1.1.................... moves to amend H.F. No. 1233 as follows:
1.2Delete everything after the enacting clause and insert:


1.6    Section 1. Minnesota Statutes 2012, section 16A.724, subdivision 3, is amended to read:
1.7    Subd. 3. MinnesotaCare federal receipts. Receipts received as a result of federal
1.8participation pertaining to administrative costs of the Minnesota health care reform waiver
1.9shall be deposited as nondedicated revenue in the health care access fund. Receipts
1.10received as a result of federal participation pertaining to grants shall be deposited in the
1.11federal fund and shall offset health care access funds for payments to providers. All federal
1.12funding received by Minnesota for implementation and administration of MinnesotaCare
1.13as a basic health program, as authorized in section 1331 of the Affordable Care Act,
1.14Public Law 111-148, as amended by Public Law 111-152, is dedicated to that program and
1.15shall be deposited into the health care access fund. Federal funding that is received for
1.16implementing and administering MinnesotaCare as a basic health program and deposited in
1.17the fund shall be used only for that program to purchase health care coverage for enrollees
1.18and reduce enrollee premiums and cost-sharing or provide additional enrollee benefits.
1.19EFFECTIVE DATE.This section is effective January 1, 2015.

1.20    Sec. 2. Minnesota Statutes 2012, section 254B.04, subdivision 1, is amended to read:
1.21    Subdivision 1. Eligibility. (a) Persons eligible for benefits under Code of Federal
1.22Regulations, title 25, part 20, persons eligible for medical assistance benefits under
1.23sections 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, or who meet
1.24the income standards of section 256B.056, subdivision 4, and persons eligible for general
1.25assistance medical care under section 256D.03, subdivision 3, are entitled to chemical
2.1dependency fund services. State money appropriated for this paragraph must be placed in
2.2a separate account established for this purpose.
2.3Persons with dependent children who are determined to be in need of chemical
2.4dependency treatment pursuant to an assessment under section 626.556, subdivision 10, or
2.5a case plan under section 260C.201, subdivision 6, or 260C.212, shall be assisted by the
2.6local agency to access needed treatment services. Treatment services must be appropriate
2.7for the individual or family, which may include long-term care treatment or treatment in a
2.8facility that allows the dependent children to stay in the treatment facility. The county
2.9shall pay for out-of-home placement costs, if applicable.
2.10(b) A person not entitled to services under paragraph (a), but with family income
2.11that is less than 215 percent of the federal poverty guidelines for the applicable family
2.12size, shall be eligible to receive chemical dependency fund services within the limit
2.13of funds appropriated for this group for the fiscal year. If notified by the state agency
2.14of limited funds, a county must give preferential treatment to persons with dependent
2.15children who are in need of chemical dependency treatment pursuant to an assessment
2.16under section 626.556, subdivision 10, or a case plan under section 260C.201, subdivision
2.176 , or 260C.212. A county may spend money from its own sources to serve persons under
2.18this paragraph. State money appropriated for this paragraph must be placed in a separate
2.19account established for this purpose.
2.20(c) Persons whose income is between 215 percent and 412 percent of the federal
2.21poverty guidelines for the applicable family size shall be eligible for chemical dependency
2.22services on a sliding fee basis, within the limit of funds appropriated for this group for the
2.23fiscal year. Persons eligible under this paragraph must contribute to the cost of services
2.24according to the sliding fee scale established under subdivision 3. A county may spend
2.25money from its own sources to provide services to persons under this paragraph. State
2.26money appropriated for this paragraph must be placed in a separate account established
2.27for this purpose.

