State Academy for the Deaf or the Minnesota State Academy for the
133.8Blind, and whose services have been accepted or contracted for by the commissioner of
133.9education, as authorized by law. In the event of injury or death of the worker, the daily
133.10wage of the worker, for the purpose of calculating compensation under this chapter, shall
133.11be the usual wage paid at the time of the injury or death for similar services performed in
133.12institutions by paid employees;
133.13(16) a voluntary uncompensated worker, other than a resident of the veterans home,
133.14who renders services at a Minnesota veterans home, and whose services have been
133.15accepted or contracted for by the commissioner of veterans affairs, as authorized by law.
133.16In the event of injury or death of the worker, the daily wage of the worker, for the purpose
133.17of calculating compensation under this chapter, shall be the usual wage paid at the time of
133.18the injury or death for similar services performed in institutions by paid employees;
133.19(17) a worker performing services under section 256B.0655 256B.0659 for a
133.20recipient in the home of the recipient or in the community under section 256B.0625,
133.21subdivision 19a
, who is paid from government funds through a fiscal intermediary under
133.22section 256B.0655, subdivision 7 256B.0659, subdivision 33. For purposes of maintaining
133.23workers' compensation insurance, the employer of the worker is as designated in law
133.24by the commissioner of the Department of Human Services, notwithstanding any other
133.25law to the contrary;
133.26(18) students enrolled in and regularly attending the Medical School of the
133.27University of Minnesota in the graduate school program or the postgraduate program. The
133.28students shall not be considered employees for any other purpose. In the event of the
133.29student's injury or death, the weekly wage of the student for the purpose of calculating
133.30compensation under this chapter, shall be the annualized educational stipend awarded to
133.31the student, divided by 52 weeks. The institution in which the student is enrolled shall
133.32be considered the "employer" for the limited purpose of determining responsibility for
133.33paying benefits under this chapter;
133.34(19) a faculty member of the University of Minnesota employed for an academic
133.35year is also an employee for the period between that academic year and the succeeding
133.36academic year if:
134.1(a) the member has a contract or reasonable assurance of a contract from the
134.2University of Minnesota for the succeeding academic year; and
134.3(b) the personal injury for which compensation is sought arises out of and in the
134.4course of activities related to the faculty member's employment by the University of
134.5Minnesota;
134.6(20) a worker who performs volunteer ambulance driver or attendant services is an
134.7employee of the political subdivision, nonprofit hospital, nonprofit corporation, or other
134.8entity for which the worker performs the services. The daily wage of the worker for the
134.9purpose of calculating compensation under this chapter shall be the usual wage paid at the
134.10time of injury or death for similar services performed by paid employees;
134.11(21) a voluntary uncompensated worker, accepted by the commissioner of
134.12administration, rendering services as a volunteer at the Department of Administration. In
134.13the event of injury or death of the worker, the daily wage of the worker, for the purpose of
134.14calculating compensation under this chapter, shall be the usual wage paid at the time of the
134.15injury or death for similar services performed in institutions by paid employees;
134.16(22) a voluntary uncompensated worker rendering service directly to the Pollution
134.17Control Agency. The daily wage of the worker for the purpose of calculating compensation
134.18payable under this chapter is the usual going wage paid at the time of injury or death for
134.19similar services if the services are performed by paid employees;
134.20(23) a voluntary uncompensated worker while volunteering services as a first
134.21responder or as a member of a law enforcement assistance organization while acting
134.22under the supervision and authority of a political subdivision. The daily wage of the
134.23worker for the purpose of calculating compensation payable under this chapter is the
134.24usual going wage paid at the time of injury or death for similar services if the services
134.25are performed by paid employees;
134.26(24) a voluntary uncompensated member of the civil air patrol rendering service on
134.27the request and under the authority of the state or any of its political subdivisions. The
134.28daily wage of the member for the purposes of calculating compensation payable under this
134.29chapter is the usual going wage paid at the time of injury or death for similar services if
134.30the services are performed by paid employees; and
134.31(25) a Minnesota Responds Medical Reserve Corps volunteer, as provided in
134.32sections 145A.04 and 145A.06, responding at the request of or engaged in training
134.33conducted by the commissioner of health. The daily wage of the volunteer for the purposes
134.34of calculating compensation payable under this chapter is established in section 145A.06.
134.35A person who qualifies under this clause and who may also qualify under another clause
134.36of this subdivision shall receive benefits in accordance with this clause.
135.1If it is difficult to determine the daily wage as provided in this subdivision, the trier
135.2of fact may determine the wage upon which the compensation is payable.

135.3    Sec. 4. Minnesota Statutes 2008, section 245C.03, subdivision 2, is amended to read:
135.4    Subd. 2. Personal care provider organizations. The commissioner shall conduct
135.5background studies on any individual required under sections 256B.0651 and 256B.0653
135.6to 256B.0656 and 256B.0659 to have a background study completed under this chapter.

135.7    Sec. 5. Minnesota Statutes 2008, section 245C.04, subdivision 3, is amended to read:
135.8    Subd. 3. Personal care provider organizations. (a) The commissioner shall
135.9conduct a background study of an individual required to be studied under section 245C.03,
135.10subdivision 2
, at least upon application for initial enrollment under sections 256B.0651
135.11and 256B.0653 to 256B.0656 and 256B.0659.
135.12(b) Organizations required to initiate background studies under sections 256B.0651
135.13and 256B.0653 to 256B.0656 and 256B.0659 for individuals described in section 245C.03,
135.14subdivision 2
, must submit a completed background study form to the commissioner
135.15before those individuals begin a position allowing direct contact with persons served
135.16by the organization.

135.17    Sec. 6. Minnesota Statutes 2008, section 245C.10, subdivision 3, is amended to read:
135.18    Subd. 3. Personal care provider organizations. The commissioner shall recover
135.19the cost of background studies initiated by a personal care provider organization under
135.20sections 256B.0651 and 256B.0653 to 256B.0656 and 256B.0659 through a fee of no
135.21more than $20 per study charged to the organization responsible for submitting the
135.22background study form. The fees collected under this subdivision are appropriated to the
135.23commissioner for the purpose of conducting background studies.

135.24    Sec. 7. Minnesota Statutes 2008, section 256B.04, subdivision 16, is amended to read:
135.25    Subd. 16. Personal care services. (a) Notwithstanding any contrary language in
135.26this paragraph, the commissioner of human services and the commissioner of health shall
135.27jointly promulgate rules to be applied to the licensure of personal care services provided
135.28under the medical assistance program. The rules shall consider standards for personal care
135.29services that are based on the World Institute on Disability's recommendations regarding
135.30personal care services. These rules shall at a minimum consider the standards and
135.31requirements adopted by the commissioner of health under section 144A.45, which the
135.32commissioner of human services determines are applicable to the provision of personal
136.1care services, in addition to other standards or modifications which the commissioner of
136.2human services determines are appropriate.
136.3The commissioner of human services shall establish an advisory group including
136.4personal care consumers and providers to provide advice regarding which standards or
136.5modifications should be adopted. The advisory group membership must include not less
136.6than 15 members, of which at least 60 percent must be consumers of personal care services
136.7and representatives of recipients with various disabilities and diagnoses and ages. At least
136.851 percent of the members of the advisory group must be recipients of personal care.
136.9The commissioner of human services may contract with the commissioner of health
136.10to enforce the jointly promulgated licensure rules for personal care service providers.
136.11Prior to final promulgation of the joint rule the commissioner of human services
136.12shall report preliminary findings along with any comments of the advisory group and a
136.13plan for monitoring and enforcement by the Department of Health to the legislature by
136.14February 15, 1992.
136.15Limits on the extent of personal care services that may be provided to an individual
136.16must be based on the cost-effectiveness of the services in relation to the costs of inpatient
136.17hospital care, nursing home care, and other available types of care. The rules must
136.18provide, at a minimum:
136.19(1) that agencies be selected to contract with or employ and train staff to provide and
136.20supervise the provision of personal care services;
136.21(2) that agencies employ or contract with a qualified applicant that a qualified
136.22recipient proposes to the agency as the recipient's choice of assistant;
136.23(3) that agencies bill the medical assistance program for a personal care service
136.24by a personal care assistant and supervision by a qualified professional supervising the
136.25personal care assistant unless the recipient selects the fiscal agent option under section
136.26256B.0655, subdivision 7 256B.0659, subdivision 33;
136.27(4) that agencies establish a grievance mechanism; and
136.28(5) that agencies have a quality assurance program.
136.29(b) The commissioner may waive the requirement for the provision of personal care
136.30services through an agency in a particular county, when there are less than two agencies
136.31providing services in that county and shall waive the requirement for personal care
136.32assistants required to join an agency for the first time during 1993 when personal care
136.33services are provided under a relative hardship waiver under Minnesota Statutes 1992,
136.34section 256B.0627, subdivision 4, paragraph (b), clause (7), and at least two agencies
136.35providing personal care services have refused to employ or contract with the independent
136.36personal care assistant.

137.1    Sec. 8. Minnesota Statutes 2008, section 256B.055, subdivision 12, is amended to read:
137.2    Subd. 12. Disabled children. (a) A person is eligible for medical assistance if the
137.3person is under age 19 and qualifies as a disabled individual under United States Code,
137.4title 42, section 1382c(a), and would be eligible for medical assistance under the state
137.5plan if residing in a medical institution, and the child requires a level of care provided in
137.6a hospital, nursing facility, or intermediate care facility for persons with developmental
137.7disabilities, for whom home care is appropriate, provided that the cost to medical
137.8assistance under this section is not more than the amount that medical assistance would pay
137.9for if the child resides in an institution. After the child is determined to be eligible under
137.10this section, the commissioner shall review the child's disability under United States Code,
137.11title 42, section 1382c(a) and level of care defined under this section no more often than
137.12annually and may elect, based on the recommendation of health care professionals under
137.13contract with the state medical review team, to extend the review of disability and level of
137.14care up to a maximum of four years. The commissioner's decision on the frequency of
137.15continuing review of disability and level of care is not subject to administrative appeal
137.16under section 256.045. The county agency shall send a notice of disability review to the
137.17enrollee six months prior to the date the recertification of disability is due. Nothing in this
137.18subdivision shall be construed as affecting other redeterminations of medical assistance
137.19eligibility under this chapter and annual cost-effective reviews under this section.
137.20    (b) For purposes of this subdivision, "hospital" means an institution as defined
137.21in section 144.696, subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part
137.224640.3600, and licensed pursuant to sections 144.50 to 144.58. For purposes of this
137.23subdivision, a child requires a level of care provided in a hospital if the child is determined
137.24by the commissioner to need an extensive array of health services, including mental health
137.25services, for an undetermined period of time, whose health condition requires frequent
137.26monitoring and treatment by a health care professional or by a person supervised by a
137.27health care professional, who would reside in a hospital or require frequent hospitalization
137.28if these services were not provided, and the daily care needs are more complex than
137.29a nursing facility level of care.
137.30    A child with serious emotional disturbance requires a level of care provided in a
137.31hospital if the commissioner determines that the individual requires 24-hour supervision
137.32because the person exhibits recurrent or frequent suicidal or homicidal ideation or
137.33behavior, recurrent or frequent psychosomatic disorders or somatopsychic disorders that
137.34may become life threatening, recurrent or frequent severe socially unacceptable behavior
137.35associated with psychiatric disorder, ongoing and chronic psychosis or severe, ongoing
137.36and chronic developmental problems requiring continuous skilled observation, or severe
138.1disabling symptoms for which office-centered outpatient treatment is not adequate, and
138.2which overall severely impact the individual's ability to function.
138.3    (c) For purposes of this subdivision, "nursing facility" means a facility which
138.4provides nursing care as defined in section 144A.01, subdivision 5, licensed pursuant to
138.5sections 144A.02 to 144A.10, which is appropriate if a person is in active restorative
138.6treatment; is in need of special treatments provided or supervised by a licensed nurse; or
138.7has unpredictable episodes of active disease processes requiring immediate judgment
138.8by a licensed nurse. For purposes of this subdivision, a child requires the level of care
138.9provided in a nursing facility if the child is determined by the commissioner to meet
138.10the requirements of the preadmission screening assessment document under section
138.11256B.0911 and the home care independent rating document under section 256B.0655,
138.12subdivision 4
, clause (3) 256B.0659, adjusted to address age-appropriate standards for
138.13children age 18 and under, pursuant to section 256B.0655, subdivision 3 256B.0659.
138.14    (d) For purposes of this subdivision, "intermediate care facility for persons with
138.15developmental disabilities" or "ICF/MR" means a program licensed to provide services to
138.16persons with developmental disabilities under section 252.28, and chapter 245A, and a
138.17physical plant licensed as a supervised living facility under chapter 144, which together
138.18are certified by the Minnesota Department of Health as meeting the standards in Code of
138.19Federal Regulations, title 42, part 483, for an intermediate care facility which provides
138.20services for persons with developmental disabilities who require 24-hour supervision
138.21and active treatment for medical, behavioral, or habilitation needs. For purposes of this
138.22subdivision, a child requires a level of care provided in an ICF/MR if the commissioner
138.23finds that the child has a developmental disability in accordance with section 256B.092,
138.24is in need of a 24-hour plan of care and active treatment similar to persons with
138.25developmental disabilities, and there is a reasonable indication that the child will need
138.26ICF/MR services.
138.27    (e) For purposes of this subdivision, a person requires the level of care provided
138.28in a nursing facility if the person requires 24-hour monitoring or supervision and a plan
138.29of mental health treatment because of specific symptoms or functional impairments
138.30associated with a serious mental illness or disorder diagnosis, which meet severity criteria
138.31for mental health established by the commissioner and published in March 1997 as
138.32the Minnesota Mental Health Level of Care for Children and Adolescents with Severe
138.33Emotional Disorders.
138.34    (f) The determination of the level of care needed by the child shall be made by
138.35the commissioner based on information supplied to the commissioner by the parent or
138.36guardian, the child's physician or physicians, and other professionals as requested by the
139.1commissioner. The commissioner shall establish a screening team to conduct the level of
139.2care determinations according to this subdivision.
139.3    (g) If a child meets the conditions in paragraph (b), (c), (d), or (e), the commissioner
139.4must assess the case to determine whether:
139.5    (1) the child qualifies as a disabled individual under United States Code, title 42,
139.6section 1382c(a), and would be eligible for medical assistance if residing in a medical
139.7institution; and
139.8    (2) the cost of medical assistance services for the child, if eligible under this
139.9subdivision, would not be more than the cost to medical assistance if the child resides in a
139.10medical institution to be determined as follows:
139.11    (i) for a child who requires a level of care provided in an ICF/MR, the cost of
139.12care for the child in an institution shall be determined using the average payment rate
139.13established for the regional treatment centers that are certified as ICF's/MR;
139.14    (ii) for a child who requires a level of care provided in an inpatient hospital setting
139.15according to paragraph (b), cost-effectiveness shall be determined according to Minnesota
139.16Rules, part 9505.3520, items F and G; and
139.17    (iii) for a child who requires a level of care provided in a nursing facility according
139.18to paragraph (c) or (e), cost-effectiveness shall be determined according to Minnesota
139.19Rules, part 9505.3040, except that the nursing facility average rate shall be adjusted to
139.20reflect rates which would be paid for children under age 16. The commissioner may
139.21authorize an amount up to the amount medical assistance would pay for a child referred to
139.22the commissioner by the preadmission screening team under section 256B.0911.
139.23    (h) Children eligible for medical assistance services under section 256B.055,
139.24subdivision 12
, as of June 30, 1995, must be screened according to the criteria in this
139.25subdivision prior to January 1, 1996. Children found to be ineligible may not be removed
139.26from the program until January 1, 1996.

139.27    Sec. 9. Minnesota Statutes 2008, section 256B.0621, subdivision 2, is amended to read:
139.28    Subd. 2. Targeted case management; definitions. For purposes of subdivisions 3
139.29to 10, the following terms have the meanings given them:
139.30    (1) "home care service recipients" means those individuals receiving the following
139.31services under sections 256B.0651 to 256B.0656 and 256B.0659: skilled nursing visits,
139.32home health aide visits, private duty nursing, personal care assistants, or therapies
139.33provided through a home health agency;
140.1    (2) "home care targeted case management" means the provision of targeted case
140.2management services for the purpose of assisting home care service recipients to gain
140.3access to needed services and supports so that they may remain in the community;
140.4    (3) "institutions" means hospitals, consistent with Code of Federal Regulations, title
140.542, section 440.10; regional treatment center inpatient services, consistent with section
140.6245.474 ; nursing facilities; and intermediate care facilities for persons with developmental
140.7disabilities;
140.8    (4) "relocation targeted case management" includes the provision of both county
140.9targeted case management and public or private vendor service coordination services
140.10for the purpose of assisting recipients to gain access to needed services and supports if
140.11they choose to move from an institution to the community. Relocation targeted case
140.12management may be provided during the lesser of:
140.13    (i) the last 180 consecutive days of an eligible recipient's institutional stay; or
140.14    (ii) the limits and conditions which apply to federal Medicaid funding for this
140.15service; and
140.16    (5) "targeted case management" means case management services provided to help
140.17recipients gain access to needed medical, social, educational, and other services and
140.18supports.

140.19    Sec. 10. Minnesota Statutes 2008, section 256B.0652, subdivision 3, is amended to
140.20read:
140.21    Subd. 3. Assessment and prior authorization process. Effective January 1, 1996,
140.22for purposes of providing informed choice, coordinating of local planning decisions, and
140.23streamlining administrative requirements, the assessment and prior authorization process
140.24for persons receiving both home care and home and community-based waivered services
140.25for persons with developmental disabilities shall meet the requirements of sections
140.26256B.0651 and 256B.0653 to 256B.0656 and 256B.0659 with the following exceptions:
140.27(a) Upon request for home care services and subsequent assessment by the public
140.28health nurse under sections 256B.0651 and 256B.0653 to 256B.0656 and 256B.0659,
140.29the public health nurse shall participate in the screening process, as appropriate, and,
140.30if home care services are determined to be necessary, participate in the development
140.31of a service plan coordinating the need for home care and home and community-based
140.32waivered services with the assigned county case manager, the recipient of services, and
140.33the recipient's legal representative, if any.
140.34(b) The public health nurse shall give prior authorization for home care services
140.35to the extent that home care services are:
141.1(1) medically necessary;
141.2(2) chosen by the recipient and their legal representative, if any, from the array of
141.3home care and home and community-based waivered services available;
141.4(3) coordinated with other services to be received by the recipient as described
141.5in the service plan; and
141.6(4) provided within the county's reimbursement limits for home care and home and
141.7community-based waivered services for persons with developmental disabilities.
141.8(c) If the public health agency is or may be the provider of home care services to the
141.9recipient, the public health agency shall provide the commissioner of human services with
141.10a written plan that specifies how the assessment and prior authorization process will be
141.11held separate and distinct from the provision of services.

141.12    Sec. 11. Minnesota Statutes 2008, section 256B.0657, subdivision 2, is amended to
141.13read:
141.14    Subd. 2. Eligibility. (a) The self-directed supports option is available to a person
141.15who:
141.16    (1) is a recipient of medical assistance as determined under sections 256B.055,
141.17256B.056 , and 256B.057, subdivision 9;
141.18    (2) is eligible for personal care assistant services under section 256B.0655
141.19256B.0659;
141.20    (3) lives in the person's own apartment or home, which is not owned, operated, or
141.21controlled by a provider of services not related by blood or marriage;
141.22    (4) has the ability to hire, fire, supervise, establish staff compensation for, and
141.23manage the individuals providing services, and to choose and obtain items, related
141.24services, and supports as described in the participant's plan. If the recipient is not able to
141.25carry out these functions but has a legal guardian or parent to carry them out, the guardian
141.26or parent may fulfill these functions on behalf of the recipient; and
141.27    (5) has not been excluded or disenrolled by the commissioner.
141.28    (b) The commissioner may disenroll or exclude recipients, including guardians and
141.29parents, under the following circumstances:
141.30    (1) recipients who have been restricted by the Primary Care Utilization Review
141.31Committee may be excluded for a specified time period;
141.32    (2) recipients who exit the self-directed supports option during the recipient's
141.33service plan year shall not access the self-directed supports option for the remainder of
141.34that service plan year; and
142.1    (3) when the department determines that the recipient cannot manage recipient
142.2responsibilities under the program.

142.3    Sec. 12. Minnesota Statutes 2008, section 256B.0657, subdivision 6, is amended to
142.4read:
142.5    Subd. 6. Services covered. (a) Services covered under the self-directed supports
142.6option include:
142.7    (1) personal care assistant services under section 256B.0655 256B.0659; and
142.8    (2) items, related services, and supports, including assistive technology, that increase
142.9independence or substitute for human assistance to the extent expenditures would
142.10otherwise be used for human assistance.
142.11    (b) Items, supports, and related services purchased under this option shall not be
142.12considered home care services for the purposes of section 144A.43.

