1.1.................... moves to amend H.F. No. 927, the delete everything amendment
1.2(A11-0177), as follows:
1.3Page 6, delete section 10
1.4Page 7, delete section 11
1.5Page 6, after line 32, insert:

1.8    Subdivision 1. Implementation of a quality rating and improvement system.
1.9(a) The commissioner of human services shall phase in the implementation of a voluntary
1.10quality rating and improvement system for child care centers. The system must build
1.11on the quality rating and improvement system in use in fiscal year 2011. The program
1.12must be designed to ensure that Minnesota's children have access to high-quality services
1.13in child care centers so that children entering kindergarten are ready for kindergarten
1.14by 2020, as stated in section 124D.142.
1.15(b) The quality rating and improvement system must:
1.16(1) set research-based program standards and quality indicators designed to improve
1.17the educational outcomes of children so that they are ready for school;
1.18(2) assess program quality using the program standards and indicators and issue
1.19quality ratings to participating child care centers;
1.20(3) establish a database to collect, store, analyze, and report data for quality ratings
1.21and to track improvement supports and incentives to programs. The database must
1.22incorporate data from or be linked to related databases, such as those maintained by the
1.23child care resource and referral system;
1.24(4) provide rating information to consumers to facilitate informed choices of child
1.25care centers;
1.26(5) provide information to child care centers to enable them to measure the results
1.27of their quality improvement efforts; and
2.1(6) provide supports to participating programs to help them improve their quality
2.3(c) A program that is accredited or has otherwise been evaluated may submit
2.4information to the commissioner of human services in the form and manner prescribed by
2.5the commissioner and may be rated on the basis of that information.
2.6(d) A program that has previously been rated under this section or has been rated
2.7through the Parent Aware pilot program may continue with that rating for two years.
2.8    Subd. 2. Phase-in of quality rating and improvement system. The commissioner
2.9must continue the quality rating and improvement system in use in fiscal year 2011 in the
2.10original pilot areas and must expand the system to at least two new, rural geographic
2.11locations by June 30, 2012. The commissioner must use a competitive process to select
2.12the new pilot areas by targeting areas that meet one or more of the following criteria:
2.13existence of a local early care and education collaborative, existence of local matching
2.14funds, and demonstration of local support from community-based early learning and care
2.15programs. The commissioner must add one new pilot area per year and work toward
2.16statewide availability of ratings by 2015."
2.17Page 16, delete section 19 and insert:

2.18    "Sec. 19. Minnesota Statutes 2010, section 256I.04, subdivision 2b, is amended to read:
2.19    Subd. 2b. Group residential housing agreements. (a) Agreements between county
2.20agencies and providers of group residential housing must be in writing and must specify
2.21the name and address under which the establishment subject to the agreement does
2.22business and under which the establishment, or service provider, if different from the
2.23group residential housing establishment, is licensed by the Department of Health or the
2.24Department of Human Services; the specific license or registration from the Department
2.25of Health or the Department of Human Services held by the provider and the number
2.26of beds subject to that license; the address of the location or locations at which group
2.27residential housing is provided under this agreement; the per diem and monthly rates that
2.28are to be paid from group residential housing funds for each eligible resident at each
2.29location; the number of beds at each location which are subject to the group residential
2.30housing agreement; whether the license holder is a not-for-profit corporation under section
2.31501(c)(3) of the Internal Revenue Code; and a statement that the agreement is subject to
2.32the provisions of sections 256I.01 to 256I.06 and subject to any changes to those sections.
2.33Group residential housing agreements may be terminated with or without cause by either
2.34the county or the provider with two calendar months prior notice.
2.35(b) Beginning July 1, 2011, counties must not enter into agreements with providers of
2.36group residential housing that do not include a residency requirement of at least 20 hours
3.1per week of volunteer or paid work. A person who is unable to obtain or retain 20 hours per
3.2month of volunteer or paid work due to a professionally certified illness, injury, disability,
3.3or incapacity must not be made ineligible for group residential housing under this section.