2.28    Sec. 3. Minnesota Statutes 2012, section 256.01, is amended by adding a subdivision
2.29to read:
2.30    Subd. 35. Federal approval. (a) The commissioner shall seek federal authority
2.31from the U.S. Department of Health and Human Services necessary to operate a health
2.32coverage program for Minnesotans with incomes up to 275 percent of the federal poverty
2.33guidelines (FPG). The proposal shall seek to secure all federal funding available from at
2.34least the following sources:
3.1(1) all premium tax credits and cost-sharing subsidies available under United States
3.2Code, title 26, section 36B, and United States Code, title 42, section 18071, for individuals
3.3with incomes above 133 percent and at or below 275 percent of the federal poverty
3.4guidelines who would otherwise be enrolled in the Minnesota Insurance Marketplace as
3.5defined in Minnesota Statutes, section 62V.02;
3.6(2) Medicaid funding; and
3.7(3) other funding sources identified by the commissioner that support coverage or
3.8care redesign in Minnesota.
3.9(b) Funding received shall be used to design and implement a health coverage
3.10program that creates a single streamlined program and meets the needs of Minnesotans with
3.11incomes up to 275 percent of the federal poverty guidelines. The program must incorporate:
3.12(1) payment reform characteristics included in the health care delivery system and
3.13accountable care organization payment models;
3.14(2) flexibility in benefit set design such that benefits can be targeted to meet enrollee
3.15needs in different income and health status situations and can provide a more seamless
3.16transition from public to private health care coverage;
3.17(3) flexibility in co-payment or premium structures to incent patients to seek
3.18high-quality, low-cost care settings; and
3.19(4) flexibility in premium structures to ease the transition from public to private
3.20health care coverage.
3.21(c) The commissioner shall develop and submit a proposal consistent with the above
3.22criteria and shall seek all federal authority necessary to implement the health coverage
3.23program. In developing the request, the commissioner shall consult with appropriate
3.24stakeholder groups and consumers.
3.25(d) The commissioner is authorized to seek any available waivers or federal
3.26approvals to accomplish the goals under paragraph (b) prior to 2017.
3.27(e) The commissioner shall report progress on implementing this subdivision to the
3.28chairs and ranking minority members of the legislative committees with jurisdiction over
3.29health and human services policy and finance by December 1, 2014.
3.30(f) The commissioner is authorized to accept and expend federal funds that support
3.31the purposes of this subdivision.

3.32    Sec. 4. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
3.33to read:
4.1    Subd. 18. Caretaker relative. "Caretaker relative" means a relative, by blood,
4.2adoption, or marriage, of a child under age 19 with whom the child is living and who
4.3assumes primary responsibility for the child's care.
4.4EFFECTIVE DATE.This section is effective January 1, 2014.

4.5    Sec. 5. Minnesota Statutes 2012, section 256B.02, is amended by adding a subdivision
4.6to read:
4.7    Subd. 19. Insurance affordability program. "Insurance affordability program"
4.8means one of the following programs:
4.9(1) medical assistance under this chapter;
4.10(2) a program that provides advance payments of the premium tax credits established
4.11under section 36B of the Internal Revenue Code or cost-sharing reductions established
4.12under section 1402 of the Affordable Care Act;
4.13(3) MinnesotaCare as defined in chapter 256L; and
4.14(4) a Basic Health Plan as defined in section 1331 of the Affordable Care Act.
4.15EFFECTIVE DATE.This section is effective the day following final enactment.

4.16    Sec. 6. Minnesota Statutes 2012, section 256B.04, subdivision 18, is amended to read:
4.17    Subd. 18. Applications for medical assistance. (a) The state agency may take
4.18 shall accept applications for medical assistance and conduct eligibility determinations for
4.19MinnesotaCare enrollees by telephone, via mail, in-person, online via an Internet Web
4.20site, and through other commonly available electronic means.
4.21    (b) The commissioner of human services shall modify the Minnesota health care
4.22programs application form to add a question asking applicants whether they have ever
4.23served in the United States military.
4.24    (c) For each individual who submits an application or whose eligibility is subject to
4.25renewal or whose eligibility is being redetermined pursuant to a change in circumstances,
4.26if the agency determines the individual is not eligible for medical assistance, the agency
4.27shall determine potential eligibility for other insurance affordability programs.
4.28EFFECTIVE DATE.This section is effective January 1, 2014.