142.13    Sec. 13. Minnesota Statutes 2008, section 256B.0657, subdivision 8, is amended to
142.14read:
142.15    Subd. 8. Self-directed budget requirements. The budget for the provision of the
142.16self-directed service option shall be equal to the greater of either:
142.17    (1) the annual amount of personal care assistant services under section 256B.0655
142.18256B.0659 that the recipient has used in the most recent 12-month period; or
142.19    (2) the amount determined using the consumer support grant methodology under
142.20section 256.476, subdivision 11, except that the budget amount shall include the federal
142.21and nonfederal share of the average service costs.

142.22    Sec. 14. Minnesota Statutes 2008, section 256B.49, subdivision 17, is amended to read:
142.23    Subd. 17. Cost of services and supports. (a) The commissioner shall ensure
142.24that the average per capita expenditures estimated in any fiscal year for home and
142.25community-based waiver recipients does not exceed the average per capita expenditures
142.26that would have been made to provide institutional services for recipients in the absence
142.27of the waiver.
142.28(b) The commissioner shall implement on January 1, 2002, one or more aggregate,
142.29need-based methods for allocating to local agencies the home and community-based
142.30waivered service resources available to support recipients with disabilities in need of
142.31the level of care provided in a nursing facility or a hospital. The commissioner shall
142.32allocate resources to single counties and county partnerships in a manner that reflects
142.33consideration of:
142.34(1) an incentive-based payment process for achieving outcomes;
143.1(2) the need for a state-level risk pool;
143.2(3) the need for retention of management responsibility at the state agency level; and
143.3(4) a phase-in strategy as appropriate.
143.4(c) Until the allocation methods described in paragraph (b) are implemented, the
143.5annual allowable reimbursement level of home and community-based waiver services
143.6shall be the greater of:
143.7(1) the statewide average payment amount which the recipient is assigned under the
143.8waiver reimbursement system in place on June 30, 2001, modified by the percentage of
143.9any provider rate increase appropriated for home and community-based services; or
143.10(2) an amount approved by the commissioner based on the recipient's extraordinary
143.11needs that cannot be met within the current allowable reimbursement level. The
143.12increased reimbursement level must be necessary to allow the recipient to be discharged
143.13from an institution or to prevent imminent placement in an institution. The additional
143.14reimbursement may be used to secure environmental modifications; assistive technology
143.15and equipment; and increased costs for supervision, training, and support services
143.16necessary to address the recipient's extraordinary needs. The commissioner may approve
143.17an increased reimbursement level for up to one year of the recipient's relocation from an
143.18institution or up to six months of a determination that a current waiver recipient is at
143.19imminent risk of being placed in an institution.
143.20(d) Beginning July 1, 2001, medically necessary private duty nursing services
143.21will be authorized under this section as complex and regular care according to sections
143.22256B.0651 and 256B.0653 to 256B.0656 and 256B.0659. The rate established by the
143.23commissioner for registered nurse or licensed practical nurse services under any home and
143.24community-based waiver as of January 1, 2001, shall not be reduced.

143.25    Sec. 15. Minnesota Statutes 2008, section 256B.501, subdivision 4a, is amended to
143.26read:
143.27    Subd. 4a. Inclusion of home care costs in waiver rates. The commissioner
143.28shall adjust the limits of the established average daily reimbursement rates for waivered
143.29services to include the cost of home care services that may be provided to waivered
143.30services recipients. This adjustment must be used to maintain or increase services and
143.31shall not be used by county agencies for inflation increases for waivered services vendors.
143.32Home care services referenced in this section are those listed in section 256B.0651,
143.33subdivision 2
. The average daily reimbursement rates established in accordance with
143.34the provisions of this subdivision apply only to the combined average, daily costs of
143.35waivered and home care services and do not change home care limitations under sections
144.1256B.0651 and 256B.0653 to 256B.0656 and 256B.0659. Waivered services recipients
144.2receiving home care as of June 30, 1992, shall not have the amount of their services
144.3reduced as a result of this section.

144.4    Sec. 16. Minnesota Statutes 2008, section 256G.02, subdivision 6, is amended to read:
144.5    Subd. 6. Excluded time. "Excluded time" means:
144.6(a) any period an applicant spends in a hospital, sanitarium, nursing home, shelter
144.7other than an emergency shelter, halfway house, foster home, semi-independent living
144.8domicile or services program, residential facility offering care, board and lodging facility
144.9or other institution for the hospitalization or care of human beings, as defined in section
144.10144.50 , 144A.01, or 245A.02, subdivision 14; maternity home, battered women's shelter,
144.11or correctional facility; or any facility based on an emergency hold under sections
144.12253B.05, subdivisions 1 and 2 , and 253B.07, subdivision 6;
144.13(b) any period an applicant spends on a placement basis in a training and habilitation
144.14program, including a rehabilitation facility or work or employment program as defined
144.15in section 268A.01; or receiving personal care assistant services pursuant to section
144.16256B.0655, subdivision 2 256B.0659; semi-independent living services provided under
144.17section 252.275, and Minnesota Rules, parts 9525.0500 to 9525.0660; day training and
144.18habilitation programs and assisted living services; and
144.19(c) any placement for a person with an indeterminate commitment, including
144.20independent living.

144.21    Sec. 17. Minnesota Statutes 2008, section 256I.05, subdivision 1a, is amended to read:
144.22    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section
144.23256I.04, subdivision 3 , the county agency may negotiate a payment not to exceed $426.37
144.24for other services necessary to provide room and board provided by the group residence
144.25if the residence is licensed by or registered by the Department of Health, or licensed by
144.26the Department of Human Services to provide services in addition to room and board,
144.27and if the provider of services is not also concurrently receiving funding for services for
144.28a recipient under a home and community-based waiver under title XIX of the Social
144.29Security Act; or funding from the medical assistance program under section 256B.0655,
144.30subdivision 2
256B.0659, for personal care services for residents in the setting; or residing
144.31in a setting which receives funding under Minnesota Rules, parts 9535.2000 to 9535.3000.
144.32If funding is available for other necessary services through a home and community-based
144.33waiver, or personal care services under section 256B.0655, subdivision 2 256B.0659,
144.34then the GRH rate is limited to the rate set in subdivision 1. Unless otherwise provided
144.35in law, in no case may the supplementary service rate exceed $426.37. The registration
145.1and licensure requirement does not apply to establishments which are exempt from state
145.2licensure because they are located on Indian reservations and for which the tribe has
145.3prescribed health and safety requirements. Service payments under this section may be
145.4prohibited under rules to prevent the supplanting of federal funds with state funds. The
145.5commissioner shall pursue the feasibility of obtaining the approval of the Secretary of
145.6Health and Human Services to provide home and community-based waiver services under
145.7title XIX of the Social Security Act for residents who are not eligible for an existing home
145.8and community-based waiver due to a primary diagnosis of mental illness or chemical
145.9dependency and shall apply for a waiver if it is determined to be cost-effective.
145.10(b) The commissioner is authorized to make cost-neutral transfers from the GRH
145.11fund for beds under this section to other funding programs administered by the department
145.12after consultation with the county or counties in which the affected beds are located.
145.13The commissioner may also make cost-neutral transfers from the GRH fund to county
145.14human service agencies for beds permanently removed from the GRH census under a plan
145.15submitted by the county agency and approved by the commissioner. The commissioner
145.16shall report the amount of any transfers under this provision annually to the legislature.
145.17(c) The provisions of paragraph (b) do not apply to a facility that has its
145.18reimbursement rate established under section 256B.431, subdivision 4, paragraph (c).

145.19    Sec. 18. Minnesota Statutes 2008, section 256J.45, subdivision 3, is amended to read:
145.20    Subd. 3. Good cause exemptions for not attending orientation. (a) The county
145.21agency shall not impose the sanction under section 256J.46 if it determines that the
145.22participant has good cause for failing to attend orientation. Good cause exists when:
145.23(1) appropriate child care is not available;
145.24(2) the participant is ill or injured;
145.25(3) a family member is ill and needs care by the participant that prevents the
145.26participant from attending orientation. For a caregiver with a child or adult in the
145.27household who meets the disability or medical criteria for home care services under
145.28section 256B.0655, subdivision 1c 256B.0659, or a home and community-based waiver
145.29services program under chapter 256B, or meets the criteria for severe emotional
145.30disturbance under section 245.4871, subdivision 6, or for serious and persistent mental
145.31illness under section 245.462, subdivision 20, paragraph (c), good cause also exists when
145.32an interruption in the provision of those services occurs which prevents the participant
145.33from attending orientation;
145.34(4) the caregiver is unable to secure necessary transportation;
145.35(5) the caregiver is in an emergency situation that prevents orientation attendance;
146.1(6) the orientation conflicts with the caregiver's work, training, or school schedule; or
146.2(7) the caregiver documents other verifiable impediments to orientation attendance
146.3beyond the caregiver's control.
146.4(b) Counties must work with clients to provide child care and transportation
146.5necessary to ensure a caregiver has every opportunity to attend orientation.

146.6    Sec. 19. Minnesota Statutes 2008, section 604A.33, subdivision 1, is amended to read:
146.7    Subdivision 1. Application. This section applies to residential treatment programs
146.8for children or group homes for children licensed under chapter 245A, residential
146.9services and programs for juveniles licensed under section 241.021, providers licensed
146.10pursuant to sections 144A.01 to 144A.33 or sections 144A.43 to 144A.47, personal care
146.11provider organizations under section 256B.0655, subdivision 1g 256B.0659, providers
146.12of day training and habilitation services under sections 252.40 to 252.46, board and
146.13lodging facilities licensed under chapter 157, intermediate care facilities for persons with
146.14developmental disabilities, and other facilities licensed to provide residential services to
146.15persons with developmental disabilities.

146.16    Sec. 20. Minnesota Statutes 2008, section 609.232, subdivision 11, is amended to read:
146.17    Subd. 11. Vulnerable adult. "Vulnerable adult" means any person 18 years of
146.18age or older who:
146.19(1) is a resident inpatient of a facility;
146.20(2) receives services at or from a facility required to be licensed to serve adults
146.21under sections 245A.01 to 245A.15, except that a person receiving outpatient services for
146.22treatment of chemical dependency or mental illness, or one who is committed as a sexual
146.23psychopathic personality or as a sexually dangerous person under chapter 253B, is not
146.24considered a vulnerable adult unless the person meets the requirements of clause (4);
146.25(3) receives services from a home care provider required to be licensed under section
146.26144A.46 ; or from a person or organization that exclusively offers, provides, or arranges
146.27for personal care assistant services under the medical assistance program as authorized
146.28under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, and
146.29256B.0653 to 256B.0656 and 256B.0659; or
146.30(4) regardless of residence or whether any type of service is received, possesses a
146.31physical or mental infirmity or other physical, mental, or emotional dysfunction:
146.32(i) that impairs the individual's ability to provide adequately for the individual's
146.33own care without assistance, including the provision of food, shelter, clothing, health
146.34care, or supervision; and
147.1(ii) because of the dysfunction or infirmity and the need for assistance, the individual
147.2has an impaired ability to protect the individual from maltreatment.

147.3    Sec. 21. Minnesota Statutes 2008, section 626.5572, subdivision 6, is amended to read:
147.4    Subd. 6. Facility. (a) "Facility" means a hospital or other entity required to be
147.5licensed under sections 144.50 to 144.58; a nursing home required to be licensed to
147.6serve adults under section 144A.02; a residential or nonresidential facility required to
147.7be licensed to serve adults under sections 245A.01 to 245A.16; a home care provider
147.8licensed or required to be licensed under section 144A.46; a hospice provider licensed
147.9under sections 144A.75 to 144A.755; or a person or organization that exclusively offers,
147.10provides, or arranges for personal care assistant services under the medical assistance
147.11program as authorized under sections 256B.04, subdivision 16, 256B.0625, subdivision
147.1219a
, 256B.0651, and 256B.0653 to 256B.0656, and 256B.0659.
147.13(b) For home care providers and personal care attendants, the term "facility" refers
147.14to the provider or person or organization that exclusively offers, provides, or arranges for
147.15personal care services, and does not refer to the client's home or other location at which
147.16services are rendered.

147.17    Sec. 22. Minnesota Statutes 2008, section 626.5572, subdivision 21, is amended to
147.18read:
147.19    Subd. 21. Vulnerable adult. "Vulnerable adult" means any person 18 years of
147.20age or older who:
147.21    (1) is a resident or inpatient of a facility;
147.22    (2) receives services at or from a facility required to be licensed to serve adults
147.23under sections 245A.01 to 245A.15, except that a person receiving outpatient services for
147.24treatment of chemical dependency or mental illness, or one who is served in the Minnesota
147.25sex offender program on a court-hold order for commitment, or is committed as a sexual
147.26psychopathic personality or as a sexually dangerous person under chapter 253B, is not
147.27considered a vulnerable adult unless the person meets the requirements of clause (4);
147.28    (3) receives services from a home care provider required to be licensed under section
147.29144A.46 ; or from a person or organization that exclusively offers, provides, or arranges
147.30for personal care assistant services under the medical assistance program as authorized
147.31under sections 256B.04, subdivision 16, 256B.0625, subdivision 19a, 256B.0651, and
147.32256B.0653 to 256B.0656, and 256B.0659; or
147.33    (4) regardless of residence or whether any type of service is received, possesses a
147.34physical or mental infirmity or other physical, mental, or emotional dysfunction:
148.1    (i) that impairs the individual's ability to provide adequately for the individual's
148.2own care without assistance, including the provision of food, shelter, clothing, health
148.3care, or supervision; and
148.4    (ii) because of the dysfunction or infirmity and the need for assistance, the individual
148.5has an impaired ability to protect the individual from maltreatment.

148.6ARTICLE 8
148.7CHEMICAL AND MENTAL HEALTH

148.8    Section 1. Minnesota Statutes 2008, section 245.4885, subdivision 1, is amended to
148.9read:
148.10    Subdivision 1. Admission criteria. The county board shall, (a) Prior to admission,
148.11except in the case of emergency admission, determine the needed level of care for all
148.12children referred for treatment of severe emotional disturbance in a treatment foster care
148.13setting, residential treatment facility, or informally admitted to a regional treatment center
148.14shall undergo an assessment to determine the appropriate level of care if public funds are
148.15used to pay for the services. The county board shall also determine the needed level of
148.16care for all children admitted to an acute care hospital for treatment of severe emotional
148.17disturbance if public funds other than reimbursement under chapters 256B and 256D
148.18are used to pay for the services.
148.19(b) The county board shall determine the appropriate level of care when
148.20county-controlled funds are used to pay for the services. When the child is enrolled in
148.21a prepaid health program under section 256B.69, the enrolled child's contracted health
148.22plan must determine the appropriate level of care. When the child is an Indian tribal
148.23member seeking placement through the tribe in a tribally operated or contracted facility,
148.24the tribe must determine the appropriate level of care. When more than one entity bears
148.25responsibility for coverage, the entities shall coordinate level of care determination
148.26activities to the extent possible.
148.27(c) The level of care determination shall determine whether the proposed treatment:
148.28(1) is necessary;
148.29(2) is appropriate to the child's individual treatment needs;
148.30(3) cannot be effectively provided in the child's home; and
148.31(4) provides a length of stay as short as possible consistent with the individual
148.32child's need.
148.33(d) When a level of care determination is conducted, the county board responsible
148.34entity may not determine that referral or admission to a treatment foster care setting, or
148.35residential treatment facility, or acute care hospital is not appropriate solely because
149.1services were not first provided to the child in a less restrictive setting and the child failed
149.2to make progress toward or meet treatment goals in the less restrictive setting. The level
149.3of care determination must be based on a diagnostic assessment that includes a functional
149.4assessment which evaluates family, school, and community living situations; and an
149.5assessment of the child's need for care out of the home using a validated tool which
149.6assesses a child's functional status and assigns an appropriate level of care. The validated
149.7tool must be approved by the commissioner of human services. If a diagnostic assessment
149.8including a functional assessment has been completed by a mental health professional
149.9within the past 180 days, a new diagnostic assessment need not be completed unless in the
149.10opinion of the current treating mental health professional the child's mental health status
149.11has changed markedly since the assessment was completed. The child's parent shall be
149.12notified if an assessment will not be completed and of the reasons. A copy of the notice
149.13shall be placed in the child's file. Recommendations developed as part of the level of care
149.14determination process shall include specific community services needed by the child and,
149.15if appropriate, the child's family, and shall indicate whether or not these services are
149.16available and accessible to the child and family.
149.17During the level of care determination process, the child, child's family, or child's
149.18legal representative, as appropriate, must be informed of the child's eligibility for case
149.19management services and family community support services and that an individual
149.20family community support plan is being developed by the case manager, if assigned.
149.21The level of care determination shall comply with section 260C.212. Wherever
149.22possible, The parent shall be consulted in the process, unless clinically inappropriate
149.23detrimental to the child.
149.24The level of care determination, and placement decision, and recommendations for
149.25mental health services must be documented in the child's record.
149.26An alternate review process may be approved by the commissioner if the county
149.27board demonstrates that an alternate review process has been established by the county
149.28board and the times of review, persons responsible for the review, and review criteria are
149.29comparable to the standards in clauses (1) to (4).

149.30    Sec. 2. Minnesota Statutes 2008, section 254A.02, is amended by adding a subdivision
149.31to read:
149.32    Subd. 8a. Placing authority. "Placing authority" means a county, prepaid health
149.33plan, or tribal governing board governed by Minnesota Rules, parts 9530.6600 to
149.349530.6655.

149.35    Sec. 3. [254A.081] GRANTS FOR DETOXIFICATION SERVICES.
150.1(a) Effective January 1, 2011, funds appropriated for alcohol and drug abuse services
150.2from the children's and community services act grants under section 256M.40 must be
150.3allocated to counties for detoxification services as defined in section 254A.08.
150.4(b) Funds must be allocated in proportion to the percent of state population at or
150.5below 100 percent of the federal poverty guideline residing in each county.
150.6(c) Upon receipt of county expenditure reports for January to June of each year, the
150.7commissioner shall pay each county based on the county's actual expenditures to date plus
150.8projected expenditures for the remainder of the calendar year up to the total amount of
150.9the allocation.
150.10(d) By January 31, 2012, and each year thereafter, counties shall report actual
150.11expenditures for detoxification services for the prior year. The commissioner shall
150.12reallocate unexpended funds to counties that expended more than their allocation, based
150.13on the percent of state population at or below 100 percent of the federal poverty guideline
150.14residing in each eligible county.

150.15    Sec. 4. Minnesota Statutes 2008, section 254A.16, is amended by adding a subdivision
150.16to read:
150.17    Subd. 6. Monitoring. The commissioner shall gather and placing authorities shall
150.18provide information to measure compliance with Minnesota Rules, parts 9530.6600 to
150.199530.6655. The commissioner shall specify the format for data collection to facilitate
150.20tracking, aggregating, and using the information.

150.21    Sec. 5. Minnesota Statutes 2008, section 254B.03, subdivision 1, is amended to read:
150.22    Subdivision 1. Local agency duties. (a) Every local agency shall provide chemical
150.23dependency services to persons residing within its jurisdiction who meet criteria
150.24established by the commissioner for placement in a chemical dependency residential or
150.25nonresidential treatment service. Chemical dependency money must be administered
150.26by the local agencies according to law and rules adopted by the commissioner under
150.27sections 14.001 to 14.69.
150.28    (b) In order to contain costs, the county board shall, with the approval of the
150.29commissioner of human services, shall select eligible vendors of chemical dependency
150.30services who can provide economical and appropriate treatment. Unless the local agency
150.31is a social services department directly administered by a county or human services board,
150.32the local agency shall not be an eligible vendor under section 254B.05. The commissioner
150.33may approve proposals from county boards to provide services in an economical manner
150.34or to control utilization, with safeguards to ensure that necessary services are provided.
150.35If a county implements a demonstration or experimental medical services funding plan,
151.1the commissioner shall transfer the money as appropriate. If a county selects a vendor
151.2located in another state, the county shall ensure that the vendor is in compliance with the
151.3rules governing licensure of programs located in the state.
151.4    (c) A culturally specific vendor that provides assessments under a variance under
151.5Minnesota Rules, part 9530.6610, shall be allowed to provide assessment services to
151.6persons not covered by the variance.
151.7EFFECTIVE DATE.This section is effective July 1, 2011.

151.8    Sec. 6. Minnesota Statutes 2008, section 254B.03, subdivision 3, is amended to read:
151.9    Subd. 3. Local agencies to pay state for county share. Local agencies shall pay
151.10the state for the county share of the services authorized by the local agency, except when
151.11the payment is made according to section 254B.09, subdivision 8.