3.4    Sec. 20. Minnesota Statutes 2010, section 256I.05, subdivision 1a, is amended to read:
3.5    Subd. 1a. Supplementary service rates. (a) Subject to the provisions of section
3.6256I.04, subdivision 3 , the county agency may negotiate a payment not to exceed $426.37
3.7for other services necessary to provide room and board provided by the group residence
3.8if the residence is licensed by or registered by the Department of Health, or licensed by
3.9the Department of Human Services to provide services in addition to room and board,
3.10and can demonstrate a chemical dependency success rate of at least 30 percent for
3.11participants six months after completing the program, and if the provider of services is
3.12not also concurrently receiving funding for services for a recipient under a home and
3.13community-based waiver under title XIX of the Social Security Act; or funding from
3.14the medical assistance program under section 256B.0659, for personal care services for
3.15residents in the setting; or residing in a setting which receives funding under Minnesota
3.16Rules, parts 9535.2000 to 9535.3000. If funding is available for other necessary services
3.17through a home and community-based waiver, or personal care services under section
3.18256B.0659 , then the GRH rate is limited to the rate set in subdivision 1. The county
3.19agency is limited to negotiating a payment not to exceed $100 for residences that provide
3.20other services necessary to provide room and board if the residence does not allow alcohol
3.21on the property, provides minimal services, and is unable to demonstrate a chemical
3.22dependency success rate of at least 30 percent for participants six months after completing
3.23the program. Unless otherwise provided in law, in no case may the supplementary service
3.24rate exceed $426.37. The registration and licensure requirement does not apply to
3.25establishments which are exempt from state licensure because they are located on Indian
3.26reservations and for which the tribe has prescribed health and safety requirements. Service
3.27payments under this section may be prohibited under rules to prevent the supplanting of
3.28federal funds with state funds. The commissioner shall pursue the feasibility of obtaining
3.29the approval of the Secretary of Health and Human Services to provide home and
3.30community-based waiver services under title XIX of the Social Security Act for residents
3.31who are not eligible for an existing home and community-based waiver due to a primary
3.32diagnosis of mental illness or chemical dependency and shall apply for a waiver if it is
3.33determined to be cost-effective.
3.34(b) The commissioner is authorized to make cost-neutral transfers from the GRH
3.35fund for beds under this section to other funding programs administered by the department
4.1after consultation with the county or counties in which the affected beds are located.
4.2The commissioner may also make cost-neutral transfers from the GRH fund to county
4.3human service agencies for beds permanently removed from the GRH census under a plan
4.4submitted by the county agency and approved by the commissioner. The commissioner
4.5shall report the amount of any transfers under this provision annually to the legislature.
4.6(c) The provisions of paragraph (b) do not apply to a facility that has its
4.7reimbursement rate established under section 256B.431, subdivision 4, paragraph (c)."
4.8Page 22, after line 15, insert:

4.10School districts may coordinate with local units of government and homeless
4.11services providers to use empty school buildings as homeless shelters."
4.12Page 23, line 18, delete "and" and delete the second comma and insert "; and
4.13256I.05, subdivisions 1d, 1e, 1f, 1g, 1h, 1i, 1j, 1k, 1l, 1m, and 1n,"
4.14Page 23, after line 22, insert:

4.15    "Section 1. Minnesota Statutes 2010, section 62D.08, subdivision 7, is amended to read:
4.16    Subd. 7. Consistent administrative expenses and investment income reporting.
4.17(a) Every health maintenance organization must directly allocate administrative expenses
4.18to specific lines of business or products when such information is available. The definition
4.19of administrative expenses must be consistent with that of the National Association
4.20of Insurance Commissioners (NAIC) as provided in the most current NAIC Blank.
4.21Remaining expenses that cannot be directly allocated must be allocated based on other
4.22methods, as recommended by the Advisory Group on Administrative Expenses. Health
4.23maintenance organizations must submit this information, including administrative
4.24expenses for dental services, using the reporting template provided by the commissioner
4.25of health.
4.26(b) Every health maintenance organization must allocate investment income based
4.27on cumulative net income over time by business line or product and must submit this
4.28information, including investment income for dental services, using the reporting template
4.29provided by the commissioner of health.

4.30    Sec. 2. Minnesota Statutes 2010, section 62J.04, subdivision 3, is amended to read:
4.31    Subd. 3. Cost containment duties. The commissioner shall:
4.32(1) establish statewide and regional cost containment goals for total health care
4.33spending under this section and collect data as described in sections 62J.38 to 62J.41 and
4.3462J.40 to monitor statewide achievement of the cost containment goals;
5.1(2) divide the state into no fewer than four regions, with one of those regions being
5.2the Minneapolis/St. Paul metropolitan statistical area but excluding Chisago, Isanti,
5.3Wright, and Sherburne Counties, for purposes of fostering the development of regional
5.4health planning and coordination of health care delivery among regional health care
5.5systems and working to achieve the cost containment goals;
5.6(3) monitor the quality of health care throughout the state and take action as
5.7necessary to ensure an appropriate level of quality;
5.8(4) issue recommendations regarding uniform billing forms, uniform electronic
5.9billing procedures and data interchanges, patient identification cards, and other uniform
5.10claims and administrative procedures for health care providers and private and public
5.11sector payers. In developing the recommendations, the commissioner shall review the
5.12work of the work group on electronic data interchange (WEDI) and the American National
5.13Standards Institute (ANSI) at the national level, and the work being done at the state and
5.14local level. The commissioner may adopt rules requiring the use of the Uniform Bill
5.1582/92 form, the National Council of Prescription Drug Providers (NCPDP) 3.2 electronic
5.16version, the Centers for Medicare and Medicaid Services 1500 form, or other standardized
5.17forms or procedures;
5.18(5) undertake health planning responsibilities;
5.19(6) authorize, fund, or promote research and experimentation on new technologies
5.20and health care procedures;
5.21(7) within the limits of appropriations for these purposes, administer or contract for
5.22statewide consumer education and wellness programs that will improve the health of
5.23Minnesotans and increase individual responsibility relating to personal health and the
5.24delivery of health care services, undertake prevention programs including initiatives to
5.25improve birth outcomes, expand childhood immunization efforts, and provide start-up
5.26grants for worksite wellness programs;
5.27(8) undertake other activities to monitor and oversee the delivery of health care
5.28services in Minnesota with the goal of improving affordability, quality, and accessibility of
5.29health care for all Minnesotans; and
5.30(9) make the cost containment goal data available to the public in a
5.31consumer-oriented manner.
5.32EFFECTIVE DATE.This section is effective July 1, 2011.