4.29    Sec. 7. Minnesota Statutes 2012, section 256B.055, subdivision 3a, is amended to read:
4.30    Subd. 3a. Families with children. Beginning July 1, 2002, Medical assistance may
4.31be paid for a person who is a child under the age of 18, or age 18 if a full-time student
4.32in a secondary school, or in the equivalent level of vocational or technical training, and
5.1reasonably expected to complete the program before reaching age 19; the parent or
5.2stepparent of a dependent child under the age of 19, including a pregnant woman; or a
5.3caretaker relative of a dependent child under the age of 19.
5.4EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
5.5approval, whichever is later. The commissioner of human services shall notify the revisor
5.6of statutes when federal approval is obtained.

5.7    Sec. 8. Minnesota Statutes 2012, section 256B.055, subdivision 6, is amended to read:
5.8    Subd. 6. Pregnant women; needy unborn child. Medical assistance may be paid
5.9for a pregnant woman who has written verification of a positive pregnancy test from a
5.10physician or licensed registered nurse, who meets the other eligibility criteria of this
5.11section and whose unborn child would be eligible as a needy child under subdivision 10 if
5.12born and living with the woman. In accordance with Code of Federal Regulations, title
5.1342, section 435.956, the commissioner must accept self-attestation of pregnancy unless
5.14the agency has information that is not reasonably compatible with such attestation. For
5.15purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.
5.16EFFECTIVE DATE.This section is effective January 1, 2014.

5.17    Sec. 9. Minnesota Statutes 2012, section 256B.055, subdivision 10, is amended to read:
5.18    Subd. 10. Infants. Medical assistance may be paid for an infant less than one year
5.19of age, whose mother was eligible for and receiving medical assistance at the time of birth
5.20or who is less than two years of age and is in a family with countable income that is equal
5.21to or less than the income standard established under section 256B.057, subdivision 1.
5.22EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
5.23approval, whichever is later. The commissioner of human services shall notify the revisor
5.24of statutes when federal approval is obtained.

5.25    Sec. 10. Minnesota Statutes 2012, section 256B.055, subdivision 15, is amended to read:
5.26    Subd. 15. Adults without children. Medical assistance may be paid for a person
5.27who is:
5.28(1) at least age 21 and under age 65;
5.29(2) not pregnant;
5.30(3) not entitled to Medicare Part A or enrolled in Medicare Part B under Title XVIII
5.31of the Social Security Act;
6.1(4) not an adult in a family with children as defined in section 256L.01, subdivision
6.23a ; and not otherwise eligible under subdivision 7 as a person who meets the categorical
6.3eligibility requirements of the supplemental security income program;
6.4(5) not enrolled under subdivision 7 as a person who would meet the categorical
6.5eligibility requirements of the supplemental security income program except for excess
6.6income or assets; and
6.7(5) (6) not described in another subdivision of this section.
6.8EFFECTIVE DATE.This section is effective January 1, 2014.

6.9    Sec. 11. Minnesota Statutes 2012, section 256B.055, is amended by adding a
6.10subdivision to read:
6.11    Subd. 17. Adults who were in foster care at the age of 18. Medical assistance may
6.12be paid for a person under 26 years of age who was in foster care under the commissioner's
6.13responsibility on the date of attaining 18 years of age, and who was enrolled in medical
6.14assistance under the state plan or a waiver of the plan while in foster care, in accordance
6.15with section 2004 of the Affordable Care Act.
6.16EFFECTIVE DATE.This section is effective January 1, 2014.

6.17    Sec. 12. Minnesota Statutes 2012, section 256B.056, subdivision 1, is amended to read:
6.18    Subdivision 1. Residency. To be eligible for medical assistance, a person must
6.19reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota,
6.20 in accordance with the rules of the state agency Code of Federal Regulations, title 42,
6.21section 435.403.
6.22EFFECTIVE DATE.This section is effective January 1, 2014.