151.12    Sec. 7. Minnesota Statutes 2008, section 254B.03, is amended by adding a subdivision
151.13to read:
151.14    Subd. 9. Commissioner to select vendors and set rates. (a) Effective July 1, 2011,
151.15the commissioner shall:
151.16(1) enter into agreements with eligible vendors that:
151.17(i) meet the standards in section 254B.05, subdivision 1;
151.18(ii) have good standing in all applicable licensure; and
151.19(iii) have a current approved provider agreement as a Minnesota health care program
151.20provider; and
151.21(2) set rates for services reimbursed under this chapter.
151.22(b) When setting rates, the commissioner shall consider the complexity and the
151.23acuity of the problems presented by the client.
151.24(c) When rates set under this section and rates set under section 254B.09, subdivision
151.258, apply to the same treatment placement, section 254B.09, subdivision 8, supersedes.

151.26    Sec. 8. Minnesota Statutes 2008, section 254B.05, subdivision 1, is amended to read:
151.27    Subdivision 1. Licensure required. Programs licensed by the commissioner are
151.28eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
151.29notwithstanding the provisions of section 245A.03. American Indian programs located on
151.30federally recognized tribal lands that provide chemical dependency primary treatment,
151.31extended care, transitional residence, or outpatient treatment services, and are licensed by
151.32tribal government are eligible vendors. Detoxification programs are not eligible vendors.
151.33Programs that are not licensed as a chemical dependency residential or nonresidential
151.34treatment program by the commissioner or by tribal government are not eligible vendors.
152.1To be eligible for payment under the Consolidated Chemical Dependency Treatment Fund,
152.2a vendor of a chemical dependency service must participate in the Drug and Alcohol
152.3Abuse Normative Evaluation System and the treatment accountability plan.
152.4Effective January 1, 2000, vendors of room and board are eligible for chemical
152.5dependency fund payment if the vendor:
152.6(1) is certified by the county or tribal governing body as having has rules prohibiting
152.7residents bringing chemicals into the facility or using chemicals while residing in the
152.8facility and provide consequences for infractions of those rules;
152.9(2) has a current contract with a county or tribal governing body;
152.10(3) is determined to meet applicable health and safety requirements;
152.11(4) is not a jail or prison; and
152.12(5) is not concurrently receiving funds under chapter 256I for the recipient.
152.13EFFECTIVE DATE.This section is effective July 1, 2011.

152.14    Sec. 9. Minnesota Statutes 2008, section 254B.09, subdivision 2, is amended to read:
152.15    Subd. 2. American Indian agreements. The commissioner may enter into
152.16agreements with federally recognized tribal units to pay for chemical dependency
152.17treatment services provided under Laws 1986, chapter 394, sections 8 to 20. The
152.18agreements must clarify how the governing body of the tribal unit fulfills local agency
152.19responsibilities regarding:
152.20(1) selection of eligible vendors under section 254B.03, subdivision 1;
152.21(2) negotiation of agreements that establish vendor services and rates for programs
152.22located on the tribal governing body's reservation;
152.23(3) (1) the form and manner of invoicing; and
152.24(4) (2) provide that only invoices for eligible vendors according to section 254B.05
152.25will be included in invoices sent to the commissioner for payment, to the extent that
152.26money allocated under subdivisions 4 and 5 is used.
152.27EFFECTIVE DATE.This section is effective July 1, 2011.

152.28    Sec. 10. [254B.11] MAXIMUM RATES.
152.29The commissioner shall publish maximum rates for vendors of the consolidated
152.30chemical dependency treatment fund by July 1 of each year for implementation the
152.31following January 1. Rates for calendar year 2010 must not exceed 185 percent of the
152.32average rate on January 1, 2009, for each group of vendors with similar attributes. Unless
152.33a new rate methodology is developed under section 254B.12, rates for services provided on
152.34and after July 1, 2011, must not exceed 160 percent of the average rate on January 1, 2009,
153.1for each group of vendors with similar attributes. Payment for services provided by Indian
153.2Health Services or by agencies operated by Indian tribes for medical assistance-eligible
153.3individuals must be governed by the applicable federal rate methodology.

153.4    Sec. 11. [254B.12] RATE METHODOLOGY.
153.5(a) The commissioner shall, with broad-based stakeholder input, develop a
153.6recommendation and present a report to the 2011 legislature, including proposed
153.7legislation for a new rate methodology for the consolidated chemical dependency
153.8treatment fund. The new methodology must replace county-negotiated rates with a
153.9uniform statewide methodology that must include:
153.10(1) a graduated reimbursement scale based on the patients' level of acuity and
153.11complexity; and
153.12(2) beginning July 1, 2012, retroactive quality incentive payments up to four percent
153.13of each provider's prior-year approved chemical dependency fund claims.
153.14(b) The quality incentive payments under paragraph (a), clause (2), must be based on
153.15each provider's performance in the prior year relating to certain program criteria, based on
153.16best practices in addiction treatment. The quality incentive criteria under paragraph (a),
153.17clause (2), may include program completion rates, national outcome measures, program
153.18innovations, lack of licensing violations, and other measures to be determined by the
153.19commissioner.

153.20    Sec. 12. Minnesota Statutes 2008, section 256B.0625, subdivision 41, is amended to
153.21read:
153.22    Subd. 41. Residential services for children with severe emotional disturbance.
153.23Medical assistance covers rehabilitative services in accordance with section 256B.0945
153.24that are provided by a county through a residential facility under contract with a county or
153.25Indian tribe, for children who have been diagnosed with severe emotional disturbance and
153.26have been determined to require the level of care provided in a residential facility.

153.27    Sec. 13. Minnesota Statutes 2008, section 256B.0625, subdivision 47, is amended to
153.28read:
153.29    Subd. 47. Treatment foster care services. Effective July 1, 2007 2011, and subject
153.30to federal approval, medical assistance covers treatment foster care services according to
153.31section 256B.0946.

153.32    Sec. 14. Minnesota Statutes 2008, section 256B.0944, is amended by adding a
153.33subdivision to read:
154.1    Subd. 4a. Alternative provider standards. If a provider entity demonstrates that,
154.2due to geographic or other barriers, it is not feasible to provide mobile crisis intervention
154.3services 24 hours a day, seven days a week, according to the standards in subdivision 4,
154.4paragraph (b), clause (1), the commissioner may approve a crisis response provider based
154.5on an alternative plan proposed by a provider entity. The alternative plan must:
154.6(1) result in increased access and a reduction in disparities in the availability of
154.7crisis services; and
154.8(2) provide mobile services outside of the usual nine-to-five office hours and on
154.9weekends and holidays.

154.10    Sec. 15. Minnesota Statutes 2008, section 256B.0945, subdivision 4, is amended to
154.11read:
154.12    Subd. 4. Payment rates. (a) Notwithstanding sections 256B.19 and 256B.041,
154.13payments to counties for residential services provided by a residential facility shall only
154.14be made of federal earnings for services provided under this section, and the nonfederal
154.15share of costs for services provided under this section shall be paid by the county from
154.16sources other than federal funds or funds used to match other federal funds. Payment to
154.17counties for services provided according to this section shall be a proportion of the per
154.18day contract rate that relates to rehabilitative mental health services and shall not include
154.19payment for costs or services that are billed to the IV-E program as room and board.
154.20    (b) Per diem rates paid to providers under this section by prepaid plans shall be the
154.21proportion of the per-day contract rate that relates to rehabilitative mental health services
154.22and shall not include payment for group foster care costs or services that are billed to the
154.23county of financial responsibility.
154.24    (c) (b) The commissioner shall set aside a portion not to exceed five percent of the
154.25federal funds earned for county expenditures under this section to cover the state costs of
154.26administering this section. Any unexpended funds from the set-aside shall be distributed
154.27to the counties in proportion to their earnings under this section.
154.28(c) The payment rate negotiated and paid to a provider by prepaid health plans
154.29under section 256B.69 for services under this section must be supplemented by the
154.30commissioner from state appropriations to cover the nontreatment costs at a rate equal to
154.31the portion of the county negotiated per diem attributable to nontreatment service costs for
154.32that provider as determined by the commissioner of human services.
154.33(d) Payment for mental health rehabilitative services provided under this section by
154.34or under contract with an Indian tribe or tribal organization or by agencies operated by or
155.1under contract with an Indian tribe or tribal organization may be made according to section
155.2256B.0625, subdivision 34, or other relevant federally approved rate setting methodology.

155.3    Sec. 16. Minnesota Statutes 2008, section 256B.0947, subdivision 1, is amended to
155.4read:
155.5    Subdivision 1. Scope. Subject to federal approval Effective November 1, 2010,
155.6medical assistance covers medically necessary, intensive nonresidential rehabilitative
155.7mental health services as defined in subdivision 2, for recipients as defined in subdivision
155.83, when the services are provided by an entity meeting the standards in this section.

155.9    Sec. 17. Minnesota Statutes 2008, section 256B.761, is amended to read:
155.10256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
155.11(a) Effective for services rendered on or after July 1, 2001, payment for medication
155.12management provided to psychiatric patients, outpatient mental health services, day
155.13treatment services, home-based mental health services, and family community support
155.14services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
155.1550th percentile of 1999 charges.
155.16(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
155.17services provided by an entity that operates: (1) a Medicare-certified comprehensive
155.18outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
155.191993, with at least 33 percent of the clients receiving rehabilitation services in the most
155.20recent calendar year who are medical assistance recipients, will be increased by 38 percent,
155.21when those services are provided within the comprehensive outpatient rehabilitation
155.22facility and provided to residents of nursing facilities owned by the entity.
155.23(c) Effective January 1, 2010, the rate for partial hospitalization for children is
155.24increased to equal the rate for partial hospitalization for adults.

155.25    Sec. 18. MENTAL HEALTH PORTION OF CHILDREN'S AND COMMUNITY
155.26SERVICES ACT GRANTS.
155.27The commissioner of human services shall consult with stakeholders to develop a
155.28recommendation to the 2010 legislative session regarding administration of the mental
155.29health services portion of those funds to be allocated to mental health starting January 1,
155.302011, from the children's and community services act grants under Minnesota Statutes,
155.31section 256M.40. The recommendation must include:
155.32(1) an effective and efficient process to administer these funds together with other
155.33mental health services funding;
155.34(2) identification of the priorities and services to be funded;
156.1(3) a reporting and monitoring methodology that is efficient and ensures
156.2accountability; and
156.3(4) a funding allocation method.

156.4    Sec. 19. AUTISM SPECTRUM DISORDER JOINT TASK FORCE.
156.5(a) The Autism Spectrum Disorder Joint Task Force is composed of 25 members,
156.6appointed as follows:
156.7(1) two members of the senate, one appointed by the majority leader and one
156.8appointed by the minority leader;
156.9(2) two members of the house of representatives, one from the majority party,
156.10appointed by the speaker of the house, and one from the minority party, appointed by
156.11the minority leader; and
156.12(3) 11 public members appointed by the legislature, with regard to geographic
156.13diversity in the state, with the senate Subcommittee on Committees of the Committee on
156.14Rules and Administration making the appointments for the senate, and the speaker of the
156.15house making the appointments for the house:
156.16(i) three members who are parents of children with autism spectrum disorder (ASD),
156.17two of whom shall be appointed by the senate, and one of whom shall be appointed by
156.18the house;
156.19(ii) two members who have ASD, one of whom shall be appointed by the senate, and
156.20one by the house;
156.21(iii) one member representing an agency that provides residential housing services to
156.22individuals with ASD, appointed by the house;
156.23(iv) one member representing an agency that provides employment services to
156.24individuals with ASD, appointed by the senate;
156.25(v) one member who is a behavior analyst, appointed by the house;
156.26(vi) two members who are providers of ASD therapy, with one member appointed
156.27by the senate and one member appointed by the house; and
156.28(vii) one member who is a director of public school student support services;
156.29(4) two members appointed by the Minnesota chapter of the American Academy
156.30of Pediatrics, one who is a developmental behavioral pediatrician and one who is a
156.31general pediatrician;
156.32(5) one member appointed by the Minnesota Psychological Society who is a
156.33neuropsychologist;
156.34(6) one member appointed by the Association of Minnesota Counties;
156.35(7) one member appointed by the Minnesota Association of School Administrators;
156.36(8) one member appointed by the Somali American Autism Foundation;
157.1(9) one member appointed by the ARC of Minnesota;
157.2(10) one member appointed by the Autism Society of Minnesota;
157.3(11) one member appointed by the Parent Advocacy Coalition for Educational
157.4Rights; and
157.5(12) one member appointed by the Minnesota Council of Health Plans.
157.6Appointments must be made by September 1, 2009. The Legislative Coordinating
157.7Commission shall provide meeting space for the task force. The senate member appointed
157.8by the minority leader of the senate shall convene the first meeting of the task force no
157.9later than October 1, 2009. The task force shall elect a chair from among the public
157.10members at the first meeting.
157.11(b) The commissioners of education, employment and economic development,
157.12health, and human services shall provide assistance to the task force, including providing
157.13the task force with a count of children who have ASD with an individual education
157.14program or an individual family service plan and children with ASD who have a 504 plan.
157.15Additionally, the commissioner of human services shall submit a count of the adults with
157.16ASD enrolled in social service programs and the number of individuals with ASD who are
157.17enrolled in medical assistance and other waiver programs.
157.18(c) The task force shall develop recommendations and report on the following topics:
157.19(1) ways to improve services provided by all state and political subdivisions;
157.20(2) sources of public and private funding available for treatment and ways to
157.21improve efficiency in the use of these funds;
157.22(3) methods to improve coordination in the delivery of service between public and
157.23private agencies, health providers, and schools;
157.24(4) increasing the availability of and the training for medical providers and educators
157.25who identify and provide services to individuals with ASD;
157.26(5) ways to enhance Minnesota's role in ASD research and delivery of service;
157.27(6) methods to educate parents, family members, and the public on ASD and the
157.28available services; and
157.29(7) treatment options supported by peer-reviewed, established scientific research
157.30for individuals with ASD.
157.31(d) The task force shall coordinate with existing efforts at the Departments of
157.32Education, Health, Human Services, and Employment and Economic Development
157.33related to ASD.
157.34(e) By January 15 of each year, the task force shall provide a report regarding its
157.35findings and consideration of the topics listed under paragraph (c), and the action taken
157.36under paragraph (d), including draft legislation if necessary, to the chairs and ranking
158.1minority members of the legislative committees with jurisdiction over health and human
158.2services.
158.3EFFECTIVE DATE.This section is effective July 1, 2009, and expires June 30,
158.42011.

158.5    Sec. 20. LAND SALE; MORATORIUM.
158.6Surplus land surrounding the Anoka-Metro Regional Treatment Center must not be
158.7sold for five years.
158.8EFFECTIVE DATE.This section is effective the day following final enactment.

158.9    Sec. 21. STATE-COUNTY CHEMICAL HEALTH CARE HOME PILOT
158.10PROJECT.
158.11    Subdivision 1. Establishment; purpose. There is established a state-county
158.12chemical health care home pilot project. The purpose of the pilot project is to redesign the
158.13structural relationship between the state and counties to promote greater accountability,
158.14productivity, and results in the delivery of state chemical dependency services. The pilot
158.15project must give counties authority to design and operate a new state-county governance
158.16model for the delivery of chemical health services.
158.17    Subd. 2. Requirements. (a) The pilot projects established under this section must
158.18meet the requirements in this subdivision.
158.19(b) For the purposes of this section, "county" or "counties" means either an
158.20individual county or a voluntary multicounty entity.
158.21(c) Counties participating in the pilot projects must develop binding agreements
158.22with the Department of Human Services that clarifies the roles, responsibilities, and
158.23performance outcomes of the delivery of chemical health services. These agreements
158.24must include a:
158.25(1) governance agreement that redefines the respective authority, powers, roles,
158.26and responsibilities of the state and participating counties. As part of the governance
158.27agreement, the participating counties must be held accountable for improving targeted
158.28performance outcomes and through the use of the waivers described in paragraph (e), be
158.29granted greater local control and flexibility to determine the most cost-effective means of
158.30achieving those outcomes;
158.31(2) performance agreement that defines measurable goals in key operational areas.
158.32This agreement must identify: dependencies and requirements necessary for the state and
158.33participating counties to maintain service outcomes; respective resource commitments;
159.1funding or expenditure flexibilities which may include exemptions to requirements in
159.2section 254B.02; and essential reporting and accountability measures; and
159.3(3) service level agreement that specifies the expectations and responsibilities of
159.4each entity regarding administrative and information technology support required to
159.5achieve the measurable goals as defined in the performance agreement.
159.6(d) Counties are responsible for meeting the outcomes, goals, and responsibilities
159.7described in the agreements made in paragraph (c) using the payments in subdivision 4.
159.8Counties accept any financial responsibility above and beyond those payments. Counties
159.9may retain any funds not spent or any savings incurred as a result of these pilot projects,
159.10so long as funds are reinvested in chemical health service delivery.
159.11(e) In order to grant greater local control and flexibility to determine the most
159.12cost-effective means of achieving performance outcomes, the pilot projects in this section
159.13are exempt from any state or federal requirements on the use of consolidated chemical
159.14dependency treatment funds.
159.15    Subd. 3. Waivers. The commissioner of human services shall seek any necessary
159.16federal waivers to carry out this section.
159.17    Subd. 4. Capitated payment. (a) Participating counties must be allocated funds
159.18from the consolidated chemical dependency treatment (CCDT) fund as provided in this
159.19subdivision.
159.20(b) The average of CCDT funds allocated to participating counties for calendar years
159.212006 through 2008 must be allocated to counties in the form of a capitated payment.
159.22(c) Counties are required to offset the capitated payment in paragraph (b) with
159.23a contribution of each participating county's average of the contributed amount of
159.24maintenance of effort for calendar years 2006 through 2008.
159.25(d) When managed care contracts are renegotiated, the portion of the capitated
159.26payment earmarked for chemical dependency services must be redirected to participating
159.27counties.
159.28    Subd. 5. Report. The Department of Human Services shall report back to the
159.29legislative committees having jurisdiction over chemical health by January 15, 2011,
159.30evaluating the effectiveness of pilot projects, including recommendations for how to
159.31implement the pilot projects on a statewide basis.
159.32    Subd. 6. Expiration. These pilot projects expire June 30, 2013.
159.33EFFECTIVE DATE.This section is effective the day following final enactment.

160.1ARTICLE 9
160.2CONTINUING CARE

160.3    Section 1. Minnesota Statutes 2008, section 144.0724, subdivision 2, is amended to
160.4read:
160.5    Subd. 2. Definitions. For purposes of this section, the following terms have the
160.6meanings given.
160.7(a) "Assessment reference date" means the last day of the minimum data set
160.8observation period. The date sets the designated endpoint of the common observation
160.9period, and all minimum data set items refer back in time from that point.
160.10(b) "Case mix index" means the weighting factors assigned to the RUG-III
160.11classifications.
160.12(c) "Index maximization" means classifying a resident who could be assigned to
160.13more than one category, to the category with the highest case mix index.
160.14(d) "Minimum data set" means the assessment instrument specified by the Centers for
160.15Medicare and Medicaid Services and designated by the Minnesota Department of Health.
160.16(e) "Representative" means a person who is the resident's guardian or conservator,
160.17the person authorized to pay the nursing home expenses of the resident, a representative
160.18of the nursing home ombudsman's office whose assistance has been requested, or any
160.19other individual designated by the resident.
160.20(f) "Resource utilization groups" or "RUG" means the system for grouping a nursing
160.21facility's residents according to their clinical and functional status identified in data
160.22supplied by the facility's minimum data set.
160.23(g) "Activities of daily living" means grooming, dressing, bathing, transferring,
160.24mobility, positioning, eating, and toileting.
160.25(h) "Nursing facility level of care determination" means the assessment process
160.26that results in a determination of a resident's or prospective resident's need for nursing
160.27facility level of care as established in subdivision 11 for purposes of medical assistance
160.28payment of long-term care services for:
160.29(1) nursing facility services under section 256B.434 or 256B.441;
160.30(2) elderly waiver services under section 256B.0915;
160.31(3) CADI and TBI waiver services under section 256B.49; and
160.32(4) state payment of alternative care services under section 256B.0913.
160.33EFFECTIVE DATE.The section is effective July 1, 2011.