5.33    Sec. 3. Minnesota Statutes 2010, section 62J.17, subdivision 4a, is amended to read:
5.34    Subd. 4a. Expenditure reporting. Each hospital, outpatient surgical center,
5.35and diagnostic imaging center, and physician clinic shall report annually to the
6.1commissioner on all major spending commitments, in the form and manner specified by
6.2the commissioner. The report shall include the following information:
6.3    (a) a description of major spending commitments made during the previous year,
6.4including the total dollar amount of major spending commitments and purpose of the
6.6    (b) the cost of land acquisition, construction of new facilities, and renovation of
6.7existing facilities;
6.8    (c) the cost of purchased or leased medical equipment, by type of equipment;
6.9    (d) expenditures by type for specialty care and new specialized services;
6.10    (e) information on the amount and types of added capacity for diagnostic imaging
6.11services, outpatient surgical services, and new specialized services; and
6.12    (f) information on investments in electronic medical records systems.
6.13For hospitals and outpatient surgical centers, this information shall be included in reports
6.14to the commissioner that are required under section 144.698. For diagnostic imaging
6.15centers, this information shall be included in reports to the commissioner that are required
6.16under section 144.565. For physician clinics, this information shall be included in reports
6.17to the commissioner that are required under section 62J.41. For all other health care
6.18providers that are subject to this reporting requirement, reports must be submitted to the
6.19commissioner by March 1 each year for the preceding calendar year.
6.20EFFECTIVE DATE.This section is effective July 1, 2011."
6.21Page 43, delete sections 17 and 18 and insert:

6.22    "Sec. 18. Minnesota Statutes 2010, section 144A.102, is amended to read:
6.25(a) By January 2000, the commissioner of health shall work with providers to
6.26examine state and federal rules and regulations governing the provision of care in licensed
6.27nursing facilities and apply for federal waivers and identify necessary changes in state
6.28law to:
6.29(1) allow the use of civil money penalties imposed upon nursing facilities to abate
6.30any deficiencies identified in a nursing facility's plan of correction; and
6.31(2) stop the accrual of any fine imposed by the Health Department when a follow-up
6.32inspection survey is not conducted by the department within the regulatory deadline.
6.33(b) By January 2012, the commissioner of health shall work with providers to
6.34examine state and federal rules and regulations governing the provision of care in licensed
7.1nursing facilities and apply for federal waivers and identify necessary changes in state
7.2law to:
7.3(1) eliminate the requirement for written plans of correction from nursing homes
7.4for federal deficiencies issued at a scope and severity that is neither widespread nor
7.5immediate jeopardy; and
7.6(2) issue the federal survey form electronically to nursing homes.
7.7The commissioner shall issue a report to the legislative chairs of the committees
7.8with jurisdiction over health and human services by January 31, 2012, on the status of
7.9implementation of this paragraph."
7.10Page 45, line 24, delete "Minneapolis" and insert "the Minneapolis area or greater
7.12Page 50, line 6, delete "obtain" and insert "request"
7.13Page 51, line 3, strike the first "and" and insert a comma and strike the second "and"
7.14and insert ", $8,337,000 in fiscal year 2012 and $6,781,000"
7.15Page 52, delete sections 34 and 35 and insert:

7.18(a) The commissioner of health, in consultation with the commissioner of human
7.19services, shall evaluate and recommend options for reorganizing health and human
7.20services regulatory responsibilities in both agencies to provide better efficiency and
7.21operational cost savings while maintaining the protection of health, safety, and welfare of
7.22the public. Regulatory responsibilities that are to be evaluated are those found in chapters
7.2362D, 62N, 62R, 62T, 144A, 144D, 144G, 146A, 146B, 149A, 153A, 245A, 245B, and
7.24245C, and sections 62Q.19, 144.058, 144.0722, 144.50, 144.651, 148.511, 148.6401,
7.25148.995, 256B.692, 626.556, and 626.557.
7.26(b) The evaluation and recommendations shall be submitted in a report to the
7.27legislative committees with jurisdiction over health and human services no later than
7.28February 15, 2012, and shall include, at a minimum, the following:
7.29(1) whether the regulatory responsibilities of each agency should be combined into
7.30a separate agency;
7.31(2) whether the regulatory responsibilities of each agency should be merged into
7.32an existing agency;
7.33(3) what cost savings would result by merging the activities regardless of where
7.34they are located;
7.35(4) what additional costs would result if the activities were merged;
8.1(5) whether there are additional regulatory responsibilities in both agencies that
8.2should be considered in any reorganization; and
8.3(6) for each option recommended, projected cost and a timetable and identification
8.4of the necessary steps and requirements for a successful transition period."
8.5Page 55, after line 17, insert:

8.7The commissioner of health shall work with stakeholders to review, develop,
8.8implement, and recommend legislative changes in the nursing home licensure process that
8.9address efficiency, eliminate duplication, and assure positive resident clinical outcomes.
8.10The commissioner shall assure that the changes are cost neutral."
8.11Page 55, delete section 39 and insert:

8.12    "Sec. 39. REPEALER.
8.13(a) Minnesota Statutes 2010, sections 62J.17, subdivisions 1, 3, 5a, 6a, and 8;
8.1462J.321, subdivision 5a; 62J.381; 62J.41, subdivisions 1 and 2; 144.1464; and 150A.22,
8.15are repealed.
8.16(b) Minnesota Statutes 2010, section 145A.14, subdivisions 1 and 2, are repealed
8.17effective January 1, 2012.
8.18(c) Minnesota Rules, parts 4651.0100, subparts 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12,
8.1914, 15, 16, 16a, 18, 19, 20, 20a, 21, 22, and 23; 4651.0110, subparts 2, 2a, 3, 4, and 5;
8.204651.0120; 4651.0130; 4651.0140; and 4651.0150, are repealed effective July 1, 2011."
8.21Page 56, delete section 2
8.22Page 57, delete section 3
8.23Page 63, delete section 5
8.24Page 79, delete section 24
8.25Page 88, after line 31, insert:

8.27(a) The commissioner of health shall convene a working group composed of the
8.28executive directors of the Boards of Medical Practice, Psychology, Social Work, and
8.29Behavioral Health and Therapy, and one representative from each professional association
8.30to make recommendations on the feasibility of developing collaborative agreements
8.31between psychiatrists and psychologists, social workers, and licensed professional clinical
8.32counselors for administration and management of psychiatric medications.
8.33(b) The executive directors shall take the lead in setting the agenda, convening
8.34subsequent meetings, and presenting a written report to the chairs and ranking minority
8.35members of the legislative committees with jurisdiction over health and human services.
9.1The report and recommendations for legislation shall be submitted no later than January
9.21, 2012.
9.3(c) The working group is not subject to the provisions of section 15.059."
9.4Page 101, line 9, delete "$145" and insert "$105"
9.5Page 120, after line 5, insert:

9.6    "Sec. 9. Minnesota Statutes 2010, section 62U.04, subdivision 9, is amended to read:
9.7    Subd. 9. Uses of information. (a) By no later As coverage is offered, sold, issued,
9.8or renewed, but not less than 12 months after the commissioner publishes the information
9.9in subdivision 3, paragraph (e):
9.10    (1) the commissioner of management and budget shall use the information and
9.11methods developed under subdivision 3 to strengthen incentives for members of the state
9.12employee group insurance program to use high-quality, low-cost providers;
9.13    (2) all political subdivisions, as defined in section 13.02, subdivision 11, that offer
9.14health benefits to their employees must offer plans that differentiate providers on their
9.15cost and quality performance and create incentives for members to use better-performing
9.17    (3) all health plan companies shall use the information and methods developed
9.18under subdivision 3 to develop products that encourage consumers to use high-quality,
9.19low-cost providers; and
9.20    (4) health plan companies that issue health plans in the individual market or the
9.21small employer market must offer at least one health plan that uses the information
9.22developed under subdivision 3 to establish financial incentives for consumers to choose
9.23higher-quality, lower-cost providers through enrollee cost-sharing or selective provider
9.25    (b) By January 1, 2011, the commissioner of health shall report to the governor
9.26and the legislature on recommendations to encourage health plan companies to promote
9.27widespread adoption of products that encourage the use of high-quality, low-cost providers.
9.28The commissioner's recommendations may include tax incentives, public reporting of
9.29health plan performance, regulatory incentives or changes, and other strategies."
9.30Page 121, after line 7, insert:

9.31    "Sec. 12. Minnesota Statutes 2010, section 256.969, subdivision 3a, is amended to read:
9.32    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
9.33assistance program must not be submitted until the recipient is discharged. However,
9.34the commissioner shall establish monthly interim payments for inpatient hospitals that
9.35have individual patient lengths of stay over 30 days regardless of diagnostic category.
9.36Except as provided in section 256.9693, medical assistance reimbursement for treatment
10.1of mental illness shall be reimbursed based on diagnostic classifications. Individual
10.2hospital payments established under this section and sections 256.9685, 256.9686, and
10.3256.9695 , in addition to third-party and recipient liability, for discharges occurring during
10.4the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
10.5inpatient services paid for the same period of time to the hospital. This payment limitation
10.6shall be calculated separately for medical assistance and general assistance medical
10.7care services. The limitation on general assistance medical care shall be effective for
10.8admissions occurring on or after July 1, 1991. Services that have rates established under
10.9subdivision 11 or 12, must be limited separately from other services. After consulting with
10.10the affected hospitals, the commissioner may consider related hospitals one entity and
10.11may merge the payment rates while maintaining separate provider numbers. The operating
10.12and property base rates per admission or per day shall be derived from the best Medicare
10.13and claims data available when rates are established. The commissioner shall determine
10.14the best Medicare and claims data, taking into consideration variables of recency of the
10.15data, audit disposition, settlement status, and the ability to set rates in a timely manner.
10.16The commissioner shall notify hospitals of payment rates by December 1 of the year
10.17preceding the rate year. The rate setting data must reflect the admissions data used to
10.18establish relative values. Base year changes from 1981 to the base year established for the
10.19rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
10.20to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
10.211. The commissioner may adjust base year cost, relative value, and case mix index data
10.22to exclude the costs of services that have been discontinued by the October 1 of the year
10.23preceding the rate year or that are paid separately from inpatient services. Inpatient stays
10.24that encompass portions of two or more rate years shall have payments established based
10.25on payment rates in effect at the time of admission unless the date of admission preceded
10.26the rate year in effect by six months or more. In this case, operating payment rates for
10.27services rendered during the rate year in effect and established based on the date of
10.28admission shall be adjusted to the rate year in effect by the hospital cost index.
10.29    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
10.30payment, before third-party liability and spenddown, made to hospitals for inpatient
10.31services is reduced by .5 percent from the current statutory rates.
10.32    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
10.33admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
10.34before third-party liability and spenddown, is reduced five percent from the current
10.35statutory rates. Mental health services within diagnosis related groups 424 to 432, and
10.36facilities defined under subdivision 16 are excluded from this paragraph.
11.1    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
11.2fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
11.3inpatient services before third-party liability and spenddown, is reduced 6.0 percent
11.4from the current statutory rates. Mental health services within diagnosis related groups
11.5424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
11.6Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
11.7assistance does not include general assistance medical care. Payments made to managed
11.8care plans shall be reduced for services provided on or after January 1, 2006, to reflect
11.9this reduction.
11.10    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
11.11fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
11.12to hospitals for inpatient services before third-party liability and spenddown, is reduced
11.133.46 percent from the current statutory rates. Mental health services with diagnosis related
11.14groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
11.15paragraph. Payments made to managed care plans shall be reduced for services provided
11.16on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
11.17    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
11.18fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
11.19to hospitals for inpatient services before third-party liability and spenddown, is reduced
11.201.9 percent from the current statutory rates. Mental health services with diagnosis related
11.21groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
11.22paragraph. Payments made to managed care plans shall be reduced for services provided
11.23on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
11.24    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
11.25for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
11.26inpatient services before third-party liability and spenddown, is reduced 1.79 percent
11.27from the current statutory rates. Mental health services with diagnosis related groups
11.28424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
11.29Payments made to managed care plans shall be reduced for services provided on or after
11.30July 1, 2011, to reflect this reduction.
11.31(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
11.32payment for fee-for-service admissions occurring on or after July 1, 2009, made to
11.33hospitals for inpatient services before third-party liability and spenddown, is reduced
11.34one percent from the current statutory rates. Facilities defined under subdivision 16 are
11.35excluded from this paragraph. Payments made to managed care plans shall be reduced for
11.36services provided on or after October 1, 2009, to reflect this reduction.
12.1(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
12.2payment for fee-for-service admissions occurring on or after July 1, 2011, made to
12.3hospitals for inpatient services before third-party liability and spenddown, is reduced
12.41.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
12.5excluded from this paragraph. Payments made to managed care plans shall be reduced for
12.6services provided on or after January 1, 2011, to reflect this reduction.
12.7(j) In addition to the reductions in paragraphs (b), (c), (d), (g), (h), and (i), the total
12.8payment for medical assistance fee-for-service admissions occurring on or after July 1,
12.92011 through June 30, 2013, made to hospitals for inpatient services before third-party
12.10liability and spenddown, is reduced by 7.04 percent from the current statutory rates. Inpatient
12.11hospital fee-for-service payments to hospitals located in the seven-county metropolitan
12.12area that are not government owned with a disproportionate population adjustment under
12.13section 256.969, subdivision 9, paragraph (b), that is greater than 17 percent on January
12.141, 2011, are excluded from this reduction. Payments made to managed care plans shall
12.15be reduced for services provided on or after January 1, 2012, through June 30, 2013, to
12.16reflect the full 24-month reduction in fee-for-service rates."
12.17Page 121, delete section 13
12.18Page 121, line 11, delete "level III pediatric" and after "hospitals" insert "with a level
12.19III neonatal intensive care unit"
12.20Page 122, line 30, before the period insert "and expires January 1, 2014"
12.21Page 126, delete section 18 and insert:

12.22    "Sec. 18. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
12.23subdivision to read:
12.24    Subd. 1b. Care coordination services provided through pediatric hospitals.
12.25(a) Medical assistance covers care coordination services provided by certain pediatric
12.26hospitals to children with high-cost medical conditions and children at risk of recurrent
12.27hospitalization for acute or chronic illnesses. There must be Level I and Level II pediatric
12.28care coordination services.
12.29(b) Level I pediatric care coordination services are provided by advanced practice
12.30nurses employed by or under contract with pediatric hospitals that have a neonatal
12.31intensive care unit and are either recipients of payments to support the training of residents
12.32from an approved graduate medical residency program under United States Code, title
12.3342, section 256e or the major pediatric teaching hospital affiliate of the University of
12.34Minnesota medical school, and that meet the criteria in this subdivision.
12.35(c) The services in paragraph (b) must be available through in-home video telehealth
12.36management and other methods, and must be designed to improve patient outcomes
13.1and reduce unnecessary hospital and emergency room utilization. The services must
13.2streamline communication, reduce redundancy, and eliminate unnecessary documentation
13.3through the use of a Web-accessible, uniform document that contains critical patient care
13.4management information, and which is accessible to all providers with patient consent.
13.5The commissioner shall develop the uniform document and associated Web site and shall
13.6implement procedures to assess patient outcomes and evaluate the effectiveness of the
13.7care coordination services provided under this subdivision.
13.8(d) Medical assistance also covers, as durable medical equipment, computers,
13.9webcams, and other technology necessary to allow in-home video telehealth management.
13.10(e) For purposes of paragraph (b), a child has a high-cost medical condition if
13.11inpatient hospital expenses for that child related to complex or chronic illnesses or
13.12conditions for the most recent calendar year exceeded $100,000, or if the expenses for that
13.13child are projected to exceed $100,000 for the current calendar year. For purposes of this
13.14subdivision, a child is at risk of recurrent hospitalization if the child was hospitalized three
13.15or more times for acute or chronic illness in the most recent calendar year.
13.16(f) For purposes of paragraph (b), "care coordination" means collaboration between
13.17the advanced practice nurse and primary care physicians and specialists to manage
13.18care and reduce hospitalizations, patient case management, development of medical
13.19management plans for chronic illnesses and recurrent acute illnesses, oversight and
13.20coordination of all aspects of care in partnership with families, organization of medical
13.21information into a summary of critical information, coordination and appropriate
13.22sequencing of tests and multiple appointments, information and assistance with accessing
13.23resources, and telephone triage for acute illnesses or problems.
13.24(g) The commissioner shall adjust managed care and county-based purchasing plan
13.25capitation rates to reflect savings from the coverage of this service.
13.26(h) Level II pediatric care coordination services are provided by registered nurses
13.27employed by or under contract with a pediatric hospital that has been designated as an
13.28essential community provider under Minnesota Statutes, section 62Q.19, subdivision 1,
13.29clause (4), and has been a recipient of payments to support the training of residents from
13.30an approved graduate medical residency program pursuant to United States Code, title 42,
13.31section 256E, and that meets the following criteria:
13.32(1) the services must be provided through telehealth management and other methods,
13.33be available on a regular schedule seven days per week, and be designed to provide
13.34collaboration in patient care as provided by the patient's family, primary care providers,
13.35and the hospital and specialized physicians;
14.1(2) for purposes of this paragraph, a child has a high-cost medical condition if the
14.2child has a serious chronic physical disability caused by a congenital anomaly, birth
14.3injury or traumatic injury, complications which can be expected to cause further
14.4injury, hospitalization, or death, but that can be effectively addressed through ongoing
14.5family and primary care supported by communication of ongoing care information and
14.6care coordination; and
14.7(3) for purposes of this paragraph, "care coordination" means the ready availability
14.8of telehealth management services to support collaboration through a registered nurse
14.9between a child's family, the primary care professional that is available to care for the
14.10child, and appropriate professionals to address urgent questions about and minimize the
14.11consequences of medical complications, develop medical management plans for complex
14.12conditions, and avoid serious health consequences and hospitalizations to treat such
14.14EFFECTIVE DATE.This section is effective January 1, 2012."
14.17Page 127, delete section 19 and insert:

14.18    "Sec. 19. Minnesota Statutes 2010, section 256B.0625, is amended by adding a
14.19subdivision to read:
14.20    Subd. 56. Evidence-based childbirth program. (a) The commissioner shall
14.21implement a program to reduce the number of elective inductions of labor prior to 39
14.22weeks' gestation. In this subdivision, the term "elective induction of labor" means the
14.23use of artificial means to stimulate labor in a woman without the presence of a medical
14.24condition affecting the woman or the child that makes the onset of labor a medical
14.25necessity. The program must promote the implementation of policies within hospitals
14.26providing services to recipients of medical assistance or MinnesotaCare that prohibit the
14.27use of elective inductions prior to 39 weeks' gestation, and adherence to such policies by
14.28the attending providers.
14.29(b) For all births covered by medical assistance or MinnesotaCare on or after
14.30January 1, 2012, a payment for professional services associated with the delivery of a
14.31child in a hospital must not be made unless the provider has submitted information about
14.32the nature of the labor and delivery including any induction of labor that was performed
14.33in conjunction with that specific birth. The information must be on a form prescribed by
14.34the commissioner.
15.1(c) The requirements in paragraph (b) must not apply to deliveries performed
15.2at a hospital that has policies and processes in place that have been approved by the
15.3commissioner which prohibit elective inductions prior to 39 weeks gestation. A process
15.4for review of hospital induction policies must be established by the commissioner and
15.5review of policies must occur at the discretion of the commissioner. The commissioner's
15.6decision to approve or rescind approval must include verification and review of items
15.7including, but not limited to:
15.8(1) policies that prohibit use of elective inductions for gestation less than 39 weeks;
15.9(2) policies that encourage providers to document and communicate with patients a
15.10final expected date of delivery by 20 weeks' gestation that includes data from ultrasound
15.11measurements as applicable;
15.12(3) policies that encourage patient education regarding elective inductions, and
15.13requires documentation of the processes used to educate patients;
15.14(4) ongoing quality improvement review as determined by the commissioner; and
15.15(5) any data that has been collected by the commissioner.
15.16(d) All hospitals must report annually to the commissioner induction information
15.17for all births that were covered by medical assistance or MinnesotaCare in a format and
15.18manner to be established by the commissioner.
15.19(e) The commissioner at any time may choose not to implement or may discontinue
15.20any or all aspects of the program if the commissioner is able to determine that hospitals
15.21representing at least 90 percent of births covered by medical assistance or MinnesotaCare
15.22have approved policies in place.
15.23EFFECTIVE DATE.This section is effective January 1, 2012."
15.24Page 128, line 24, after the period insert "Authorization determinations must be
15.25communicated within three working days."
15.26Page 128, delete section 20
15.27Page 130, line 18, strike "The actual acquisition"
15.28Page 130, strike line 19
15.29Page 130, line 20, strike "minus 30 percent"
15.30Page 137, delete section 32
15.31Page 140, line 2, delete the new language and reinstate the stricken language
15.32Page 140, line 22, after "apply" insert "to providers included in provider peer
15.34Page 141, line 26, delete the new language and reinstate the stricken "$12"
15.35Page 151, delete lines 17 to 20
15.36Page 151, line 26, delete "reinsurance" and insert "malpractice insurance"
16.1Page 151, delete lines 30 and 31 and insert "licensed traditional midwives, certified
16.2nurse midwives, family practitioners, obstetricians, perinatologists, neonatologists, and
16.3other advanced practice registered nurses."
16.4Page 152, line 14, delete "appropriate and" and insert "competent"
16.5Page 152, line 15, delete "language-appropriate"
Page 163, delete section 6616.6Page 202, line 11, after "are" insert "not"
16.7Page 203, line 23, delete "the" and insert "any applicable federal"
16.8Page 203, delete line 24
16.9Page 207, after line 36, insert:

16.16When negotiating with external vendors to provide managed care services, the
16.17commissioner of human services shall require use of an advanced request for information
16.18tool. This tool must provide the department with an evidence-based assessment that
16.19focuses on the cost control, quality, and information transparency of the health care
16.20vendor. The assessment may include evidence-based performance measures that have
16.21been shown to influence better health, better health care, and more cost-effective use of
16.22resources including, but not limited to, areas that determine each plan's capabilities and
16.23performance with respect to:
16.24(1) consumer engagement, support, and incentives;
16.25(2) processes and outcomes for closing gaps in care according to clinical guideline
16.27(3) provider management, including outcome and population-based reimbursement,
16.28transparent measurement of provider performance, and support of physician practice
16.29structures that lead to better care; and
16.30(4) measures of clinical outcomes and waste approved by the National Quality

16.32    Sec. 114. RISK CORRIDORS.
16.33(a) Effective for services rendered on or after January 1, 2012, the commissioner
16.34shall establish risk corridors for state public programs that are actuarially sound for each
17.1managed care plan and each county-based purchasing plan. The risk corridors will be
17.2calculated annually based on the calendar year's net underwriting gain or loss. If the
17.3managed care plan or county-based purchasing plan has achieved a net underwriting gain
17.4of greater than three percent of revenue, 80 percent of any excess must be repaid to the
17.5commissioner by July 31 of the year following calculation of the risk corridor year, and
17.620 percent must be invested by the plan directly into programs for improving quality of
17.7care or access to care for state public health care program enrollees. If the managed
17.8care plan or county-based purchasing plan has incurred a net underwriting loss greater
17.9than three percent of total revenue, 50 percent of any excess must be repaid to the plan
17.10by the commissioner by July 31 of the year following calculation of the risk corridor
17.11year. Determination of total revenues and net underwriting gain or loss must be based
17.12on the Minnesota Supplement Report #1 which is filed on April 1 of the year following
17.13calculation of the risk corridor and adjusted for the actual withhold calculation under
17.14sections 256B.69, subdivision 5a and 256L.12, subdivision 9. The report must be filed
17.15with and publicly disclosed by the Minnesota Department of Health.
17.16(b) For purposes of this section, "state public programs" means those prepaid
17.17medical assistance and MinnesotaCare programs for which a managed care plan or
17.18county-based purchasing plan contracts with the commissioner to provide coverage under
17.19sections 256B.69, 256B.692, and 256L.12. The risk corridors shall not apply to plans for
17.20persons who are enrolled in integrated Medicare and medical assistance programs under
17.21section 256B.69, subdivisions 23 and 28.
17.22(c) This section expires January 1, 2014."
17.23Page 209, line 28, delete "article 8" and insert "article 3"
17.24Page 231, line 17, reinstate the stricken "and"
17.25Page 231, delete line 18
17.26Page 231, line 19, reinstate the stricken "(4)" and delete "(5)"
17.27Page 231, line 20, after "section" insert ", including assisting recipients with
17.28rehabilitation exercises that are part of a recipient's care plan if trained in the procedures
17.29and tasks and no additional personal care assistance service time is necessary to complete this task"
17.30Page 233, line 24, delete everything after the period
17.31Page 233, delete lines 25 and 26 and insert "When the personal care assistant is a
17.32relative of the recipient, the commissioner shall pay 80 percent of the provider rate. For
17.33purposes of this section, relative means the parent or adoptive parent of an adult child, a
17.34sibling aged 16 years or older, an adult child, a grandparent, or a grandchild."
17.35Page 233, after line 26, insert:

18.1    "Sec. 13. Minnesota Statutes 2010, section 256B.0659, subdivision 28, is amended to
18.3    Subd. 28. Personal care assistance provider agency; required documentation.
18.4(a) Required documentation must be completed and kept in the personal care assistance
18.5provider agency file or the recipient's home residence. The required documentation
18.6consists of:
18.7(1) employee files, including:
18.8(i) applications for employment;
18.9(ii) background study requests and results;
18.10(iii) orientation records about the agency policies;
18.11(iv) trainings completed with demonstration of competence;
18.12(v) supervisory visits;
18.13(vi) evaluations of employment; and
18.14(vii) signature on fraud statement;
18.15(2) recipient files, including:
18.16(i) demographics;
18.17(ii) emergency contact information and emergency backup plan;
18.18(iii) personal care assistance service plan;
18.19(iv) personal care assistance care plan;
18.20(v) month-to-month service use plan;
18.21(vi) all communication records;
18.22(vii) start of service information, including the written agreement with recipient; and
18.23(viii) date the home care bill of rights was given to the recipient;
18.24(3) agency policy manual, including:
18.25(i) policies for employment and termination;
18.26(ii) grievance policies with resolution of consumer grievances;
18.27(iii) staff and consumer safety;
18.28(iv) staff misconduct; and
18.29(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
18.30resolution of consumer grievances;
18.31(4) time sheets for each personal care assistant along with completed activity sheets
18.32for each recipient served; and
18.33(5) agency marketing and advertising materials and documentation of marketing
18.34activities and costs; and
18.35(6) for each personal care assistant, whether or not the personal care assistant is
18.36providing care to a relative as defined in subdivision 11.
19.1(b) The commissioner may assess a fine of up to $500 on provider agencies that do
19.2not consistently comply with the requirements of this subdivision."
19.3Page 259, delete section 32
19.4Page 266, line 7, delete "five" and insert "three"
19.5Page 267, line 7, delete "five" and insert "two"
19.6Page 284, line 23, delete "and"
19.7Page 284, line 25, delete the period and after "models" insert "; and"
19.8Page 284, after line 25, insert:"(4) implementation of a methodology to fully fund
19.9county case management administrative functions."
19.10Page 285, line 14, after the period insert "Appointed nongovernmental members
19.11of the task force shall serve as staff for the task force and take on the responsibilities of
19.12coordinating meetings, reporting on committee recommendations, and providing other
19.13staff support as needed to meet the responsibilities of the task force as described in
19.14subdivision 3. Legislative appointment of nongovernmental members of the task force
19.15shall be conditioned upon agreement from the appointees to provide staff assistance to
19.16execute the work of the task force."
19.17Page 285, line 28, after the period insert "The task force shall be independently
19.18staffed and coordinated by nongovernmental appointees who serve on the task force, no
19.19state funding shall be appropriated for expenses related to the task force under this section."
19.20Page 309, line 25, delete "deemed necessary" and insert "the person meets the
19.21criteria established"
19.22Page 309, line 27, delete "deemed appropriate" and insert "the person meets the
19.23criteria established"
19.24Page 310, after line 20, insert:
19.25"EFFECTIVE DATE.This section is effective for all chemical dependency
19.26residential treatment beginning or after July 1, 2011."
19.27Page 313, after line 21, insert:

19.29The commissioner shall develop specific criteria to approve treatment for individuals
19.30who require residential chemical dependency treatment in excess of the maximum allowed
19.31in section 254B.04, subdivision 1, due to co-occurring disorders, including disorders
19.32related to cognition, traumatic brain injury, or documented disability. Criteria shall be
19.33developed for use no later than October 1, 2011."
19.34Page 325, line 5, delete "$1,924,434,000" and insert "$1,964,344,000"
19.35Page 325, line 8, delete "$453,836,000" and insert "$530,566,000"
19.36Page 325, line 10, delete "$38,592,000" and insert "$41,444,000"
20.1Page 325, line 11, delete "190,844,000" and insert "$194,092,000"
20.2Page 326, line 31, delete "$3,950,500" and insert "$2,536,949,000"
20.3Page 326, line 35, delete "$526,251" and insert "$526,251,000"
20.4Page 329, after line 18, insert:
20.5"Northern Connections. $100,000 is
20.6appropriated in fiscal year 2012 and
20.7$100,000 is appropriated in fiscal year 2013
20.8from the general fund to the commissioner
20.9of human services for a grant to expand
20.10Northern Connections workforce program
20.11that provides one-stop supportive services
20.12to individuals as they transition into the
20.13workforce to up to two interested counties
20.14in rural Minnesota."
20.15Page 330, after line 1, insert:
20.16"Child Care Development Funds. The
20.17commissioner of human services shall direct
20.18$1,000,000 in federal child care development
20.19funds for the purpose of continuing
20.20the quality rating and improvement system
20.21as described in Minnesota Statutes, section
20.22119B.135, in the original pilot area and
20.23expanding the system to two new rural
20.24geographic locations."
20.25Page 338, after line 29, insert: "Carryforward. Funds appropriated for fiscal year 2011 are available until expended."
20.29Renumber the sections in sequence and correct the internal references
20.30Amend the title accordingly
20.31Adjust amounts accordingly