6.23    Sec. 13. Minnesota Statutes 2012, section 256B.056, subdivision 1c, is amended to read:
6.24    Subd. 1c. Families with children income methodology. (a)(1) [Expired, 1Sp2003
6.25c 14 art 12 s 17]
6.26(2) For applications processed within one calendar month prior to July 1, 2003,
6.27eligibility shall be determined by applying the income standards and methodologies in
6.28effect prior to July 1, 2003, for any months in the six-month budget period before July
6.291, 2003, and the income standards and methodologies in effect on July 1, 2003, for any
6.30months in the six-month budget period on or after that date. The income standards for
6.31each month shall be added together and compared to the applicant's total countable income
6.32for the six-month budget period to determine eligibility.
7.1(3) For children ages one through 18 whose eligibility is determined under section
7.2256B.057, subdivision 2, the following deductions shall be applied to income counted
7.3toward the child's eligibility as allowed under the state's AFDC plan in effect as of July
7.416, 1996: $90 work expense, dependent care, and child support paid under court order.
7.5This clause is effective October 1, 2003.
7.6(b) For families with children whose eligibility is determined using the standard
7.7specified in section 256B.056, subdivision 4, paragraph (c), 17 percent of countable
7.8earned income shall be disregarded for up to four months and the following deductions
7.9shall be applied to each individual's income counted toward eligibility as allowed under
7.10the state's AFDC plan in effect as of July 16, 1996: dependent care and child support paid
7.11under court order.
7.12(c) If the four-month disregard in paragraph (b) has been applied to the wage
7.13earner's income for four months, the disregard shall not be applied again until the wage
7.14earner's income has not been considered in determining medical assistance eligibility for
7.1512 consecutive months.
7.16(d) The commissioner shall adjust the income standards under this section each July
7.171 by the annual update of the federal poverty guidelines following publication by the
7.18United States Department of Health and Human Services except that the income standards
7.19shall not go below those in effect on July 1, 2009.
7.20(e) For children age 18 or under, annual gifts of $2,000 or less by a tax-exempt
7.21organization to or for the benefit of the child with a life-threatening illness must be
7.22disregarded from income.

7.23    Sec. 14. Minnesota Statutes 2012, section 256B.056, subdivision 3, is amended to read:
7.24    Subd. 3. Asset limitations for certain individuals and families. (a) To be
7.25eligible for medical assistance, a person must not individually own more than $3,000 in
7.26assets, or if a member of a household with two family members, husband and wife, or
7.27parent and child, the household must not own more than $6,000 in assets, plus $200 for
7.28each additional legal dependent. In addition to these maximum amounts, an eligible
7.29individual or family may accrue interest on these amounts, but they must be reduced to the
7.30maximum at the time of an eligibility redetermination. The accumulation of the clothing
7.31and personal needs allowance according to section 256B.35 must also be reduced to the
7.32maximum at the time of the eligibility redetermination. The value of assets that are not
7.33considered in determining eligibility for medical assistance is the value of those assets
7.34excluded under the supplemental security income program for aged, blind, and disabled
7.35persons, with the following exceptions:
8.1(1) household goods and personal effects are not considered;
8.2(2) capital and operating assets of a trade or business that the local agency determines
8.3are necessary to the person's ability to earn an income are not considered;
8.4(3) motor vehicles are excluded to the same extent excluded by the supplemental
8.5security income program;
8.6(4) assets designated as burial expenses are excluded to the same extent excluded by
8.7the supplemental security income program. Burial expenses funded by annuity contracts
8.8or life insurance policies must irrevocably designate the individual's estate as contingent
8.9beneficiary to the extent proceeds are not used for payment of selected burial expenses;
8.10(5) for a person who no longer qualifies as an employed person with a disability due
8.11to loss of earnings, assets allowed while eligible for medical assistance under section
8.12256B.057, subdivision 9 , are not considered for 12 months, beginning with the first month
8.13of ineligibility as an employed person with a disability, to the extent that the person's total
8.14assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph (d);
8.15    (6) when a person enrolled in medical assistance under section 256B.057, subdivision
8.169 , is age 65 or older and has been enrolled during each of the 24 consecutive months
8.17before the person's 65th birthday, the assets owned by the person and the person's spouse
8.18must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph (d),
8.19when determining eligibility for medical assistance under section 256B.055, subdivision
8.207 . The income of a spouse of a person enrolled in medical assistance under section
8.21256B.057, subdivision 9 , during each of the 24 consecutive months before the person's
8.2265th birthday must be disregarded when determining eligibility for medical assistance
8.23under section 256B.055, subdivision 7. Persons eligible under this clause are not subject to
8.24the provisions in section 256B.059. A person whose 65th birthday occurs in 2012 or 2013
8.25is required to have qualified for medical assistance under section 256B.057, subdivision 9,
8.26prior to age 65 for at least 20 months in the 24 months prior to reaching age 65; and
8.27(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
8.28required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
8.29Law 111-5. For purposes of this clause, an American Indian is any person who meets the
8.30definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
8.31(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
8.3215.
8.33EFFECTIVE DATE.This section is effective January 1, 2014.