160.34    Sec. 2. Minnesota Statutes 2008, section 144.0724, subdivision 4, is amended to read:
161.1    Subd. 4. Resident assessment schedule. (a) A facility must conduct and
161.2electronically submit to the commissioner of health case mix assessments that conform
161.3with the assessment schedule defined by Code of Federal Regulations, title 42, section
161.4483.20 , and published by the United States Department of Health and Human Services,
161.5Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
161.6Instrument User's Manual, version 2.0, October 1995, and subsequent clarifications made
161.7in the Long-Term Care Assessment Instrument Questions and Answers, version 2.0,
161.8August 1996. The commissioner of health may substitute successor manuals or question
161.9and answer documents published by the United States Department of Health and Human
161.10Services, Centers for Medicare and Medicaid Services, to replace or supplement the
161.11current version of the manual or document.
161.12(b) The assessments used to determine a case mix classification for reimbursement
161.13include the following:
161.14(1) a new admission assessment must be completed by day 14 following admission;
161.15(2) an annual assessment must be completed within 366 days of the last
161.16comprehensive assessment;
161.17(3) a significant change assessment must be completed within 14 days of the
161.18identification of a significant change; and
161.19(4) the second quarterly assessment following either a new admission assessment,
161.20an annual assessment, or a significant change assessment, and all quarterly assessments
161.21beginning October 1, 2006. Each quarterly assessment must be completed within 92
161.22days of the previous assessment.
161.23(c) In addition to the assessments listed in paragraph (b), the assessments used to
161.24determine nursing facility level of care include the following:
161.25(1) preadmission screening completed under section 256B.0911, subdivision 4a,
161.26by a county, tribe, or managed care organization under contract with the Department
161.27of Human Services; and
161.28(2) a face-to-face long-term care consultation assessment completed under section
161.29256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care organization
161.30under contract with the Department of Human Services.
161.31EFFECTIVE DATE.The section is effective July 1, 2011.

161.32    Sec. 3. Minnesota Statutes 2008, section 144.0724, subdivision 8, is amended to read:
161.33    Subd. 8. Request for reconsideration of resident classifications. (a) The resident,
161.34or resident's representative, or the nursing facility or boarding care home may request that
161.35the commissioner of health reconsider the assigned reimbursement classification. The
162.1request for reconsideration must be submitted in writing to the commissioner within
162.230 days of the day the resident or the resident's representative receives the resident
162.3classification notice. The request for reconsideration must include the name of the
162.4resident, the name and address of the facility in which the resident resides, the reasons for
162.5the reconsideration, the requested classification changes, and documentation supporting
162.6the requested classification. The documentation accompanying the reconsideration request
162.7is limited to documentation which establishes that the needs of the resident at the time of
162.8the assessment justify a classification which is different than the classification established
162.9by the commissioner of health.
162.10(b) Upon request, the nursing facility must give the resident or the resident's
162.11representative a copy of the assessment form and the other documentation that was given
162.12to the commissioner of health to support the assessment findings. The nursing facility
162.13shall also provide access to and a copy of other information from the resident's record that
162.14has been requested by or on behalf of the resident to support a resident's reconsideration
162.15request. A copy of any requested material must be provided within three working days of
162.16receipt of a written request for the information. If a facility fails to provide the material
162.17within this time, it is subject to the issuance of a correction order and penalty assessment
162.18under sections 144.653 and 144A.10. Notwithstanding those sections, any correction order
162.19issued under this subdivision must require that the nursing facility immediately comply
162.20with the request for information and that as of the date of the issuance of the correction
162.21order, the facility shall forfeit to the state a $100 fine for the first day of noncompliance, and
162.22an increase in the $100 fine by $50 increments for each day the noncompliance continues.
162.23(c) In addition to the information required under paragraphs (a) and (b), a
162.24reconsideration request from a nursing facility must contain the following information: (i)
162.25the date the reimbursement classification notices were received by the facility; (ii) the date
162.26the classification notices were distributed to the resident or the resident's representative;
162.27and (iii) a copy of a notice sent to the resident or to the resident's representative. This
162.28notice must inform the resident or the resident's representative that a reconsideration of the
162.29resident's classification is being requested, the reason for the request, that the resident's
162.30rate will change if the request is approved by the commissioner, the extent of the change,
162.31that copies of the facility's request and supporting documentation are available for review,
162.32and that the resident also has the right to request a reconsideration. If the facility fails to
162.33provide the required information with the reconsideration request, the request must be
162.34denied, and the facility may not make further reconsideration requests on that specific
162.35reimbursement classification.
163.1(d) Reconsideration by the commissioner must be made by individuals not involved
163.2in reviewing the assessment, audit, or reconsideration that established the disputed
163.3classification. The reconsideration must be based upon the initial assessment and upon the
163.4information provided to the commissioner under paragraphs (a) and (b). If necessary for
163.5evaluating the reconsideration request, the commissioner may conduct on-site reviews.
163.6Within 15 working days of receiving the request for reconsideration, the commissioner
163.7shall affirm or modify the original resident classification. The original classification
163.8must be modified if the commissioner determines that the assessment resulting in the
163.9classification did not accurately reflect the needs or assessment characteristics of the
163.10resident at the time of the assessment. The resident and the nursing facility or boarding
163.11care home shall be notified within five working days after the decision is made. A decision
163.12by the commissioner under this subdivision is the final administrative decision of the
163.13agency for the party requesting reconsideration.
163.14(e) The resident classification established by the commissioner shall be the
163.15classification that applies to the resident while the request for reconsideration is pending.
163.16If a request for reconsideration applies to an assessment used to determine nursing facility
163.17level of care under subdivision 4, paragraph (c), the resident shall continue to be eligible
163.18for nursing facility level of care while the request for reconsideration is pending.
163.19(f) The commissioner may request additional documentation regarding a
163.20reconsideration necessary to make an accurate reconsideration determination.
163.21EFFECTIVE DATE.The section is effective July 1, 2011.

163.22    Sec. 4. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision
163.23to read:
163.24    Subd. 11. Nursing facility level of care. (a) For purposes of medical assistance
163.25payment of long-term care services, a recipient must be determined, using assessments
163.26defined in subdivision 4, to meet one of the following nursing facility level of care criteria:
163.27(1) the person needs the assistance of another person or constant supervision to
163.28begin and complete at least four activities of daily living;
163.29(2) the person needs the assistance of another person or constant supervision to begin
163.30and complete toileting, transferring, or positioning and the assistance cannot be scheduled;
163.31(3) the person has significant difficulty with memory, using information, daily
163.32decision making, or behavioral needs that require intervention;
163.33(4) the person has had a previous qualifying nursing facility stay of at least 90
163.34days; or
164.1(5) the person is determined to be at risk for nursing facility admission or
164.2readmission through a face-to-face long-term care consultation assessment as specified
164.3in section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or managed care
164.4organization under contract with the Department of Human Services. The person is
164.5considered at risk under this clause if the person currently lives alone or will live alone
164.6upon discharge and also meets one of the following criteria:
164.7(i) the person has experienced a fall resulting in a fracture;
164.8(ii) the person has been determined to be at risk of maltreatment or neglect,
164.9including self-neglect; or
164.10(iii) the person has a sensory impairment that substantially impacts functional ability
164.11and maintenance of a community residence.
164.12(b) The assessment used to establish medical assistance payment for nursing facility
164.13services must be the most recent assessment performed under subdivision 4, paragraph
164.14(b), that occurred no more than 90 calendar days before the effective date of medical
164.15assistance financial eligibility determination. In no case shall medical assistance payment
164.16for long-term care services occur prior to the date of the determination of nursing facility
164.17level of care.
164.18(c) The assessment used to establish medical assistance payment for services
164.19provided under sections 256B.0915 and 256B.49 and alternative care payment for services
164.20provided under section 256B.0913 must be the most recent face-to-face assessment
164.21performed under subdivision 4, paragraph (c), clause (2), that occurred no more than 60
164.22calendar days before the effective date of financial eligibility determination.
164.23EFFECTIVE DATE.The section is effective July 1, 2011.

164.24    Sec. 5. Minnesota Statutes 2008, section 144.0724, is amended by adding a subdivision
164.25to read:
164.26    Subd. 12. Appeal of nursing facility level of care determination. A resident or
164.27prospective resident whose level of care determination results in a denial of long-term care
164.28services can appeal the determination as outlined in section 256B.0911, subdivision 3a,
164.29paragraph (h), clause (7).
164.30EFFECTIVE DATE.The section is effective July 1, 2011.

164.31    Sec. 6. Minnesota Statutes 2008, section 144A.073, is amended by adding a
164.32subdivision to read:
164.33    Subd. 12. Extension of approval of moratorium exception projects.
164.34Notwithstanding subdivision 3, the commissioner of health shall extend project approval
165.1by an additional 18 months for an approved proposal for an exception to the nursing home
165.2licensure and certification moratorium if the proposal was approved under this section
165.3between July 1, 2007, and June 30, 2009.

165.4    Sec. 7. Minnesota Statutes 2008, section 144A.44, subdivision 2, is amended to read:
165.5    Subd. 2. Interpretation and enforcement of rights. These rights are established
165.6for the benefit of persons who receive home care services. "Home care services" means
165.7home care services as defined in section 144A.43, subdivision 3, and unlicensed personal
165.8care assistance services, including services covered by medical assistance under section
165.9256B.0625, subdivision 19a. A home care provider may not require a person to surrender
165.10these rights as a condition of receiving services. A guardian or conservator or, when there
165.11is no guardian or conservator, a designated person, may seek to enforce these rights. This
165.12statement of rights does not replace or diminish other rights and liberties that may exist
165.13relative to persons receiving home care services, persons providing home care services, or
165.14providers licensed under Laws 1987, chapter 378. A copy of these rights must be provided
165.15to an individual at the time home care services, including personal care assistance
165.16services, are initiated. The copy shall also contain the address and phone number of the
165.17Office of Health Facility Complaints and the Office of Ombudsman for Long-Term Care
165.18and a brief statement describing how to file a complaint with these offices. Information
165.19about how to contact the Office of Ombudsman for Long-Term Care shall be included in
165.20notices of change in client fees and in notices where home care providers initiate transfer
165.21or discontinuation of services.

165.22    Sec. 8. Minnesota Statutes 2008, section 245A.03, is amended by adding a subdivision
165.23to read:
165.24    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
165.25initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
165.262960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
165.279555.6265, under this chapter for a physical location that will not be the primary residence
165.28of the license holder for the entire period of licensure. If a license is issued during this
165.29moratorium, and the license holder changes the license holder's primary residence away
165.30from the physical location of the foster care license, the commissioner shall revoke the
165.31license according to section 245A.07. Exceptions to the moratorium include:
165.32(1) foster care settings that are required to be registered under chapter 144D;
165.33(2) foster care licenses replacing foster care licenses in existence on the effective
165.34date of this section and determined to be needed by the commissioner under paragraph (b);
166.1(3) new foster care licenses determined to be needed by the commissioner under
166.2paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center;
166.3(4) new foster care licenses determined to be needed by the commissioner under
166.4paragraph (b) for persons requiring hospital level of care; or
166.5(5) new foster care licenses determined to be needed by the commissioner for the
166.6transition of people from personal care assistance to the home and community-based
166.7services.
166.8(b) The commissioner shall determine the need for newly licensed foster care homes
166.9as defined under this subdivision. As part of the determination, the commissioner shall
166.10consider the availability of foster care capacity in the area which the licensee seeks to
166.11operate, and the recommendation of the local county board. The determination by the
166.12commissioner must be final. A determination of need is not required for a change in
166.13ownership at the same address.
166.14(c) The commissioner shall study the effects of the license moratorium under this
166.15subdivision and shall report back to the legislature by January 15, 2011.
166.16EFFECTIVE DATE.This section is effective the day following final enactment.

166.17    Sec. 9. Minnesota Statutes 2008, section 245A.11, is amended by adding a subdivision
166.18to read:
166.19    Subd. 8. Community residential setting license. (a) The commissioner shall
166.20establish provider standards for residential support services that integrate service standards
166.21and the residential setting under one license. The commissioner shall propose statutory
166.22language and an implementation plan for licensing requirements for residential support
166.23services to the legislature by January 15, 2011.
166.24(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
166.25for services in settings licensed as adult foster care under Minnesota Rules, parts
166.269555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to
166.272960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph
166.28(b), must be required to obtain a community residential setting license.

166.29    Sec. 10. Minnesota Statutes 2008, section 252.43, is amended to read:
166.30252.43 COMMISSIONER'S DUTIES.
166.31The commissioner shall supervise county boards' provision of day training and
166.32habilitation services to adults with developmental disabilities. The commissioner shall:
166.33(1) determine the need for day training and habilitation services under section 252.28;
167.1(2) approve payment rates established by a county under section 252.46, subdivision
167.21
;
167.3(3) adopt rules for the administration and provision of day training and habilitation
167.4services under sections 252.40 to 252.46 and sections 245A.01 to 245A.16 and 252.28,
167.5subdivision 2
;
167.6(4) (3) enter into interagency agreements necessary to ensure effective coordination
167.7and provision of day training and habilitation services;
167.8(5) (4) monitor and evaluate the costs and effectiveness of day training and
167.9habilitation services; and
167.10(6) (5) provide information and technical help to county boards and vendors in their
167.11administration and provision of day training and habilitation services.

167.12    Sec. 11. Minnesota Statutes 2008, section 252.46, is amended by adding a subdivision
167.13to read:
167.14    Subd. 1a. Day training and habilitation rates. The commissioner shall establish
167.15a statewide rate-setting methodology for all day training and habilitation services. The
167.16rate-setting methodology must abide by the principles of transparency and equitability
167.17across the state. The methodology must involve a uniform process of structuring rates for
167.18each service and must promote quality and participant choice.

167.19    Sec. 12. Minnesota Statutes 2008, section 256.01, is amended by adding a subdivision
167.20to read:
167.21    Subd. 29. State medical review team. (a) To ensure the timely processing of
167.22determinations of disability by the commissioner's state medical review team under
167.23sections 256B.055, subdivision 7, paragraph (b), and 256B.057, subdivision 9, paragraph
167.24(j), the commissioner shall review all medical evidence submitted by county agencies with
167.25a referral and seek additional information from providers, applicants, and enrollees to
167.26support the determination of disability where necessary.
167.27    (b) Prior to a denial or withdrawal of a requested determination of disability due
167.28to insufficient evidence, the commissioner shall (1) ensure that the missing evidence is
167.29necessary and appropriate to a determination of disability, and (2) assist applicants and
167.30enrollees to obtain the evidence, including, but not limited to, medical examinations
167.31and electronic medical records.
167.32(c) The commissioner shall provide the chairs of the legislative committees with
167.33jurisdiction over health and human services finance and budget the following information
167.34on the activities of the state medical review team by February 1, 2010, and annually
167.35thereafter:
168.1(1) the number of applications to the state medical review team that were denied,
168.2approved, or withdrawn;
168.3(2) the average length of time from receipt of the application to a decision;
168.4(3) the number of appeals and appeal results;
168.5(4) for applicants, their age, health coverage at the time of application, hospitalization
168.6history within three months of application, and whether an application for Social Security
168.7or Supplemental Security Income benefits is pending; and
168.8(5) specific information on the medical certification, licensure, or other credentials
168.9of the person or persons performing the medical review determinations and length of
168.10time in that position.

168.11    Sec. 13. [256.0281] INTERAGENCY DATA EXCHANGE.
168.12The Department of Human Services, the Department of Health, and the Office of the
168.13Ombudsman for Mental Health and Developmental Disabilities may establish interagency
168.14agreements governing the electronic exchange of data on providers and individuals
168.15collected, maintained, or used by each agency when such exchange is outlined by each
168.16agency in an interagency agreement to accomplish the purposes in clauses (1) to (4):
168.17(1) to improve provider enrollment processes for home and community-based
168.18services and state plan home care services;
168.19(2) to improve quality management of providers between state agencies;
168.20(3) to establish and maintain provider eligibility to participate as providers under
168.21Minnesota health care programs; and
168.22(4) to meet the quality assurance reporting requirements under federal law under
168.23section 1915(c) of the Social Security Act related to home and community-based waiver
168.24programs.
168.25Each interagency agreement must include provisions to ensure anonymity of individuals,
168.26including mandated reporters, and must outline the specific uses of and access to shared
168.27data within each agency. Electronic interfaces between source data systems developed
168.28under these interagency agreements must incorporate these provisions as well as other
168.29HIPPA provisions related to individual data.

168.30    Sec. 14. Minnesota Statutes 2008, section 256.975, subdivision 7, is amended to read:
168.31    Subd. 7. Consumer information and assistance; senior linkage. (a) The
168.32Minnesota Board on Aging shall operate a statewide information and assistance service
168.33to aid older Minnesotans and their families in making informed choices about long-term
168.34care options and health care benefits. Language services to persons with limited English
168.35language skills may be made available. The service, known as Senior LinkAge Line, must
169.1be available during business hours through a statewide toll-free number and must also
169.2be available through the Internet.
169.3    (b) The service must assist provide long-term care options counseling by assisting
169.4older adults, caregivers, and providers in accessing information about choices in long-term
169.5care services that are purchased through private providers or available through public
169.6options. The service must:
169.7    (1) develop a comprehensive database that includes detailed listings in both
169.8consumer- and provider-oriented formats;
169.9    (2) make the database accessible on the Internet and through other telecommunication
169.10and media-related tools;
169.11    (3) link callers to interactive long-term care screening tools and make these tools
169.12available through the Internet by integrating the tools with the database;
169.13    (4) develop community education materials with a focus on planning for long-term
169.14care and evaluating independent living, housing, and service options;
169.15    (5) conduct an outreach campaign to assist older adults and their caregivers in
169.16finding information on the Internet and through other means of communication;
169.17    (6) implement a messaging system for overflow callers and respond to these callers
169.18by the next business day;
169.19    (7) link callers with county human services and other providers to receive more
169.20in-depth assistance and consultation related to long-term care options;
169.21    (8) link callers with quality profiles for nursing facilities and other providers
169.22developed by the commissioner of health; and
169.23    (9) incorporate information about housing with services and consumer rights
169.24within the MinnesotaHelp.info network long-term care database to facilitate consumer
169.25comparison of services and costs among housing with services establishments and with
169.26other in-home services and to support financial self-sufficiency as long as possible.
169.27Housing with services establishments and their arranged home care providers shall provide
169.28information to the commissioner of human services that is consistent with information
169.29required by the commissioner of health under section 144G.06, the Uniform Consumer
169.30Information Guide price and other information requested by the commissioner of human
169.31services regarding rents and services. The commissioners of human services and health
169.32shall align the data elements required by this section, and section 144G.06, the Uniform
169.33Consumer Information Guide, to provide consumers standardized information and ease
169.34of comparison of long-term care options. The commissioner of human services shall
169.35provide the data to the Minnesota Board on Aging for inclusion in the MinnesotaHelp.info
169.36network long-term care database.
170.1    (c) The Minnesota Board on Aging shall conduct an evaluation of the effectiveness
170.2of the statewide information and assistance, and submit this evaluation to the legislature
170.3by December 1, 2002. The evaluation must include an analysis of funding adequacy, gaps
170.4in service delivery, continuity in information between the service and identified linkages,
170.5and potential use of private funding to enhance the service.

170.6    Sec. 15. Minnesota Statutes 2008, section 256B.055, subdivision 7, is amended to read:
170.7    Subd. 7. Aged, blind, or disabled persons. (a) Medical assistance may be paid for
170.8a person who meets the categorical eligibility requirements of the supplemental security
170.9income program or, who would meet those requirements except for excess income or
170.10assets, and who meets the other eligibility requirements of this section.
170.11(b) Following a determination that the applicant is not aged or blind and does not
170.12meet any other category of eligibility for medical assistance and has not been determined
170.13disabled by the Social Security Administration, applicants under this subdivision shall be
170.14referred to the commissioner's state medical review team for a determination of disability.
170.15Disability shall be determined according to the rules of title XVI and title XIX of the
170.16Social Security Act and pertinent rules and policies of the Social Security Administration.

170.17    Sec. 16. Minnesota Statutes 2008, section 256B.057, subdivision 9, is amended to read:
170.18    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid
170.19for a person who is employed and who:
170.20(1) meets the definition of disabled under the supplemental security income program;
170.21(2) is at least 16 but less than 65 years of age;
170.22(3) meets the asset limits in paragraph (c); and
170.23(4) effective November 1, 2003, pays a premium and other obligations under
170.24paragraph (e).
170.25Any spousal income or assets shall be disregarded for purposes of eligibility and premium
170.26determinations.
170.27(b) After the month of enrollment, a person enrolled in medical assistance under
170.28this subdivision who:
170.29(1) is temporarily unable to work and without receipt of earned income due to a
170.30medical condition, as verified by a physician, may retain eligibility for up to four calendar
170.31months; or
170.32(2) effective January 1, 2004, loses employment for reasons not attributable to the
170.33enrollee, may retain eligibility for up to four consecutive months after the month of job
170.34loss. To receive a four-month extension, enrollees must verify the medical condition or
171.1provide notification of job loss. All other eligibility requirements must be met and the
171.2enrollee must pay all calculated premium costs for continued eligibility.
171.3(c) For purposes of determining eligibility under this subdivision, a person's assets
171.4must not exceed $20,000, excluding:
171.5(1) all assets excluded under section 256B.056;
171.6(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
171.7Keogh plans, and pension plans; and
171.8(3) medical expense accounts set up through the person's employer.
171.9(d)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65
171.10earned income disregard. To be eligible, a person applying for medical assistance under
171.11this subdivision must have earned income above the disregard level.
171.12(2) Effective January 1, 2004, to be considered earned income, Medicare, Social
171.13Security, and applicable state and federal income taxes must be withheld. To be eligible,
171.14a person must document earned income tax withholding.
171.15(e)(1) A person whose earned and unearned income is equal to or greater than 100
171.16percent of federal poverty guidelines for the applicable family size must pay a premium
171.17to be eligible for medical assistance under this subdivision. The premium shall be based
171.18on the person's gross earned and unearned income and the applicable family size using a
171.19sliding fee scale established by the commissioner, which begins at one percent of income
171.20at 100 percent of the federal poverty guidelines and increases to 7.5 percent of income
171.21for those with incomes at or above 300 percent of the federal poverty guidelines. Annual
171.22adjustments in the premium schedule based upon changes in the federal poverty guidelines
171.23shall be effective for premiums due in July of each year.
171.24(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for
171.25medical assistance under this subdivision. An enrollee shall pay the greater of a $35
171.26premium or the premium calculated in clause (1).
171.27(3) Effective November 1, 2003, all enrollees who receive unearned income must
171.28pay one-half of one percent of unearned income in addition to the premium amount.
171.29(4) Effective November 1, 2003, for enrollees whose income does not exceed 200
171.30percent of the federal poverty guidelines and who are also enrolled in Medicare, the
171.31commissioner must reimburse the enrollee for Medicare Part B premiums under section
171.32256B.0625, subdivision 15 , paragraph (a).
171.33(5) Increases in benefits under title II of the Social Security Act shall not be counted
171.34as income for purposes of this subdivision until July 1 of each year.
172.1(f) A person's eligibility and premium shall be determined by the local county
172.2agency. Premiums must be paid to the commissioner. All premiums are dedicated to
172.3the commissioner.
172.4(g) Any required premium shall be determined at application and redetermined at
172.5the enrollee's six-month income review or when a change in income or household size is
172.6reported. Enrollees must report any change in income or household size within ten days
172.7of when the change occurs. A decreased premium resulting from a reported change in
172.8income or household size shall be effective the first day of the next available billing month
172.9after the change is reported. Except for changes occurring from annual cost-of-living
172.10increases, a change resulting in an increased premium shall not affect the premium amount
172.11until the next six-month review.
172.12(h) Premium payment is due upon notification from the commissioner of the
172.13premium amount required. Premiums may be paid in installments at the discretion of
172.14the commissioner.
172.15(i) Nonpayment of the premium shall result in denial or termination of medical
172.16assistance unless the person demonstrates good cause for nonpayment. Good cause exists
172.17if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
172.18D, are met. Except when an installment agreement is accepted by the commissioner,
172.19all persons disenrolled for nonpayment of a premium must pay any past due premiums
172.20as well as current premiums due prior to being reenrolled. Nonpayment shall include
172.21payment with a returned, refused, or dishonored instrument. The commissioner may
172.22require a guaranteed form of payment as the only means to replace a returned, refused,
172.23or dishonored instrument.
172.24(j) Following a determination that the applicant is not aged or blind and does not
172.25meet any other category of eligibility for medical assistance and has not been determined
172.26disabled by the Social Security Administration, applicants under this subdivision shall be
172.27referred to the commissioner's state medical review team for a determination of disability.
172.28Disability shall be determined according to the rules of title XVI and title XIX of the
172.29Social Security Act and pertinent rules and policies of the Social Security Administration.

172.30    Sec. 17. Minnesota Statutes 2008, section 256B.0625, subdivision 6a, is amended to
172.31read:
172.32    Subd. 6a. Home health services. Home health services are those services specified
172.33in Minnesota Rules, part 9505.0295 sections 256B.0651 and 256B.0653. Medical
172.34assistance covers home health services at a recipient's home residence. Medical assistance
172.35does not cover home health services for residents of a hospital, nursing facility, or
173.1intermediate care facility, unless the commissioner of human services has prior authorized
173.2skilled nurse visits for less than 90 days for a resident at an intermediate care facility for
173.3persons with developmental disabilities, to prevent an admission to a hospital or nursing
173.4facility or unless a resident who is otherwise eligible is on leave from the facility and the
173.5facility either pays for the home health services or forgoes the facility per diem for the
173.6leave days that home health services are used. Home health services must be provided by
173.7a Medicare certified home health agency. All nursing and home health aide services must
173.8be provided according to sections 256B.0651 to 256B.0656 256B.0653.

173.9    Sec. 18. Minnesota Statutes 2008, section 256B.0625, subdivision 7, is amended to
173.10read:
173.11    Subd. 7. Private duty nursing. Medical assistance covers private duty nursing
173.12services in a recipient's home. Recipients who are authorized to receive private duty
173.13nursing services in their home may use approved hours outside of the home during hours
173.14when normal life activities take them outside of their home. To use private duty nursing
173.15services at school, the recipient or responsible party must provide written authorization in
173.16the care plan identifying the chosen provider and the daily amount of services to be used at
173.17school. Medical assistance does not cover private duty nursing services for residents of a
173.18hospital, nursing facility, intermediate care facility, or a health care facility licensed by the
173.19commissioner of health, except as authorized in section 256B.64 for ventilator-dependent
173.20recipients in hospitals or unless a resident who is otherwise eligible is on leave from the
173.21facility and the facility either pays for the private duty nursing services or forgoes the
173.22facility per diem for the leave days that private duty nursing services are used. Total hours
173.23of service and payment allowed for services outside the home cannot exceed that which is
173.24otherwise allowed in an in-home setting according to sections 256B.0651 and 256B.0653
173.25256B.0654 to 256B.0656. All private duty nursing services must be provided according to
173.26the limits established under sections 256B.0651 and 256B.0653 to 256B.0656. Private
173.27duty nursing services may not be reimbursed if the nurse is the foster care provider of
173.28a recipient who is under age 18.

173.29    Sec. 19. Minnesota Statutes 2008, section 256B.0625, subdivision 8, is amended to
173.30read:
173.31    Subd. 8. Physical therapy. Medical assistance covers physical therapy, as
173.32described in section 148.65, and related services, including specialized maintenance
173.33therapy. Services provided by a physical therapy assistant shall be reimbursed at the
173.34same rate as services performed by a physical therapist when the services of the physical
173.35therapy assistant are provided under the direction of a physical therapist who is on the
174.1premises. Services provided by a physical therapy assistant that are provided under the
174.2direction of a physical therapist who is not on the premises shall be reimbursed at 65
174.3percent of the physical therapist rate.

174.4    Sec. 20. Minnesota Statutes 2008, section 256B.0625, subdivision 8a, is amended to
174.5read:
174.6    Subd. 8a. Occupational therapy. Medical assistance covers occupational therapy,
174.7as described in section 148.6404, and related services, including specialized maintenance
174.8therapy. Services provided by an occupational therapy assistant shall be reimbursed at
174.9the same rate as services performed by an occupational therapist when the services of
174.10the occupational therapy assistant are provided under the direction of the occupational
174.11therapist who is on the premises. Services provided by an occupational therapy assistant
174.12that are provided under the direction of an occupational therapist who is not on the
174.13premises shall be reimbursed at 65 percent of the occupational therapist rate.

174.14    Sec. 21. Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to
174.15read:
174.16    Subd. 19a. Personal care assistant services. Medical assistance covers personal
174.17care assistant services in a recipient's home. To qualify for personal care assistant services,
174.18a recipient must require assistance and be determined dependent in one activity of daily
174.19living as defined in section 256B.0659 or have a level I behavior as defined in section
174.20256B.0659. Recipients or responsible parties must be able to identify the recipient's needs,
174.21direct and evaluate task accomplishment, and provide for health and safety. Approved
174.22hours may be used outside the home when normal life activities take them outside the
174.23home. To use personal care assistant services at school, the recipient or responsible party
174.24must provide written authorization in the care plan identifying the chosen provider and the
174.25daily amount of services to be used at school. Total hours for services, whether actually
174.26performed inside or outside the recipient's home, cannot exceed that which is otherwise
174.27allowed for personal care assistant services in an in-home setting according to sections
174.28256B.0651 and 256B.0653 to 256B.0656. Medical assistance does not cover personal care
174.29assistant services for residents of a hospital, nursing facility, intermediate care facility,
174.30health care facility licensed by the commissioner of health, or unless a resident who is
174.31otherwise eligible is on leave from the facility and the facility either pays for the personal
174.32care assistant services or forgoes the facility per diem for the leave days that personal care
174.33assistant services are used. All personal care assistant services must be provided according
174.34to sections 256B.0651 and 256B.0653 to 256B.0656. Personal care assistant services may
174.35not be reimbursed if the personal care assistant is the spouse or legal paid guardian of the
175.1recipient or the parent of a recipient under age 18, or the responsible party or the foster
175.2care provider of a recipient who cannot direct the recipient's own care unless, in the case of
175.3a foster care provider, a county or state case manager visits the recipient as needed, but not
175.4less than every six months, to monitor the health and safety of the recipient and to ensure
175.5the goals of the care plan are met. Parents of adult recipients, adult children of the recipient
175.6or adult siblings of the recipient may be reimbursed for personal care assistant services,
175.7if they are granted a waiver under sections 256B.0651 and 256B.0653 to 256B.0656.
175.8Notwithstanding the provisions of section 256B.0655, subdivision 2, paragraph (b), clause
175.9(4) 256B.0659, the noncorporate legal unpaid guardian or conservator of an adult, who
175.10is not the responsible party and not the personal care provider organization, may be
175.11granted a hardship waiver under sections 256B.0651 and 256B.0653 to 256B.0656, to be
175.12reimbursed to provide personal care assistant services to the recipient if the guardian or
175.13conservator meet all criteria for a personal care assistant according to section 256B.0659,
175.14and shall not be considered to have a service provider interest for purposes of participation
175.15on the screening team under section 256B.092, subdivision 7.

175.16    Sec. 22. Minnesota Statutes 2008, section 256B.0625, subdivision 19c, is amended to
175.17read:
175.18    Subd. 19c. Personal care. (a) Medical assistance covers personal care assistant
175.19services provided by an individual who is qualified to provide the services according
175.20to subdivision 19a and sections 256B.0651 and 256B.0653 to 256B.0656, where the
175.21services have a statement of need by a physician, provided in accordance with a plan, and
175.22are supervised by the recipient or a qualified professional. The physician's statement of
175.23need for personal care assistant services shall be documented on a form approved by the
175.24commissioner and include the diagnosis or condition of the person that results in a need
175.25for personal care assistant services and be updated when the person's medical condition
175.26requires a change, but at least annually if the need for personal care assistant services is
175.27ongoing.
175.28    (b) "Qualified professional" means a mental health professional as defined in section
175.29245.462, subdivision 18 , or 245.4871, subdivision 27; or a registered nurse as defined in
175.30sections 148.171 to 148.285, or a licensed social worker as defined in section 148B.21; or
175.31qualified developmental disabilities professional under Code of Federal Regulations, title
175.3242. As part of the assessment, the county public health nurse will assist the recipient or
175.33responsible party to identify the most appropriate person to provide supervision of the
175.34personal care assistant. The qualified professional shall perform the duties described
175.35required in Minnesota Rules, part 9505.0335, subpart 4 section 256B.0659.

176.1    Sec. 23. Minnesota Statutes 2008, section 256B.0651, is amended to read:
176.2256B.0651 HOME CARE SERVICES.
176.3    Subdivision 1. Definitions. (a) "Activities of daily living" includes eating, toileting,
176.4grooming, dressing, bathing, transferring, mobility, and positioning For the purposes of
176.5sections 256B.0651 to 256B.0656 and 256B.0659, the terms in paragraphs (b) to (g)
176.6have the meanings given.
176.7(b) "Activities of daily living" has the meaning given in section 256B.0659,
176.8subdivision 1, paragraph (b).
176.9(b) (c) "Assessment" means a review and evaluation of a recipient's need for home
176.10care services conducted in person as required in section 256B.0911. Assessments for home
176.11health agency services shall be conducted by a home health agency nurse. Assessments
176.12for medical assistance home care services for developmental disability and alternative care
176.13services for developmentally disabled home and community-based waivered recipients
176.14may be conducted by the county public health nurse to ensure coordination and avoid
176.15duplication. Assessments must be completed on forms provided by the commissioner
176.16within 30 days of a request for home care services by a recipient or responsible party.
176.17(c) (d) "Home care services" means a health service, determined by the commissioner
176.18as medically necessary, that is ordered by a physician and documented in a service plan
176.19that is reviewed by the physician at least once every 60 days for the provision of home
176.20health services, or private duty nursing, or at least once every 365 days for personal care.
176.21Home care services are provided to the recipient at the recipient's residence that is a
176.22place other than a hospital or long-term care facility or as specified in section 256B.0625
176.23means medical assistance covered services that are home health agency services, including
176.24skilled nurse visits; home health aide visits; physical therapy, occupational therapy,
176.25respiratory therapy, and language-speech pathology therapy; private duty nursing; and
176.26personal care assistance.
176.27(e) "Home residence" means a residence owned or rented by the recipient either
176.28alone, with roommates of the recipient's choosing, or with an unpaid responsible party
176.29or legal representative; or a family foster home where the license holder lives with the
176.30recipient and is not paid to provide home care services for the recipient.
176.31(d) (f) "Medically necessary" has the meaning given in Minnesota Rules, parts
176.329505.0170 to 9505.0475.
176.33(e) "Telehomecare" means the use of telecommunications technology by a home
176.34health care professional to deliver home health care services, within the professional's
176.35scope of practice, to a patient located at a site other than the site where the practitioner
176.36is located.
177.1(g) "Ventilator-dependent" means an individual who receives mechanical ventilation
177.2for life support at least six hours per day and is expected to be or has been dependent on a
177.3ventilator for at least 30 consecutive days.
177.4    Subd. 2. Services covered. Home care services covered under this section and
177.5sections 256B.0653 256B.0652 to 256B.0656 and 256B.0659 include:
177.6(1) nursing services under section sections 256B.0625, subdivision 6a, and
177.7256B.0653
;
177.8(2) private duty nursing services under section sections 256B.0625, subdivision
177.97
, and 256B.0654;
177.10(3) home health services under section sections 256B.0625, subdivision 6a, and
177.11256B.0653
;
177.12(4) personal care assistant services under section sections 256B.0625, subdivision
177.1319a
, and 256B.0659;
177.14(5) supervision of personal care assistant services provided by a qualified
177.15professional under section sections 256B.0625, subdivision 19a, and 256B.0659;
177.16(6) qualified professional of personal care assistant services under the fiscal
177.17intermediary option as specified in section 256B.0655, subdivision 7;
177.18(7) (6) face-to-face assessments by county public health nurses for services under
177.19section sections 256B.0625, subdivision 19a, and 256B.0659; and
177.20(8) (7) service updates and review of temporary increases for personal care assistant
177.21services by the county public health nurse for services under section sections 256B.0625,
177.22subdivision 19a
, and 256B.0659.
177.23    Subd. 3. Noncovered home care services. The following home care services are
177.24not eligible for payment under medical assistance:
177.25(1) skilled nurse visits for the sole purpose of supervision of the home health aide;
177.26(2) a skilled nursing visit:
177.27(i) only for the purpose of monitoring medication compliance with an established
177.28medication program for a recipient; or
177.29(ii) to administer or assist with medication administration, including injections,
177.30prefilling syringes for injections, or oral medication set-up of an adult recipient, when as
177.31determined and documented by the registered nurse, the need can be met by an available
177.32pharmacy or the recipient is physically and mentally able to self-administer or prefill
177.33a medication;
177.34(3) home care services to a recipient who is eligible for covered services under the
177.35Medicare program or any other insurance held by the recipient;
177.36(4) services to other members of the recipient's household;
178.1(5) a visit made by a skilled nurse solely to train other home health agency workers;
178.2(6) any home care service included in the daily rate of the community-based
178.3residential facility where the recipient is residing;
178.4(7) nursing and rehabilitation therapy services that are reasonably accessible to a
178.5recipient outside the recipient's place of residence, excluding the assessment, counseling
178.6and education, and personal assistant care;
178.7(8) any home health agency service, excluding personal care assistant services and
178.8private duty nursing services, which are performed in a place other than the recipient's
178.9residence; and
178.10(9) Medicare evaluation or administrative nursing visits on dual-eligible recipients
178.11that do not qualify for Medicare visit billing.
178.12(1) services provided in a nursing facility, hospital, or intermediate care facility with
178.13exceptions in section 256B.0653;
178.14(2) services for the sole purpose of monitoring medication compliance with an
178.15established medication program for a recipient;
178.16(3) home care services for covered services under the Medicare program or any other
178.17insurance held by the recipient;
178.18(4) services to other members of the recipient's household;
178.19(5) any home care service included in the daily rate of the community-based
178.20residential facility where the recipient is residing;
178.21(6) nursing and rehabilitation therapy services that are reasonably accessible to a
178.22recipient outside the recipient's place of residence, excluding the assessment, counseling
178.23and education, and personal assistance care; or
178.24(7) Medicare evaluation or administrative nursing visits on dual-eligible recipients
178.25that do not qualify for Medicare visit billing.
178.26    Subd. 4. Prior Authorization; exceptions. All home care services above the limits
178.27in subdivision 11 must receive the commissioner's prior authorization before services
178.28begin, except when:
178.29(1) the home care services were required to treat an emergency medical condition
178.30that if not immediately treated could cause a recipient serious physical or mental disability,
178.31continuation of severe pain, or death. The provider must request retroactive authorization
178.32no later than five working days after giving the initial service. The provider must be able
178.33to substantiate the emergency by documentation such as reports, notes, and admission or
178.34discharge histories;
178.35(2) the home care services were provided on or after the date on which the recipient's
178.36eligibility began, but before the date on which the recipient was notified that the case was
179.1opened. Authorization will be considered if the request is submitted by the provider
179.2within 20 working days of the date the recipient was notified that the case was opened;
179.3a recipient's medical assistance eligibility has lapsed, is then retroactively reinstated,
179.4and an authorization for home care services is completed based on the date of a current
179.5assessment, eligibility, and request for authorization;
179.6(3) a third-party payor for home care services has denied or adjusted a payment.
179.7Authorization requests must be submitted by the provider within 20 working days of the
179.8notice of denial or adjustment. A copy of the notice must be included with the request;
179.9(4) the commissioner has determined that a county or state human services agency
179.10has made an error; or
179.11(5) the professional nurse determines an immediate need for up to 40 skilled nursing
179.12or home health aide visits per calendar year and submits a request for authorization within
179.1320 working days of the initial service date, and medical assistance is determined to be
179.14the appropriate payer. if a recipient enrolled in managed care experiences a temporary
179.15disenrollment from a health plan, the commissioner shall accept the current health plan
179.16authorization for personal care assistance services for up to 60 days. The request must
179.17be received within the first 30 days of the disenrollment. If the recipient's reenrollment
179.18in managed care is after the 60 days and before 90 days, the provider shall request an
179.19additional 30-day extension of the current health plan authorization, for a total limit of
179.2090 days from the time of disenrollment.
179.21    Subd. 5. Retroactive authorization. A request for retroactive authorization will be
179.22evaluated according to the same criteria applied to prior authorization requests.
179.23    Subd. 6. Prior Authorization. (a) The commissioner, or the commissioner's
179.24designee, shall review the assessment, service update, request for temporary services,
179.25request for flexible use option, service plan, and any additional information that is
179.26submitted. The commissioner shall, within 30 days after receiving a complete request,
179.27assessment, and service plan, authorize home care services as follows: provided in this
179.28section.
179.29(a) Home health services. (b) All Home health services provided by a home health
179.30aide including skilled nurse visits and home health aide visits must be prior authorized
179.31by the commissioner or the commissioner's designee. Prior Authorization must be based
179.32on medical necessity and cost-effectiveness when compared with other care options.
179.33The commissioner must receive the request for authorization of skilled nurse visits and
179.34home health aide visits within 20 working days of the start of service. When home health
179.35services are used in combination with personal care and private duty nursing, the cost of
179.36all home care services shall be considered for cost-effectiveness. The commissioner shall
180.1limit home health aide visits to no more than one visit each per day. The commissioner, or
180.2the commissioner's designee, may authorize up to two skilled nurse visits per day.
180.3(b) Ventilator-dependent recipients. (c) If the recipient is ventilator-dependent, the
180.4monthly medical assistance authorization for home care services shall not exceed what the
180.5commissioner would pay for care at the highest cost hospital designated as a long-term
180.6hospital under the Medicare program. For purposes of this paragraph, home care services
180.7means all direct care services provided in the home that would be included in the payment
180.8for care at the long-term hospital. "Ventilator-dependent" means an individual who
180.9receives mechanical ventilation for life support at least six hours per day and is expected
180.10to be or has been dependent for at least 30 consecutive days. Recipients who meet the
180.11definition of ventilator dependent and the EN home care rating and utilize a combination
180.12of home care services are limited up to a total of 24 hours of home care services per day.
180.13Additional hours may be authorized when a recipient's assessment indicates a need for two
180.14staff to perform activities. Additional time is limited to four hours per day.
180.15    Subd. 7. Prior Authorization; time limits. (a) The commissioner or the
180.16commissioner's designee shall determine the time period for which a prior an authorization
180.17shall be effective and, if flexible use has been requested, whether to allow the flexible use
180.18option. If the recipient continues to require home care services beyond the duration of
180.19the prior authorization, the home care provider must request a new prior authorization.
180.20A personal care provider agency must request a new personal care assistant services
180.21assessment, or service update if allowed, at least 60 days prior to the end of the current
180.22prior authorization time period. The request for the assessment must be made on a form
180.23approved by the commissioner. Under no circumstances, other than the exceptions
180.24in subdivision 4, shall a prior An authorization must be valid prior to the date the
180.25commissioner receives the request or for no more than 12 months.
180.26(b) A recipient who appeals a reduction in previously authorized home care
180.27services may continue previously authorized services, other than temporary services
180.28under subdivision 8, pending an appeal under section 256.045. The commissioner must
180.29provide a detailed explanation of why the authorized services are reduced in amount from
180.30those requested by the home care provider.
180.31    Subd. 8. Prior Authorization requests; temporary services. The agency nurse,
180.32the independently enrolled private duty nurse, or county public health nurse may request
180.33a temporary authorization for home care services by telephone. The commissioner may
180.34approve a temporary level of home care services based on the assessment, and service
180.35or care plan information, and primary payer coverage determination information as
180.36required. Authorization for a temporary level of home care services including nurse
181.1supervision is limited to the time specified by the commissioner, but shall not exceed
181.245 days, unless extended because the county public health nurse has not completed the
181.3required assessment and service plan, or the commissioner's determination has not been
181.4made. The level of services authorized under this provision shall have no bearing on a
181.5future prior authorization.
181.6    Subd. 9. Prior Authorization for foster care setting. (a) Home care services
181.7provided in an adult or child foster care setting must receive prior authorization by the
181.8department commissioner according to the limits established in subdivision 11.
181.9(b) The commissioner may not authorize:
181.10(1) home care services that are the responsibility of the foster care provider under
181.11the terms of the foster care placement agreement and administrative rules;
181.12(2) personal care assistant services when the foster care license holder is also
181.13the personal care provider or personal care assistant unless the recipient can direct the
181.14recipient's own care, or case management is provided as required in section 256B.0625,
181.15subdivision 19a
; or
181.16(3) personal care assistant services when the responsible party is an employee of, or
181.17under contract with, or has any direct or indirect financial relationship with the personal
181.18care provider or personal care assistant, unless case management is provided as required
181.19in section 256B.0625, subdivision 19a; or
181.20(4) (3) personal care assistant and private duty nursing services when the number
181.21of foster care residents licensed capacity is greater than four unless the county responsible
181.22for the recipient's foster placement made the placement prior to April 1, 1992, requests
181.23that personal care assistant and private duty nursing services be provided, and case
181.24management is provided as required in section 256B.0625, subdivision 19a.
181.25    Subd. 10. Limitation on payments. Medical assistance payments for home care
181.26services shall be limited according to subdivisions 4 to 12 and sections 256B.0654,
181.27subdivision 2
, and 256B.0655, subdivisions 3 and 4.
181.28    Subd. 11. Limits on services without prior authorization. A recipient may receive
181.29the following home care services during a calendar year:
181.30(1) up to two face-to-face assessments to determine a recipient's need for personal
181.31care assistant services;
181.32(2) one service update done to determine a recipient's need for personal care assistant
181.33services; and
181.34(3) up to nine face-to-face skilled nurse visits.
181.35    Subd. 12. Approval of home care services. The commissioner or the
181.36commissioner's designee shall determine the medical necessity of home care services, the
182.1level of caregiver according to subdivision 2, and the institutional comparison according to
182.2subdivisions 4 to 12 and sections 256B.0654, subdivision 2, and 256B.0655, subdivisions
182.33 and 4
256B.0659, the cost-effectiveness of services, and the amount, scope, and duration
182.4of home care services reimbursable by medical assistance, based on the assessment,
182.5primary payer coverage determination information as required, the service plan, the
182.6recipient's age, the cost of services, the recipient's medical condition, and diagnosis or
182.7disability. The commissioner may publish additional criteria for determining medical
182.8necessity according to section 256B.04.
182.9    Subd. 13. Recovery of excessive payments. The commissioner shall seek
182.10monetary recovery from providers of payments made for services which exceed the limits
182.11established in this section and sections 256B.0653 to 256B.0656 and 256B.0659. This
182.12subdivision does not apply to services provided to a recipient at the previously authorized
182.13level pending an appeal under section 256.045, subdivision 10.
182.14    Subd. 14. Referrals to Medicare providers required. Home care providers that
182.15do not participate in or accept Medicare assignment must refer and document the referral
182.16of dual-eligible recipients to Medicare providers when Medicare is determined to be the
182.17appropriate payer for services and supplies and equipment. Providers must be terminated
182.18from participation in the medical assistance program for failure to make these referrals.
182.19    Subd. 15. Quality assurance for program integrity. The commissioner shall
182.20maintain processes for monitoring ongoing program integrity including provider standards
182.21and training, consumer surveys, and random reviews of documentation.
182.22    Subd. 16. Oversight of enrolled providers. The commissioner shall establish
182.23an ongoing quality assurance process for home care services. The commissioner has
182.24the authority to request proof of documentation of meeting provider standards, quality
182.25standards of care, correct billing practices, and other information. Failure to provide access
182.26and information to demonstrate compliance with laws, rules, or policies must result in
182.27suspension, denial, or termination of the provider agency's enrollment with the department.