8.34    Sec. 15. Minnesota Statutes 2012, section 256B.056, subdivision 4, is amended to read:
9.1    Subd. 4. Income. (a) To be eligible for medical assistance, a person eligible under
9.2section 256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of
9.3the federal poverty guidelines. Effective January 1, 2000, and each successive January,
9.4recipients of supplemental security income may have an income up to the supplemental
9.5security income standard in effect on that date.
9.6(b) To be eligible for medical assistance, families and children may have an income
9.7up to 133-1/3 percent of the AFDC income standard in effect under the July 16, 1996,
9.8AFDC state plan. Effective July 1, 2000, the base AFDC standard in effect on July 16,
9.91996, shall be increased by three percent.
9.10(c) Effective July 1, 2002 January 1, 2014, to be eligible for medical assistance,
9.11families and children under section 256B.055, subdivision 3a, a parent or caretaker
9.12relative may have an income up to 100 133 percent of the federal poverty guidelines for
9.13the family household size.
9.14(d) To be eligible for medical assistance under section 256B.055, subdivision 15,
9.15a person may have an income up to 75 133 percent of federal poverty guidelines for
9.16the family household size.
9.17(e) In computing income to determine eligibility of persons under paragraphs (a) to
9.18(d) who are not residents of long-term care facilities, the commissioner shall disregard
9.19increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
9.20Veterans aid and attendance benefits and Veterans Administration unusual medical
9.21expense payments are considered income to the recipient To be eligible for medical
9.22assistance under section 256B.055, subdivision 16, a child age 19 to 20 may have an
9.23income up to 133 percent of the federal poverty guidelines for the household size.
9.24(f) To be eligible for medical assistance under section 256B.055, subdivision
9.253a, a child under age 19 may have income up to 275 percent of the federal poverty
9.26guidelines for the household size or an equivalent standard when converted using modified
9.27adjusted gross income methodology as required under the Affordable Care Act. Children
9.28who are enrolled in medical assistance as of December 31, 2013, and are determined
9.29ineligible for medical assistance because of the elimination of income disregards under
9.30modified adjusted gross income methodology as defined in subdivision 1a of this section
9.31remain eligible for medical assistance under the Children's Health Insurance Program
9.32Reauthorization Act of 2009, Public Law 111-3, until the date of their next regularly
9.33scheduled eligibility redetermination as required in section 256B.056, subdivision 7a.
9.34(g) In computing income to determine eligibility of persons under paragraphs (a) to
9.35(f) who are not residents of long-term care facilities, the commissioner shall disregard
9.36increases in income as required by Public Laws 94-566, section 503; 99-272; and 99-509.
10.1For persons eligible under paragraph (a), veteran aid and attendance benefits and Veterans
10.2Administration unusual medical expense payments are considered income to the recipient.
10.3EFFECTIVE DATE.This section is effective January 1, 2014.

10.4    Sec. 16. Minnesota Statutes 2012, section 256B.056, subdivision 5c, is amended to read:
10.5    Subd. 5c. Excess income standard. (a) The excess income standard for families
10.6with children parents and caretaker relatives, pregnant women, infants, and children ages
10.7two through 20 is the standard specified in subdivision 4, paragraph (c).
10.8(b) The excess income standard for a person whose eligibility is based on blindness,
10.9disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
10.10family size. Effective July 1, 2002, the excess income standard for this paragraph shall
10.11equal 75 percent of the federal poverty guidelines.
10.12EFFECTIVE DATE.This section is effective January 1, 2014.