182.28    Sec. 24. Minnesota Statutes 2008, section 256B.0652, is amended to read:
182.29256B.0652 PRIOR AUTHORIZATION AND REVIEW OF HOME CARE
182.30SERVICES.
182.31    Subdivision 1. State coordination. The commissioner shall supervise the
182.32coordination of the prior authorization and review of home care services that are
182.33reimbursed by medical assistance.
183.1    Subd. 2. Duties. (a) The commissioner may contract with or employ qualified
183.2registered nurses and necessary support staff, or contract with qualified agencies, to
183.3provide home care prior authorization and review services for medical assistance
183.4recipients who are receiving home care services.
183.5(b) Reimbursement for the prior authorization function shall be made through the
183.6medical assistance administrative authority. The state shall pay the nonfederal share.
183.7The functions will be to:
183.8(1) assess the recipient's individual need for services required to be cared for safely
183.9in the community;
183.10(2) ensure that a service care plan that meets the recipient's needs is developed
183.11by the appropriate agency or individual;
183.12(3) ensure cost-effectiveness and nonduplication of medical assistance home care
183.13services;
183.14(4) recommend the approval or denial of the use of medical assistance funds to pay
183.15for home care services;
183.16(5) reassess the recipient's need for and level of home care services at a frequency
183.17determined by the commissioner; and
183.18(6) conduct on-site assessments when determined necessary by the commissioner
183.19and recommend changes to care plans that will provide more efficient and appropriate
183.20home care.; and
183.21(7) on the department's Web site:
183.22(i) provide a link to MinnesotaHelp.info for a list of enrolled home care agencies
183.23with the following information: main office address, contact information for the agency,
183.24counties in which services are provided, type of home care services provided, whether
183.25the personal care assistance choice option is offered, types of qualified professionals
183.26employed, number of personal care assistants employed, and data on staff turnover; and
183.27(ii) post data on home care services including information from both fee-for-service
183.28and managed care plans on recipients as available.
183.29(c) In addition, the commissioner or the commissioner's designee may:
183.30(1) review care service plans and reimbursement data for utilization of services that
183.31exceed community-based standards for home care, inappropriate home care services,
183.32medical necessity, home care services that do not meet quality of care standards, or
183.33unauthorized services and make appropriate referrals within the department or to other
183.34appropriate entities based on the findings;
183.35(2) assist the recipient in obtaining services necessary to allow the recipient to
183.36remain safely in or return to the community;
184.1(3) coordinate home care services with other medical assistance services under
184.2section 256B.0625;
184.3(4) assist the recipient with problems related to the provision of home care services;
184.4(5) assure the quality of home care services; and
184.5(6) assure that all liable third-party payers including, but not limited to, Medicare
184.6have been used prior to medical assistance for home care services, including but not
184.7limited to, home health agency, elected hospice benefit, waivered services, alternative care
184.8program services, and personal care services.
184.9(d) For the purposes of this section, "home care services" means medical assistance
184.10services defined under section 256B.0625, subdivisions 6a, 7, and 19a.
184.11    Subd. 3. Assessment and prior authorization process for persons receiving
184.12personal care assistance and developmental disabilities services. Effective January 1,
184.131996, For purposes of providing informed choice, coordinating of local planning decisions,
184.14and streamlining administrative requirements, the assessment and prior authorization
184.15process for persons receiving both home care and home and community-based waivered
184.16services for persons with developmental disabilities shall meet the requirements of
184.17sections 256B.0651 and 256B.0653 to 256B.0656 with the following exceptions:
184.18(a) Upon request for home care services and subsequent assessment by the public
184.19health nurse under sections 256B.0651 and 256B.0653 to 256B.0656, the public health
184.20nurse shall participate in the screening process, as appropriate, and, if home care
184.21services are determined to be necessary, participate in the development of a service plan
184.22coordinating the need for home care and home and community-based waivered services
184.23with the assigned county case manager, the recipient of services, and the recipient's legal
184.24representative, if any.
184.25(b) The public health nurse shall give prior authorization for home care services
184.26to the extent that home care services are:
184.27(1) medically necessary;
184.28(2) chosen by the recipient and their legal representative, if any, from the array of
184.29home care and home and community-based waivered services available;
184.30(3) coordinated with other services to be received by the recipient as described
184.31in the service plan; and
184.32(4) provided within the county's reimbursement limits for home care and home and
184.33community-based waivered services for persons with developmental disabilities.
184.34(c) If the public health agency is or may be the provider of home care services to the
184.35recipient, the public health agency shall provide the commissioner of human services with
185.1a written plan that specifies how the assessment and prior authorization process will be
185.2held separate and distinct from the provision of services.

185.3    Sec. 25. Minnesota Statutes 2008, section 256B.0653, is amended to read:
185.4256B.0653 HOME HEALTH AGENCY COVERED SERVICES.
185.5    Subdivision 1. Homecare; skilled nurse visits Scope. "Skilled nurse visits" are
185.6provided in a recipient's residence under a plan of care or service plan that specifies a level
185.7of care which the nurse is qualified to provide. These services are:
185.8(1) nursing services according to the written plan of care or service plan and accepted
185.9standards of medical and nursing practice in accordance with chapter 148;
185.10(2) services which due to the recipient's medical condition may only be safely and
185.11effectively provided by a registered nurse or a licensed practical nurse;
185.12(3) assessments performed only by a registered nurse; and
185.13(4) teaching and training the recipient, the recipient's family, or other caregivers
185.14requiring the skills of a registered nurse or licensed practical nurse. This section applies to
185.15home health agency services including, home health aide, skilled nursing visits, physical
185.16therapy, occupational therapy, respiratory therapy, and speech language pathology therapy.
185.17    Subd. 2. Telehomecare; skilled nurse visits Definitions. Medical assistance
185.18covers skilled nurse visits according to section 256B.0625, subdivision 6a, provided via
185.19telehomecare, for services which do not require hands-on care between the home care
185.20nurse and recipient. The provision of telehomecare must be made via live, two-way
185.21interactive audiovisual technology and may be augmented by utilizing store-and-forward
185.22technologies. Store-and-forward technology includes telehomecare services that do not
185.23occur in real time via synchronous transmissions, and that do not require a face-to-face
185.24encounter with the recipient for all or any part of any such telehomecare visit. Individually
185.25identifiable patient data obtained through real-time or store-and-forward technology must
185.26be maintained as health records according to sections 144.291 to 144.298. If the video
185.27is used for research, training, or other purposes unrelated to the care of the patient, the
185.28identity of the patient must be concealed. A communication between the home care nurse
185.29and recipient that consists solely of a telephone conversation, facsimile, electronic mail, or
185.30a consultation between two health care practitioners, is not to be considered a telehomecare
185.31visit. Multiple daily skilled nurse visits provided via telehomecare are allowed. Coverage
185.32of telehomecare is limited to two visits per day. All skilled nurse visits provided via
185.33telehomecare must be prior authorized by the commissioner or the commissioner's
185.34designee and will be covered at the same allowable rate as skilled nurse visits provided
185.35in-person. For the purposes of this section, the following terms have the meanings given.
186.1(a) "Assessment" means an evaluation of the recipient's medical need for home
186.2health agency services by a registered nurse or appropriate therapist that is conducted
186.3within 30 days of a request and as specified in Code of Federal Regulations, title 42,
186.4sections 484.1 to 494.55.
186.5(b) "Home care therapies" means occupational, physical, and respiratory therapy
186.6and speech-language pathology services, provided in the home by a Medicare-certified
186.7home health agency.
186.8(c) "Home health agency services" means services delivered in the recipient's home
186.9residence, except as specified in section 256B.0625, by a home health agency to a recipient
186.10with medical needs due to illness, disability, or physical conditions.
186.11(d) "Home health aide" means an employee of a home health agency who meets
186.12the requirements of Code of Federal Regulations, title 42, sections 484.1 to 494.55, and
186.13completes medically oriented tasks written in the plan of care for a recipient.
186.14(e) "Home health agency" means a home care provider agency that is
186.15Medicare-certified satisfying the requirements of Code of Federal Regulations, title 42,
186.16sections 484.1 to 494.55.
186.17(f) "Occupational therapy services" mean the services defined in section 148.6402.
186.18(g) "Physical therapy services" mean the services defined in section 148.65.
186.19(h) "Respiratory therapy services" mean the services defined in chapter 147C and
186.20Minnesota Rules, part 4668.0003, subpart 37.
186.21(i) "Speech-language pathology services" mean the services defined in section
186.22148.512.
186.23(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
186.24required due to a recipient's medical condition that can only be safely provided by a
186.25professional nurse to restore and maintain optimal health.
186.26(k) "Store-and-forward technology" means telehomecare services that do not occur
186.27in real time via synchronous transmissions such as diabetic and vital sign monitoring.
186.28(l) "Telehomecare" means the use of telecommunications technology via
186.29live, two-way interactive audiovisual technology which may be augmented by
186.30store-and-forward technology.
186.31(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to
186.32deliver a skilled nurse visit to a recipient located at a site other than the site where the
186.33nurse is located and is used in combination with face-to-face skilled nurse visits to
186.34adequately meet the recipient's needs.
186.35    Subd. 3. Therapies through home health agencies Home health aide visits.
186.36(a) Medical assistance covers physical therapy and related services, including specialized
187.1maintenance therapy. Services provided by a physical therapy assistant shall be
187.2reimbursed at the same rate as services performed by a physical therapist when the
187.3services of the physical therapy assistant are provided under the direction of a physical
187.4therapist who is on the premises. Services provided by a physical therapy assistant that are
187.5provided under the direction of a physical therapist who is not on the premises shall be
187.6reimbursed at 65 percent of the physical therapist rate. Direction of the physical therapy
187.7assistant must be provided by the physical therapist as described in Minnesota Rules, part
187.89505.0390, subpart 1, item B. The physical therapist and physical therapist assistant may
187.9not both bill for services provided to a recipient on the same day.
187.10(b) Medical assistance covers occupational therapy and related services, including
187.11specialized maintenance therapy. Services provided by an occupational therapy assistant
187.12shall be reimbursed at the same rate as services performed by an occupational therapist
187.13when the services of the occupational therapy assistant are provided under the direction of
187.14the occupational therapist who is on the premises. Services provided by an occupational
187.15therapy assistant under the direction of an occupational therapist who is not on the
187.16premises shall be reimbursed at 65 percent of the occupational therapist rate. Direction
187.17of the occupational therapy assistant must be provided by the occupational therapist as
187.18described in Minnesota Rules, part 9505.0390, subpart 1, item B. The occupational
187.19therapist and occupational therapist assistant may not both bill for services provided
187.20to a recipient on the same day.
187.21(a) Home health aide visits must be provided by a certified home health aide
187.22using a written plan of care that is updated in compliance with Medicare regulations.
187.23A home health aide shall provide hands-on personal care, perform simple procedures
187.24as an extension of therapy or nursing services, and assist in instrumental activities of
187.25daily living as defined in section 256B.0659. Home health aide visits must be provided
187.26in the recipient's home.
187.27(b) All home health aide visits must have authorization under section 256B.0652.
187.28The commissioner shall limit home health aide visits to no more than one visit per day
187.29per recipient.
187.30(c) Home health aides must be supervised by a registered nurse or an appropriate
187.31therapist when providing services that are an extension of therapy.
187.32    Subd. 4. Skilled nurse visit services. (a) Skilled nurse visit services must be
187.33provided by a registered nurse or a licensed practical nurse under the supervision of a
187.34registered nurse, according to the written plan of care and accepted standards of medical
187.35and nursing practice according to chapter 148. Skilled nurse visit services must be ordered
187.36by a physician and documented in a plan of care that is reviewed and approved by the
188.1ordering physician at least once every 60 days. All skilled nurse visits must be medically
188.2necessary and provided in the recipient's home residence except as allowed under section
188.3256B.0625, subdivision 6a.
188.4(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of
188.5up to two visits per day per recipient. All visits must be based on assessed needs.
188.6(c) Telehomecare skilled nurse visits are allowed when the recipient's health status
188.7can be accurately measured and assessed without a need for a face-to-face, hands-on
188.8encounter. All telehomecare skilled nurse visits must have authorization and are paid at
188.9the same allowable rates as face-to-face skilled nurse visits.
188.10(d) The provision of telehomecare must be made via live, two-way interactive
188.11audiovisual technology and may be augmented by utilizing store-and-forward
188.12technologies. Individually identifiable patient data obtained through real-time or
188.13store-and-forward technology must be maintained as health records according to sections
188.14144.291 to 144.298. If the video is used for research, training, or other purposes unrelated
188.15to the care of the patient, the identity of the patient must be concealed.
188.16(e) Authorization for skilled nurse visits must be completed under section
188.17256B.0652. A total of nine face-to-face skilled nurses visits per calendar year do not
188.18require authorization. All telehomecare skilled nurse visits require authorization.
188.19    Subd. 5. Home care therapies. (a) Home care therapies include the following:
188.20physical therapy, occupational therapy, respiratory therapy, and speech and language
188.21pathology therapy services.
188.22(b) Home care therapies must be:
188.23(1) provided in the recipient's residence after it has been determined the recipient is
188.24unable to access outpatient therapy;
188.25(2) prescribed, ordered, or referred by a physician and documented in a plan of care
188.26and reviewed, according to Minnesota Rules, part 9505.0390;
188.27(3) assessed by an appropriate therapist; and
188.28(4) provided by a Medicare-certified home health agency enrolled as a Medicaid
188.29provider agency.
188.30(c) Restorative and specialized maintenance therapies must be provided according to
188.31Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be
188.32used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
188.33(d) For both physical and occupational therapies, the therapist and the therapist's
188.34assistant may not both bill for services provided to a recipient on the same day.
188.35    Subd. 6. Noncovered home health agency services. The following are not eligible
188.36for payment under medical assistance as a home health agency service:
189.1(1) telehomecare skilled nurses services that is communication between the home
189.2care nurse and recipient that consists solely of a telephone conversation, facsimile,
189.3electronic mail, or a consultation between two health care practitioners;
189.4(2) the following skilled nurse visits:
189.5(i) for the purpose of monitoring medication compliance with an established
189.6medication program for a recipient;
189.7(ii) administering or assisting with medication administration, including injections,
189.8prefilling syringes for injections, or oral medication setup of an adult recipient, when,
189.9as determined and documented by the registered nurse, the need can be met by an
189.10available pharmacy or the recipient or a family member is physically and mentally able
189.11to self-administer or prefill a medication;
189.12(iii) services done for the sole purpose of supervision of the home health aide or
189.13personal care assistant;
189.14(iv) services done for the sole purpose to train other home health agency workers;
189.15(v) services done for the sole purpose of blood samples or lab draw or Synagis
189.16injections when the recipient is able to access these services outside the home; and
189.17(vi) Medicare evaluation or administrative nursing visits required by Medicare;
189.18(3) home health aide visits when the following activities are the sole purpose for the
189.19visit: companionship, socialization, household tasks, transportation, and education; and
189.20(4) home care therapies provided in other settings such as a clinic, day program, or as
189.21an inpatient or when the recipient can access therapy outside of the recipient's residence.