10.13    Sec. 17. Minnesota Statutes 2012, section 256B.056, is amended by adding a
10.14subdivision to read:
10.15    Subd. 7a. Periodic renewal of eligibility. (a) The commissioner shall make an
10.16annual redetermination of eligibility based on information contained in the enrollee's case
10.17file and other information available to the agency, including but not limited to information
10.18accessed through an electronic database, without requiring the enrollee to submit any
10.19information when sufficient data is available for the agency to renew eligibility.
10.20(b) If the commissioner cannot renew eligibility in accordance with paragraph (a),
10.21the commissioner must provide the enrollee with a prepopulated renewal form containing
10.22eligibility information available to the agency and permit the enrollee to submit the form
10.23with any corrections or additional information to the agency and sign the renewal form via
10.24any of the modes of submission specified in section 256B.04, subdivision 18.
10.25(c) An enrollee who is terminated for failure to complete the renewal process may
10.26subsequently submit the renewal form and required information within four months after
10.27the date of termination and have coverage reinstated without a lapse, if otherwise eligible
10.28under this chapter.
10.29(d) Notwithstanding paragraph (a), individuals eligible under subdivision 5 shall be
10.30required to renew eligibility every six months.
10.31EFFECTIVE DATE.This section is effective January 1, 2014.

10.32    Sec. 18. Minnesota Statutes 2012, section 256B.056, subdivision 10, is amended to read:
11.1    Subd. 10. Eligibility verification. (a) The commissioner shall require women who
11.2are applying for the continuation of medical assistance coverage following the end of the
11.360-day postpartum period to update their income and asset information and to submit
11.4any required income or asset verification.
11.5    (b) The commissioner shall determine the eligibility of private-sector health care
11.6coverage for infants less than one year of age eligible under section 256B.055, subdivision
11.710 , or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
11.8if this is determined to be cost-effective.
11.9    (c) The commissioner shall verify assets and income for all applicants, and for all
11.10recipients upon renewal.
11.11    (d) The commissioner shall utilize information obtained through the electronic
11.12service established by the secretary of the United States Department of Health and Human
11.13Services and other available electronic data sources in Code of Federal Regulations, title
11.1442, sections 435.940 to 435.956, to verify eligibility requirements. The commissioner
11.15shall establish standards to define when information obtained electronically is reasonably
11.16compatible with information provided by applicants and enrollees, including use of
11.17self-attestation, to accomplish real-time eligibility determinations and maintain program
11.18integrity.
11.19EFFECTIVE DATE.This section is effective January 1, 2014.

11.20    Sec. 19. Minnesota Statutes 2012, section 256B.057, subdivision 1, is amended to read:
11.21    Subdivision 1. Infants and pregnant women. (a)(1) An infant less than one year
11.22 two years of age or a pregnant woman who has written verification of a positive pregnancy
11.23test from a physician or licensed registered nurse is eligible for medical assistance if the
11.24individual's countable family household income is equal to or less than 275 percent of the
11.25federal poverty guideline for the same family household size or an equivalent standard
11.26when converted using modified adjusted gross income methodology as required under
11.27the Affordable Care Act. For purposes of this subdivision, "countable family income"
11.28means the amount of income considered available using the methodology of the AFDC
11.29program under the state's AFDC plan as of July 16, 1996, as required by the Personal
11.30Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public
11.31Law 104-193, except for the earned income disregard and employment deductions.
11.32    (2) For applications processed within one calendar month prior to the effective date,
11.33eligibility shall be determined by applying the income standards and methodologies in
11.34effect prior to the effective date for any months in the six-month budget period before
11.35that date and the income standards and methodologies in effect on the effective date for
12.1any months in the six-month budget period on or after that date. The income standards
12.2for each month shall be added together and compared to the applicant's total countable
12.3income for the six-month budget period to determine eligibility.
12.4    (b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]
12.5    (2) For applications processed within one calendar month prior to July 1, 2003,
12.6eligibility shall be determined by applying the income standards and methodologies in
12.7effect prior to July 1, 2003, for any months in the six-month budget period before July 1,
12.82003, and the income standards and methodologies in effect on the expiration date for any
12.9months in the six-month budget period on or after July 1, 2003. The income standards
12.10for each month shall be added together and compared to the applicant's total countable
12.11income for the six-month budget period to determine eligibility.
12.12    (3) An amount equal to the amount of earned income exceeding 275 percent of
12.13the federal poverty guideline, up to a maximum of the amount by which the combined
12.14total of 185 percent of the federal poverty guideline plus the earned income disregards
12.15and deductions allowed under the state's AFDC plan as of July 16, 1996, as required
12.16by the Personal Responsibility and Work Opportunity Act of 1996 (PRWORA), Public
12.17Law 104-193, exceeds 275 percent of the federal poverty guideline will be deducted for
12.18pregnant women and infants less than one year of age.
12.19    (c) Dependent care and child support paid under court order shall be deducted from
12.20the countable income of pregnant women.
12.21    (d) (b) An infant born to a woman who was eligible for and receiving medical
12.22assistance on the date of the child's birth shall continue to be eligible for medical assistance
12.23without redetermination until the child's first birthday.
12.24EFFECTIVE DATE.This section is effective January 1, 2014.

12.25    Sec. 20. Minnesota Statutes 2012, section 256B.057, subdivision 8, is amended to read:
12.26    Subd. 8. Children under age two. Medical assistance may be paid for a child under
12.27two years of age whose countable family income is above 275 percent of the federal poverty
12.28guidelines for the same size family but less than or equal to 280 percent of the federal
12.29poverty guidelines for the same size family or an equivalent standard when converted using
12.30modified adjusted gross income methodology as required under the Affordable Care Act.
12.31EFFECTIVE DATE.This section is effective January 1, 2014.

12.32    Sec. 21. Minnesota Statutes 2012, section 256B.057, subdivision 10, is amended to read:
13.1    Subd. 10. Certain persons needing treatment for breast or cervical cancer. (a)
13.2Medical assistance may be paid for a person who:
13.3(1) has been screened for breast or cervical cancer by the Minnesota breast and
13.4cervical cancer control program, and program funds have been used to pay for the person's
13.5screening;
13.6(2) according to the person's treating health professional, needs treatment, including
13.7diagnostic services necessary to determine the extent and proper course of treatment, for
13.8breast or cervical cancer, including precancerous conditions and early stage cancer;
13.9(3) meets the income eligibility guidelines for the Minnesota breast and cervical
13.10cancer control program;
13.11(4) is under age 65;
13.12(5) is not otherwise eligible for medical assistance under United States Code, title
13.1342, section 1396a(a)(10)(A)(i); and
13.14(6) is not otherwise covered under creditable coverage, as defined under United
13.15States Code, title 42, section 1396a(aa).
13.16(b) Medical assistance provided for an eligible person under this subdivision shall
13.17be limited to services provided during the period that the person receives treatment for
13.18breast or cervical cancer.
13.19(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance
13.20without meeting the eligibility criteria relating to income and assets in section 256B.056,
13.21subdivisions 1a to 5b 5a.

13.22    Sec. 22. Minnesota Statutes 2012, section 256B.057, is amended by adding a
13.23subdivision to read:
13.24    Subd. 12. Presumptive eligibility determinations made by qualified hospitals.
13.25The commissioner shall establish a process to qualify hospitals that are participating
13.26providers under the medical assistance program to determine presumptive eligibility for
13.27medical assistance for applicants who may have a basis of eligibility using the modified
13.28adjusted gross income methodology as defined in section 256B.056, subdivision 1a,
13.29paragraph (b), clause (1).
13.30EFFECTIVE DATE.This section is effective January 1, 2014.