189.22    Sec. 26. Minnesota Statutes 2008, section 256B.0654, is amended to read:
189.23256B.0654 PRIVATE DUTY NURSING.
189.24    Subdivision 1. Definitions. (a) "Assessment" means a review and evaluation of a
189.25recipient's need for home care services conducted in person. Assessments for private duty
189.26nursing shall be conducted by a registered private duty nurse. Assessments for medical
189.27assistance home care services for developmental disabilities and alternative care services
189.28for developmentally disabled home and community-based waivered recipients may be
189.29conducted by the county public health nurse to ensure coordination and avoid duplication.
189.30(b) (a) "Complex and regular private duty nursing care" means:
189.31(1) complex care is private duty nursing services provided to recipients who are
189.32ventilator dependent or for whom a physician has certified that were it not for private
189.33duty nursing the recipient would meet meets the criteria for inpatient hospital intensive
189.34care unit (ICU) level of care; and
189.35(2) regular care is private duty nursing provided to all other recipients.
190.1(b) "Private duty nursing" means ongoing professional nursing services by a
190.2registered or licensed practical nurse including assessment, professional nursing tasks, and
190.3education, based on an assessment and physician orders to maintain or restore optimal
190.4health of the recipient.
190.5(c) "Private duty nursing agency" means a medical assistance enrolled provider
190.6licensed under chapter 144A to provide private duty nursing services.
190.7(d) "Regular private duty nursing" means nursing services provided to a recipient
190.8who is considered stable and not at an inpatient hospital intensive care unit level of care,
190.9but may have episodes of instability that are not life threatening.
190.10(e) "Shared private duty nursing" means the provision of nursing services by a
190.11private duty nurse to two recipients at the same time and in the same setting.
190.12    Subd. 2. Authorization; private duty nursing services. (a) All private duty
190.13nursing services shall be prior authorized by the commissioner or the commissioner's
190.14designee. Prior Authorization for private duty nursing services shall be based on
190.15medical necessity and cost-effectiveness when compared with alternative care options.
190.16The commissioner may authorize medically necessary private duty nursing services in
190.17quarter-hour units when:
190.18(1) the recipient requires more individual and continuous care than can be provided
190.19during a skilled nurse visit; or
190.20(2) the cares are outside of the scope of services that can be provided by a home
190.21health aide or personal care assistant.
190.22(b) The commissioner may authorize:
190.23(1) up to two times the average amount of direct care hours provided in nursing
190.24facilities statewide for case mix classification "K" as established by the annual cost report
190.25submitted to the department by nursing facilities in May 1992;
190.26(2) private duty nursing in combination with other home care services up to the total
190.27cost allowed under section 256B.0655, subdivision 4;
190.28(3) up to 16 hours per day if the recipient requires more nursing than the maximum
190.29number of direct care hours as established in clause (1) and the recipient meets the hospital
190.30admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540.
190.31(c) The commissioner may authorize up to 16 hours per day of medically necessary
190.32private duty nursing services or up to 24 hours per day of medically necessary private duty
190.33nursing services until such time as the commissioner is able to make a determination of
190.34eligibility for recipients who are cooperatively applying for home care services under
190.35the community alternative care program developed under section 256B.49, or until it is
190.36determined by the appropriate regulatory agency that a health benefit plan is or is not
191.1required to pay for appropriate medically necessary health care services. Recipients
191.2or their representatives must cooperatively assist the commissioner in obtaining this
191.3determination. Recipients who are eligible for the community alternative care program
191.4may not receive more hours of nursing under this section and sections 256B.0651,
191.5256B.0653 , 256B.0655, and 256B.0656, and 256B.0659 than would otherwise be
191.6authorized under section 256B.49.
191.7    Subd. 2a. Private duty nursing services. (a) Private duty nursing services must
191.8be used:
191.9(1) in the recipient's home or outside the home when normal life activities require;
191.10(2) when the recipient requires more individual and continuous care than can be
191.11provided during a skilled nurse visit; and
191.12(3) when the care required is outside of the scope of services that can be provided by
191.13a home health aide or personal care assistant.
191.14(b) Private duty nursing services must be:
191.15(1) assessed by a registered nurse on a form approved by the commissioner;
191.16(2) ordered by a physician and documented in a plan of care that is reviewed by the
191.17physician at least once every 60 days; and
191.18(3) authorized by the commissioner under section 256B.0652.
191.19    Subd. 2b. Noncovered private duty nursing services. Private duty nursing
191.20services do not cover the following:
191.21(1) nursing services by a nurse who is the foster care provider of a person who has
191.22not reached 18 years of age unless allowed under subdivision 4;
191.23(2) nursing services to more than two persons receiving shared private duty nursing
191.24services from a private duty nurse in a single setting; and
191.25(3) nursing services provided by a registered nurse or licensed practical nurse who is
191.26the recipient's legal guardian or related to the recipient as spouse, parent, or child, whether
191.27by blood, marriage, or adoption except as specified in section 256B.0652, subdivision 4.
191.28    Subd. 3. Shared private duty nursing care option. (a) Medical assistance
191.29payments for shared private duty nursing services by a private duty nurse shall be limited
191.30according to this subdivision. For the purposes of this section and sections 256B.0651,
191.31256B.0653, 256B.0655, and 256B.0656, "private duty nursing agency" means an agency
191.32licensed under chapter 144A to provide private duty nursing services. Unless otherwise
191.33provided in this subdivision, all other statutory and regulatory provisions relating to
191.34private duty nursing services apply to shared private duty nursing services. Nothing in
191.35this subdivision shall be construed to reduce the total number of private duty nursing
191.36hours authorized for an individual recipient.
192.1(b) Recipients of private duty nursing services may share nursing staff and the
192.2commissioner shall provide a rate methodology for shared private duty nursing. For two
192.3persons sharing nursing care, the rate paid to a provider shall not exceed 1.5 times the
192.4regular private duty nursing rates paid for serving a single individual by a registered nurse
192.5or licensed practical nurse. These rates apply only to situations in which both recipients
192.6are present and receive shared private duty nursing care on the date for which the service
192.7is billed. No more than two persons may receive shared private duty nursing services
192.8from a private duty nurse in a single setting.
192.9(c) (b) Shared private duty nursing care is the provision of nursing services by a
192.10private duty nurse to two medical assistance eligible recipients at the same time and in
192.11the same setting. This subdivision does not apply when a private duty nurse is caring for
192.12multiple recipients in more than one setting.
192.13(c) For the purposes of this subdivision, "setting" means:
192.14(1) the home residence or foster care home of one of the individual recipients as
192.15defined in section 256B.0651; or
192.16(2) a child care program licensed under chapter 245A or operated by a local school
192.17district or private school; or
192.18(3) an adult day care service licensed under chapter 245A; or
192.19(4) outside the home residence or foster care home of one of the recipients when
192.20normal life activities take the recipients outside the home.
192.21This subdivision does not apply when a private duty nurse is caring for multiple
192.22recipients in more than one setting.
192.23(d) The private duty nursing agency must offer the recipient the option of shared or
192.24one-on-one private duty nursing services. The recipient may withdraw from participating
192.25in a shared service arrangement at any time.
192.26(d) (e) The recipient or the recipient's legal representative, and the recipient's
192.27physician, in conjunction with the home health care private duty nursing agency, shall
192.28determine:
192.29(1) whether shared private duty nursing care is an appropriate option based on the
192.30individual needs and preferences of the recipient; and
192.31(2) the amount of shared private duty nursing services authorized as part of the
192.32overall authorization of nursing services.
192.33(e) (f) The recipient or the recipient's legal representative, in conjunction with the
192.34private duty nursing agency, shall approve the setting, grouping, and arrangement of
192.35shared private duty nursing care based on the individual needs and preferences of the
193.1recipients. Decisions on the selection of recipients to share services must be based on the
193.2ages of the recipients, compatibility, and coordination of their care needs.
193.3(f) (g) The following items must be considered by the recipient or the recipient's
193.4legal representative and the private duty nursing agency, and documented in the recipient's
193.5health service record:
193.6(1) the additional training needed by the private duty nurse to provide care to
193.7two recipients in the same setting and to ensure that the needs of the recipients are met
193.8appropriately and safely;
193.9(2) the setting in which the shared private duty nursing care will be provided;
193.10(3) the ongoing monitoring and evaluation of the effectiveness and appropriateness
193.11of the service and process used to make changes in service or setting;
193.12(4) a contingency plan which accounts for absence of the recipient in a shared private
193.13duty nursing setting due to illness or other circumstances;
193.14(5) staffing backup contingencies in the event of employee illness or absence; and
193.15(6) arrangements for additional assistance to respond to urgent or emergency care
193.16needs of the recipients.
193.17(g) The provider must offer the recipient or responsible party the option of shared or
193.18one-on-one private duty nursing services. The recipient or responsible party can withdraw
193.19from participating in a shared service arrangement at any time.
193.20(h) The private duty nursing agency must document the following in the
193.21health service record for each individual recipient sharing private duty nursing care
193.22The documentation for shared private duty nursing must be on a form approved by
193.23the commissioner for each individual recipient sharing private duty nursing. The
193.24documentation must be part of the recipient's health service record and include:
193.25(1) permission by the recipient or the recipient's legal representative for the
193.26maximum number of shared nursing care hours per week chosen by the recipient and
193.27permission for shared private duty nursing services provided in and outside the recipient's
193.28home residence;
193.29(2) permission by the recipient or the recipient's legal representative for shared
193.30private duty nursing services provided outside the recipient's residence;
193.31(3) permission by the recipient or the recipient's legal representative for others to
193.32receive shared private duty nursing services in the recipient's residence;
193.33(4) (2) revocation by the recipient or the recipient's legal representative of for the
193.34shared private duty nursing care authorization, or the shared care to be provided to others in
193.35the recipient's residence, or the shared private duty nursing services to be provided outside
193.36permission, or services provided to others in and outside the recipient's residence; and
194.1(5) (3) daily documentation of the shared private duty nursing services provided by
194.2each identified private duty nurse, including:
194.3(i) the names of each recipient receiving shared private duty nursing services
194.4together;
194.5(ii) the setting for the shared services, including the starting and ending times that
194.6the recipient received shared private duty nursing care; and
194.7(iii) notes by the private duty nurse regarding changes in the recipient's condition,
194.8problems that may arise from the sharing of private duty nursing services, and scheduling
194.9and care issues.
194.10(i) Unless otherwise provided in this subdivision, all other statutory and regulatory
194.11provisions relating to private duty nursing services apply to shared private duty nursing
194.12services.
194.13Nothing in this subdivision shall be construed to reduce the total number of private
194.14duty nursing hours authorized for an individual recipient under subdivision 2.
194.15(i) The commissioner shall provide a rate methodology for shared private duty
194.16nursing. For two persons sharing nursing care, the rate paid to a provider must not exceed
194.171.5 times the regular private duty nursing rates paid for serving a single individual by a
194.18registered nurse or licensed practical nurse. These rates apply only to situations in which
194.19both recipients are present and receive shared private duty nursing care on the date for
194.20which the service is billed.
194.21    Subd. 4. Hardship criteria; private duty nursing. (a) Payment is allowed for
194.22extraordinary services that require specialized nursing skills and are provided by parents
194.23of minor children, family foster parents, spouses, and legal guardians who are providing
194.24private duty nursing care under the following conditions:
194.25(1) the provision of these services is not legally required of the parents, family
194.26foster parents, spouses, or legal guardians;
194.27(2) the services are necessary to prevent hospitalization of the recipient; and
194.28(3) the recipient is eligible for state plan home care or a home and community-based
194.29waiver and one of the following hardship criteria are met:
194.30(i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to
194.31provide nursing care for the recipient; or
194.32(ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with
194.33less compensation to provide nursing care for the recipient; or
194.34(iii) the parent, spouse, or legal guardian takes a leave of absence without pay to
194.35provide nursing care for the recipient; or
195.1(iv) because of labor conditions, special language needs, or intermittent hours of
195.2care needed, the parent, spouse, or legal guardian is needed in order to provide adequate
195.3private duty nursing services to meet the medical needs of the recipient.
195.4(b) Private duty nursing may be provided by a parent, spouse, or legal guardian who
195.5is a nurse licensed in Minnesota. Private duty nursing services provided by a parent,
195.6spouse, or legal guardian cannot be used in lieu of nursing services covered and available
195.7under liable third-party payors, including Medicare. The private duty nursing provided by
195.8a parent, family foster parent, spouse, or legal guardian must be included in the service
195.9plan. Authorized skilled nursing services for a single recipient or recipients with the same
195.10residence and provided by the parent, family foster parent, spouse, or legal guardian
195.11may not exceed 50 percent of the total approved nursing hours, or eight hours per day,
195.12whichever is less, up to a maximum of 40 hours per week. A parent or parents, family
195.13foster parents, spouse, or legal guardian shall not provide more than 40 hours of services in
195.14a seven-day period. For parents, family foster parents, and legal guardians, 40 hours is the
195.15total amount allowed regardless of the number of children or adults who receive services.
195.16Nothing in this subdivision precludes the parent's, family foster parents', spouse's, or legal
195.17guardian's obligation of assuming the nonreimbursed family responsibilities of emergency
195.18backup caregiver and primary caregiver.
195.19(c) A parent, family foster parent, or a spouse may not be paid to provide private
195.20duty nursing care if:
195.21(1) the parent or spouse fails to pass a criminal background check according to
195.22chapter 245C, or if;
195.23(2) it has been determined by the home health care agency, the case manager, or the
195.24physician that the private duty nursing care provided by the parent, family foster parents,
195.25spouse, or legal guardian is unsafe; or
195.26(3) the parent, family foster parents, spouse, or legal guardian do not follow
195.27physician orders.
195.28(d) For purposes of this section, "assessment" means a review and evaluation of a
195.29recipient's need for home care services conducted in person. Assessments for private duty
195.30nursing must be conducted by a registered nurse.

195.31    Sec. 27. Minnesota Statutes 2008, section 256B.0655, subdivision 1b, is amended to
195.32read:
195.33    Subd. 1b. Assessment. "Assessment" means a review and evaluation of a recipient's
195.34need for home care services conducted in person. Assessments for personal care assistant
195.35services shall be conducted by the county public health nurse or a certified public
196.1health nurse under contract with the county. A face-to-face An in-person assessment
196.2must include: documentation of health status, determination of need, evaluation of
196.3service effectiveness, identification of appropriate services, service plan development
196.4or modification, coordination of services, referrals and follow-up to appropriate payers
196.5and community resources, completion of required reports, recommendation of service
196.6authorization, and consumer education. Once the need for personal care assistant
196.7services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654,
196.8and 256B.0656, the county public health nurse or certified public health nurse under
196.9contract with the county is responsible for communicating this recommendation to the
196.10commissioner and the recipient. A face-to-face assessment for personal care assistant
196.11services is conducted on those recipients who have never had a county public health
196.12nurse assessment. A face-to-face An in-person assessment must occur at least annually or
196.13when there is a significant change in the recipient's condition or when there is a change
196.14in the need for personal care assistant services. A service update may substitute for
196.15the annual face-to-face assessment when there is not a significant change in recipient
196.16condition or a change in the need for personal care assistant service. A service update
196.17may be completed by telephone, used when there is no need for an increase in personal
196.18care assistant services, and used for two consecutive assessments if followed by a
196.19face-to-face assessment. A service update must be completed on a form approved by the
196.20commissioner. A service update or review for temporary increase includes a review of
196.21initial baseline data, evaluation of service effectiveness, redetermination of service need,
196.22modification of service plan and appropriate referrals, update of initial forms, obtaining
196.23service authorization, and on going consumer education. Assessments must be completed
196.24on forms provided by the commissioner within 30 days of a request for home care services
196.25by a recipient or responsible party or personal care provider agency.

196.26    Sec. 28. Minnesota Statutes 2008, section 256B.0655, subdivision 4, is amended to
196.27read:
196.28    Subd. 4. Prior Authorization; personal care assistance and qualified
196.29professional. The commissioner, or the commissioner's designee, shall review the
196.30assessment, service update, request for temporary services, request for flexible use option,
196.31service plan, and any additional information that is submitted. The commissioner shall,
196.32within 30 days after receiving a complete request, assessment, and service plan, authorize
196.33home care services as follows:
196.34(1) (a) All personal care assistant services and, supervision by a qualified
196.35professional, if requested by the recipient, and additional services beyond the limits
197.1established in section 256B.0652, subdivision 11, must be prior authorized by the
197.2commissioner or the commissioner's designee before services begin except for the
197.3assessments established in section sections 256B.0651, subdivision 11, and 256B.0911.
197.4The authorization for personal care assistance and qualified professional services under
197.5section 256B.0659 must be completed within 30 calendar days after receiving a complete
197.6request.
197.7(b) The amount of personal care assistant services authorized must be based on
197.8the recipient's home care rating. The home care rating shall be determined by the
197.9commissioner or the commissioner's designee based on information submitted to the
197.10commissioner identifying the following:
197.11A child may not be found to be dependent in an activity of daily living if because
197.12of the child's age an adult would either perform the activity for the child or assist the
197.13child with the activity and the amount of assistance needed is similar to the assistance
197.14appropriate for a typical child of the same age. Based on medical necessity, the
197.15commissioner may authorize:
197.16(A) up to two times the average number of direct care hours provided in nursing
197.17facilities for the recipient's comparable case mix level; or
197.18(B) up to three times the average number of direct care hours provided in nursing
197.19facilities for recipients who have complex medical needs or are dependent in at least seven
197.20activities of daily living and need physical assistance with eating or have a neurological
197.21diagnosis; or
197.22(C) up to 60 percent of the average reimbursement rate, as of July 1, 1991, for care
197.23provided in a regional treatment center for recipients who have Level I behavior, plus any
197.24inflation adjustment as provided by the legislature for personal care service; or
197.25(D) up to the amount the commissioner would pay, as of July 1, 1991, plus any
197.26inflation adjustment provided for home care services, for care provided in a regional
197.27treatment center for recipients referred to the commissioner by a regional treatment center
197.28preadmission evaluation team. For purposes of this clause, home care services means
197.29all services provided in the home or community that would be included in the payment
197.30to a regional treatment center; or
197.31(E) up to the amount medical assistance would reimburse for facility care for
197.32recipients referred to the commissioner by a preadmission screening team established
197.33under section 256B.0911 or 256B.092; and
197.34(F) a reasonable amount of time for the provision of supervision by a qualified
197.35professional of personal care assistant services, if a qualified professional is requested by
197.36the recipient or responsible party.
198.1(2) The number of direct care hours shall be determined according to the annual cost
198.2report submitted to the department by nursing facilities. The average number of direct care
198.3hours, as established by May 1, 1992, shall be calculated and incorporated into the home
198.4care limits on July 1, 1992. These limits shall be calculated to the nearest quarter hour.
198.5(3) The home care rating shall be determined by the commissioner or the
198.6commissioner's designee based on information submitted to the commissioner by the
198.7county public health nurse on forms specified by the commissioner. The home care rating
198.8shall be a combination of current assessment tools developed under sections 256B.0911
198.9and 256B.501 with an addition for seizure activity that will assess the frequency and
198.10severity of seizure activity and with adjustments, additions, and clarifications that are
198.11necessary to reflect the needs and conditions of recipients who need home care including
198.12children and adults under 65 years of age. The commissioner shall establish these forms
198.13and protocols under this section and sections 256B.0651, 256B.0653, 256B.0654, and
198.14256B.0656 and shall use an advisory group, including representatives of recipients,
198.15providers, and counties, for consultation in establishing and revising the forms and
198.16protocols.
198.17(4) A recipient shall qualify as having complex medical needs if the care required is
198.18difficult to perform and because of recipient's medical condition requires more time than
198.19community-based standards allow or requires more skill than would ordinarily be required
198.20and the recipient needs or has one or more of the following:
198.21(A) daily tube feedings;
198.22(B) daily parenteral therapy;
198.23(C) wound or decubiti care;
198.24(D) postural drainage, percussion, nebulizer treatments, suctioning, tracheotomy
198.25care, oxygen, mechanical ventilation;
198.26(E) catheterization;
198.27(F) ostomy care;
198.28(G) quadriplegia; or
198.29(H) other comparable medical conditions or treatments the commissioner determines
198.30would otherwise require institutional care.
198.31(5) A recipient shall qualify as having Level I behavior if there is reasonable
198.32supporting evidence that the recipient exhibits, or that without supervision, observation, or
198.33redirection would exhibit, one or more of the following behaviors that cause, or have the
198.34potential to cause:
198.35(A) injury to the recipient's own body;
198.36(B) physical injury to other people; or
199.1(C) destruction of property.
199.2(6) Time authorized for personal care relating to Level I behavior in paragraph
199.3(5), clauses (A) to (C), shall be based on the predictability, frequency, and amount of
199.4intervention required.
199.5(7) A recipient shall qualify as having Level II behavior if the recipient exhibits on a
199.6daily basis one or more of the following behaviors that interfere with the completion of
199.7personal care assistant services under subdivision 2, paragraph (a):
199.8(A) unusual or repetitive habits;
199.9(B) withdrawn behavior; or
199.10(C) offensive behavior.
199.11(8) A recipient with a home care rating of Level II behavior in paragraph (7), clauses
199.12(A) to (C), shall be rated as comparable to a recipient with complex medical needs under
199.13paragraph (4). If a recipient has both complex medical needs and Level II behavior, the
199.14home care rating shall be the next complex category up to the maximum rating under
199.15paragraph (1), clause (B).
199.16(1) total number of dependencies of activities of daily living as defined in section
199.17256B.0659;
199.18(2) number of complex health-related functions as defined in section 256B.0659; and
199.19(3) number of behavior descriptions as defined in section 256B.0659.
199.20(c) The methodology to determine total time for personal care assistance services is
199.21based on the median paid units per day for each home care rating from fiscal year 2007
199.22data. Each home care rating has a base level of hours assigned. Additional time is added
199.23through the assessment and identification of the following:
199.24(1) 30 additional minutes per day for a dependency in each critical activity of daily
199.25living as defined in section 256B.0659;
199.26(2) 30 additional minutes per day for each complex health-related function as
199.27defined in section 256B.0659; and
199.28(3) 30 additional minutes per day for each behavior issue as defined in section
199.29256B.0659.
199.30(d) A limit of 96 units of qualified professional supervision may be authorized for
199.31each recipient receiving personal care assistance services. A request to the commissioner
199.32to exceed this total in a calendar year must be requested by the personal care provider
199.33agency on a form approved by the commissioner.

199.34    Sec. 29. [256B.0659] PERSONAL CARE ASSISTANCE PROGRAM.
200.1    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
200.2paragraphs (b) to (p) have the meanings given unless otherwise provided in text.
200.3(b) "Activities of daily living" means grooming, dressing, bathing, transferring,
200.4mobility, positioning, eating, and toileting.
200.5(c) "Behavior" means categories to determine the home care rating and is based on
200.6the criteria found in this section. Level I behavior means physical aggression to self or
200.7others and destruction of property.
200.8(d) "Complex health-related functions" means a category to determine the home care
200.9rating and is based on the criteria found in this section.
200.10(e) "Critical activities of daily living" means transferring, mobility, eating, and
200.11toileting.
200.12(f) "Dependency in activities of daily living" means a person requires assistance to
200.13begin or complete one or more of the activities of daily living.
200.14(g) "Health-related functions" means functions that can be delegated or assigned
200.15by a licensed health care professional under state law to be performed by a personal
200.16care assistant.
200.17(h) "Instrumental activities of daily living" means activities to include meal planning
200.18and preparation; basic assistance with paying bills; shopping for food, clothing, and
200.19other essential items; performing household tasks integral to the personal care assistance
200.20services; communication by telephone and other media; and traveling and participating
200.21in the community.
200.22(i) "Managerial official" has the same definition as described in Code of Federal
200.23Regulations, title 42, section 455.
200.24(j) "Qualified professional" means a professional providing supervision of personal
200.25care assistance services and staff as defined in section 256B.0625, subdivision 19c.
200.26(k) "Personal care assistance provider agency" means a medical assistance enrolled
200.27provider that provides or assists with providing personal care assistance services and
200.28includes personal care assistance provider organizations, personal care assistance choice
200.29agency, class A licensed nursing agency, and Medicare-certified home health agency.
200.30(l) "Personal care assistant" means an individual employed by a personal care
200.31assistance agency that provides personal care assistance services.
200.32(m) "Personal care assistance care plan" means a written description of personal
200.33care assistance services developed by the personal care assistance provider according
200.34to the service plan.
200.35(n) "Responsible party" means an individual who is capable of providing the support
200.36necessary to assist the recipient to live in the community.
201.1(o) "Self-administered medication" means medication taken orally, by injection or
201.2insertion, or applied topically without the need for assistance.
201.3(p) "Service plan" means a written summary of the assessment and description of the
201.4services needed by the recipient.
201.5    Subd. 2. Personal care assistance services; covered services. (a) The personal
201.6care assistance services eligible for payment include services and supports furnished
201.7to an individual, as needed, to assist in:
201.8(1) activities of daily living;
201.9(2) health-related procedures and tasks;
201.10(3) assistance with behavior needs; and
201.11(4) instrumental activities of daily living.
201.12(b) Activities of daily living include the following covered services:
201.13(1) dressing, including assistance with choosing, application, and changing of
201.14clothing and application of special appliances, wraps, or clothing;
201.15(2) grooming, including assistance with basic hair care, oral care, shaving, applying
201.16cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
201.17except for recipients who are diabetic or have poor circulation;
201.18(3) bathing, including assistance with basic personal hygiene and skin care;
201.19(4) eating, including assistance with hand washing and application of orthotics
201.20required for eating, transfers, and feeding;
201.21(5) transfers, including assistance with transferring the recipient from one seating or
201.22reclining area to another;
201.23(6) mobility, including assistance with ambulation, including use of a wheelchair.
201.24Mobility does not include providing transportation for a recipient;
201.25(7) positioning, including assistance with positioning or turning a recipient for
201.26necessary care and comfort; and
201.27(8) toileting, including assistance with helping recipient with bowel or bladder
201.28elimination and care including transfers, mobility, positioning, feminine hygiene, use of
201.29toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and
201.30adjusting clothing.
201.31(c) Health-related procedures or tasks include the following covered services:
201.32(1) range of motion and passive exercise to maintain a recipient's optimal level of
201.33strength and muscle functioning;
201.34(2) assistance with self-administered medication as defined by this section, including
201.35reminders to take medication, bringing medication to the recipient, and assistance with
201.36opening medication under the direction of the recipient or responsible party;
202.1(3) interventions for seizure disorders, including monitoring and observation; and
202.2(4) other activities considered within the scope of the personal care service and
202.3meeting the definition of health-related procedures or tasks under this section.
202.4(d) A personal care assistant may perform health-related procedures and tasks
202.5associated with the complex health-related needs of a recipient if the tasks meet the
202.6definition of health-related procedures and tasks under this section and the personal care
202.7assistant is trained by a qualified professional and demonstrates competency to safely
202.8complete the task. Delegation of health-related procedures and tasks and all training must
202.9be documented in the personal care assistance care plan and the recipient's and personal
202.10care assistant's files.
202.11(e) For a personal care assistant to provide the health-related procedures and tasks of
202.12tracheostomy suctioning and services to recipients on ventilator support there must be:
202.13(1) delegation and training by a registered nurse, certified or licensed respiratory
202.14therapist, or a physician;
202.15(2) utilization of clean rather than sterile procedure;
202.16(3) specialized training about the health-related functions and equipment, including
202.17ventilator operation and maintenance;
202.18(4) individualized training regarding the needs of the recipient; and
202.19(5) supervision by a qualified professional who is a registered nurse.
202.20(f) A personal care assistant may observe and redirect the recipient for episodes
202.21where there is a need for redirection due to behaviors. Training of the personal care
202.22assistant must occur based on the needs of the recipient, the personal care assistance care
202.23plan, and any other support services provided.
202.24(g) Instrumental activities of daily living under subdivision 1, paragraph (h), include
202.25accompanying a recipient to obtain medical diagnosis or treatment when assistance is
202.26required by the recipient during the appointment.
202.27    Subd. 3. Noncovered personal care assistance services. (a) Personal care
202.28assistance services are not eligible for medical assistance payment under this section
202.29when provided:
202.30(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
202.31guardian, licensed foster provider, or responsible party;
202.32(2) in lieu of other staffing options in a residential or child care setting;
202.33(3) solely as a child care or babysitting service; or
202.34(4) without authorization by the commissioner or the commissioner's designee.
202.35(b) The following personal care services are not eligible for medical assistance
202.36payment under this section when provided in residential settings:
203.1(1) when the provider of home care services who is not related by blood, marriage,
203.2or adoption owns or otherwise controls the living arrangement, including licensed or
203.3unlicensed services; or
203.4(2) when personal care assistance services are the responsibility of a residential or
203.5program license holder under the terms of a service agreement and administrative rules.
203.6(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
203.7for medical assistance reimbursement for personal care assistance services under this
203.8section include:
203.9(1) sterile procedures;
203.10(2) injections of fluids and medications into veins, muscles, or skin;
203.11(3) instrumental activities of daily living without a dependency in at least two
203.12activities of daily living;
203.13(4) home maintenance or chore services;
203.14(5) homemaker services not an integral part of assessed personal care assistance
203.15services needed by a recipient;
203.16(6) application of restraints or implementation of procedures under section 245.825;
203.17(7) instrumental activities of daily living for children under the age of 18; and
203.18(8) assessments for personal care assistance services by personal care assistance
203.19provider agencies or by independently enrolled registered nurses.
203.20    Subd. 4. Assessment for personal care assistance services. (a) An assessment as
203.21defined in section 256B.0911 must be completed for personal care assistance services.
203.22(b) The following conditions apply to the assessment:
203.23(1) a person must be assessed as dependent in an activity of daily living based
203.24on the person's need, on a daily basis, for:
203.25(i) cueing or supervision to complete the task; or
203.26(ii) hands-on assistance to complete the task;
203.27(2) an adult may not be found to be dependent in an activity of daily living because
203.28of individual choices; and
203.29(3) a child may not be found to be dependent in an activity of daily living if because
203.30of the child's age an adult would either perform the activity for the child or assist the child
203.31with the activity. Assistance needed is the assistance appropriate for a typical child of
203.32the same age.
203.33(c) Assessment for complex health-related functions must meet the criteria in
203.34this paragraph. During the assessment process, a recipient qualifies as having complex
203.35health-related functions if the recipient has one or more of the interventions that are
204.1ordered by a physician, specified in a personal care assistance care plan, and found in
204.2the following:
204.3(1) tube feedings requiring:
204.4(i) a gastro/jejunostomy tube; or
204.5(ii) continuous tube feeding lasting longer than 12 hours per day;
204.6(2) wounds described as:
204.7    (i) stage III or stage IV;
204.8    (ii) multiple wounds;
204.9    (iii) requiring sterile or clean dressing changes or a wound vac; or
204.10    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
204.11specialized care;
204.12    (3) parenteral therapy described as:
204.13    (i) IV therapy more than two times per week lasting longer than four hours for
204.14each treatment; or
204.15    (ii) total parenteral nutrition (TPN) daily;
204.16    (4) respiratory interventions including:
204.17    (i) oxygen required more than eight hours per day;
204.18    (ii) respiratory vest more than one time per day;
204.19    (iii) bronchial drainage treatments more than two times per day;
204.20    (iv) sterile or clean suctioning more than six times per day;
204.21    (v) dependence on another to apply respiratory ventilation augmentation devises
204.22such as BiPAP and CPAP; and
204.23    (vi) ventilator dependence under section 256B.0652;
204.24    (5) insertion and maintenance of catheter including:
204.25(i) sterile catheter changes more than one time per month;
204.26(ii) clean self-catheterization more than six times per day; or
204.27(iii) bladder irrigations;
204.28(6) bowel program more than two times per week requiring more than 30 minutes to
204.29perform each time;
204.30(7) neurological intervention including:
204.31(i) seizures more than two times per week and requiring significant physical
204.32assistance to maintain safety; or
204.33(ii) swallowing disorders diagnosed by a physician and requiring specialized
204.34assistance from another on a daily basis; and
204.35(8) other congenital or acquired diseases creating a need for significantly increased
204.36direct hands-on assistance and interventions in six to eight activities of daily living.
205.1(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
205.2qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
205.3assistance at least four times per week and shows one or more of the following behaviors:
205.4(1) physical aggression towards self, others, or property that requires immediate
205.5response of another;
205.6(2) increased vulnerability due to cognitive deficits or socially inappropriate
205.7behavior; or
205.8(3) verbally aggressive and resistive to care.
205.9    Subd. 5. Service and support planning. (a) The assessor, with the recipient or
205.10responsible party, shall review the assessment information and determine referrals for
205.11other payers, services, and community supports as appropriate.
205.12(b) The recipient must be referred for evaluation, services, or supports that are
205.13appropriate to help meet the recipient's needs including, but not limited to, the following
205.14circumstances:
205.15(1) when there is another payer who is responsible to provide the service to meet
205.16the recipient's needs;
205.17(2) when the recipient qualifies for assistance with behaviors under this section,
205.18a referral into the mental health system for a mental health diagnostic and functional
205.19assessment must be completed;
205.20(3) when the recipient is eligible for medical assistance and meets medical assistance
205.21eligibility for a home health aide or skilled nurse visit;
205.22(4) when the recipient would benefit from an evaluation for another service; and
205.23(5) when there is a more appropriate service to meet the assessed needs.
205.24    (c) The reimbursement rates for public health nurse visits that relate to the provision
205.25of personal care assistance services under this section and section 256B.0625, subdivision
205.2619a
, are:
205.27    (1) $210.50 for a face-to-face assessment visit;
205.28    (2) $105.25 for each service update; and
205.29    (3) $105.25 for each request for a temporary service increase.
205.30    (d) The rates specified in paragraph (c) must be adjusted to reflect provider rate
205.31increases for personal care assistance services that are approved by the legislature for the
205.32fiscal year ending June 30, 2000, and subsequent fiscal years. Any requirements applied
205.33by the legislature to provider rate increases for personal care assistance services also
205.34apply to adjustments under this paragraph.
205.35    (e) Effective July 1, 2008, the payment rate for an assessment under this section and
205.36section 256B.0651 shall be reduced by 25 percent when the assessment is not completed
206.1on time and the service agreement documentation is not submitted in time to continue
206.2services. The commissioner shall reduce the amount of the claim for those assessments
206.3that are not submitted on time.
206.4    Subd. 6. Service plan. The service plan must be completed by the assessor with the
206.5recipient and responsible party on a form determined by the commissioner and include
206.6a summary of the assessment with a description of the need, authorized amount, and
206.7expected outcomes and goals of personal care assistance services. The recipient and
206.8the provider chosen by the recipient or responsible party must be given a copy of the
206.9completed service plan. The recipient or responsible party must be given information by
206.10the assessor about the options in the personal care assistance program to allow for review
206.11and decision making.
206.12    Subd. 7. Personal care assistance care plan. (a) Each recipient must have a current
206.13personal care assistance care plan based on the service plan in subdivision 21 that is
206.14developed by the qualified professional with the recipient and responsible party. A copy of
206.15the most current personal care assistance care plan is required to be in the recipient's home
206.16and in the recipient's file at the provider agency.
206.17(b) The personal care assistance care plan must have the following components:
206.18(1) start and end date of the care plan;
206.19(2) recipient demographic information, including name and telephone number;
206.20(3) emergency numbers and procedures, including a backup plan;
206.21(4) name of responsible party and instructions for contact;
206.22(5) description of the recipient's individualized needs for assistance with activities of
206.23daily living, instrumental activities of daily living, health-related tasks, and behaviors; and
206.24(6) dated signatures of recipient or responsible party and qualified professional.
206.25(c) The personal care assistance care plan must have instructions and comments
206.26about the recipient's needs for assistance and any special instructions or procedures
206.27required. The month-to-month plan for the use of personal care assistance services is part
206.28of the personal care assistance care plan. The personal care assistance care plan must
206.29be completed within the first week after start of services with a personal care provider
206.30agency and must be updated as needed when there is a change in need for personal care
206.31assistance services. A new personal care assistance care plan is required annually at the
206.32time of the reassessment.
206.33    Subd. 8. Communication with recipient's physician. The personal care assistance
206.34program requires communication with the recipient's physician about a recipient's assessed
206.35needs for personal care assistance services. The commissioner shall work with the state
206.36medical director to develop options for communication with the recipient's physician.
207.1    Subd. 9. Responsible party; generally. (a) "Responsible party" means an
207.2individual who is capable of providing the support necessary to assist the recipient to live
207.3in the community.
207.4(b) A responsible party must be 18 years of age, actively participate in planning and
207.5directing of personal care assistance services, and attend all assessments for the recipient.
207.6(c) A responsible party must not have a direct or indirect financial interest in care
207.7provided to the recipient and must not be the:
207.8(1) personal care assistant;
207.9(2) home care provider agency staff; or
207.10(3) county staff acting as part of employment.
207.11(d) A licensed family foster parent who lives with the recipient may be the
207.12responsible party as long as the foster parent does not also have a direct or indirect
207.13financial interest in the provision of personal care assistance services.
207.14(e) A responsible party is required when:
207.15(1) the person is a minor according to section 524.5-102, subdivision 10;
207.16(2) the person is an incapacitated adult according to section 524.5-102, subdivision
207.176, resulting in a court-appointed guardian; or
207.18(3) the assessment according to section 256B.0911 determines that the recipient is in
207.19need of a responsible party to direct the recipient's care.
207.20(f) There may be two persons designated as the responsible party for reasons such
207.21as divided households and court-ordered custodies. Each person named as responsible
207.22party must meet the program criteria and responsibilities.
207.23(g) The recipient or the recipient's legal representative shall appoint a responsible
207.24party if necessary to direct and supervise the care provided to the recipient. The
207.25responsible party must be identified at the time of assessment and listed on the recipient's
207.26service agreement and personal care assistance care plan.
207.27    Subd. 10. Responsible party; duties; delegation. (a) A responsible party with a
207.28personal care assistance provider agency shall enter into a written agreement, on a form
207.29determined by the commissioner, to perform the following duties:
207.30(1) be available while care is provided in a method agreed upon by the individual
207.31or the individual's legal representative and documented in the recipient's personal care
207.32assistance care plan;
207.33(2) monitor personal care assistance services to ensure the recipient's personal care
207.34assistance care plan is being followed; and
207.35(3) review and sign personal care assistance time sheets after services are provided
207.36to provide verification that personal care assistance services were provided.
208.1Failure to provide the support required by the recipient must result in a referral to the
208.2county common entry point.
208.3(b) Responsible parties who are parents of minors or guardians of minors or
208.4incapacitated persons may delegate the responsibility to another adult who is not the
208.5personal care assistant during a temporary absence of at least 24 hours but not more
208.6than six months. The person delegated as a responsible party must be able to meet the
208.7definition of the responsible party, except that the delegated responsible party is required
208.8to reside with the recipient only while serving as the responsible party. The responsible
208.9party must ensure that the delegate performs the functions of the responsible party, is
208.10identified at the time of the assessment, and is listed on the personal care assistance
208.11care plan. The responsible party must communicate to the personal care assistance
208.12provider agency about the need for a delegate responsible party, including the name of the
208.13delegated responsible party, dates the delegated responsible party will be acting as the
208.14responsible party, and contact numbers.
208.15    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
208.16must meet the following requirements:
208.17(1) be at least 18 years of age and if 16 or 17 years of age only if:
208.18(i) supervised by a qualified professional every 60 days; and
208.19(ii) employed by only one personal care assistance provider agency responsible
208.20for compliance with current labor laws;
208.21(2) be employed by a personal care assistance provider agency;
208.22(3) enroll with the department as a non-pay-to provider after clearing a background
208.23study. Before a personal care assistant provides services, the personal care assistance
208.24provider agency must initiate a background study on the personal care assistant under
208.25chapter 245C, and the personal care assistance provider agency must have received a
208.26notice from the commissioner that the personal care assistant is:
208.27(i) not disqualified under section 245C.14; or
208.28(ii) is disqualified, but the personal care assistant has received a set aside of the
208.29disqualification under section 245C.22;
208.30(4) be able to effectively communicate with the recipient and personal care
208.31assistance provider agency;
208.32(5) be able to provide covered personal care assistance services according to the
208.33recipient's personal care assistance care plan, respond appropriately to recipient needs,
208.34and report changes in the recipient's condition to the supervising qualified professional