13.31    Sec. 23. Minnesota Statutes 2012, section 256B.059, subdivision 1, is amended to read:
13.32    Subdivision 1. Definitions. (a) For purposes of this section and sections 256B.058
13.33and 256B.0595, the terms defined in this subdivision have the meanings given them.
13.34    (b) "Community spouse" means the spouse of an institutionalized spouse.
14.1    (c) "Spousal share" means one-half of the total value of all assets, to the extent that
14.2either the institutionalized spouse or the community spouse had an ownership interest at
14.3the time of the first continuous period of institutionalization.
14.4    (d) "Assets otherwise available to the community spouse" means assets individually
14.5or jointly owned by the community spouse, other than assets excluded by subdivision 5,
14.6paragraph (c).
14.7    (e) "Community spouse asset allowance" is the value of assets that can be transferred
14.8under subdivision 3.
14.9    (f) "Institutionalized spouse" means a person who is:
14.10    (1) in a hospital, nursing facility, or intermediate care facility for persons with
14.11developmental disabilities, or receiving home and community-based services under section
14.12256B.0915 , 256B.092, or 256B.49 and is expected to remain in the facility or institution
14.13or receive the home and community-based services for at least 30 consecutive days; and
14.14    (2) married to a person who is not in a hospital, nursing facility, or intermediate
14.15care facility for persons with developmental disabilities, and is not receiving home and
14.16community-based services under section 256B.0915, 256B.092, or 256B.49.
14.17    (g) "For the sole benefit of" means no other individual or entity can benefit in any
14.18way from the assets or income at the time of a transfer or at any time in the future.
14.19    (h) "Continuous period of institutionalization" means a 30-consecutive-day period
14.20of time in which a person is expected to stay in a medical or long-term care facility, or
14.21receive home and community-based services that would qualify for coverage under the
14.22elderly waiver (EW) or alternative care (AC) programs section 256B.0913, 256B.0915,
14.23256B.092, or 256B.49. For a stay in a facility, the 30-consecutive-day period begins
14.24on the date of entry into a medical or long-term care facility. For receipt of home and
14.25community-based services, the 30-consecutive-day period begins on the date that the
14.26following conditions are met:
14.27    (1) the person is receiving services that meet the nursing facility level of care
14.28determined by a long-term care consultation;
14.29    (2) the person has received the long-term care consultation within the past 60 days;
14.30    (3) the services are paid by the EW program under section 256B.0915 or the AC
14.31program under section 256B.0913, 256B.0915, 256B.092, or 256B.49 or would qualify
14.32for payment under the EW or AC programs those sections if the person were otherwise
14.33eligible for either program, and but for the receipt of such services the person would have
14.34resided in a nursing facility; and
14.35    (4) the services are provided by a licensed provider qualified to provide home and
14.36community-based services.
15.1EFFECTIVE DATE.This section is effective January 1, 2014.

15.2    Sec. 24. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
15.3    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
15.4to citizens of the United States, qualified noncitizens as defined in this subdivision, and
15.5other persons residing lawfully in the United States. Citizens or nationals of the United
15.6States must cooperate in obtaining satisfactory documentary evidence of citizenship or
15.7nationality according to the requirements of the federal Deficit Reduction Act of 2005,
15.8Public Law 109-171.
15.9(b) "Qualified noncitizen" means a person who meets one of the following
15.10immigration criteria:
15.11(1) admitted for lawful permanent residence according to United States Code, title 8;
15.12(2) admitted to the United States as a refugee according to United States Code,
15.13title 8, section 1157;
15.14(3) granted asylum according to United States Code, title 8, section 1158;
15.15(4) granted withholding of deportation according to United States Code, title 8,
15.16section 1253(h);
15.17(5) paroled for a period of at least one year according to United States Code, title 8,
15.18section 1182(d)(5);
15.19(6) granted conditional entrant status according to United States Code, title 8,
15.20section 1153(a)(7);
15.21(7) determined to be a battered noncitizen by the United States Attorney General
15.22according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
15.23title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
15.24(8) is a child of a noncitizen determined to be a battered noncitizen by the United
15.25States Attorney General according to the Illegal Immigration Reform and Immigrant
15.26Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
15.27Public Law 104-200; or
15.28(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
15.29Law 96-422, the Refugee Education Assistance Act of 1980.
15.30(c) All qualified noncitizens who were residing in the United States before August
15.3122, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
15.32medical assistance with federal financial participation.
15.33(d) Beginning December 1, 1996, qualified noncitizens who entered the United
15.34States on or after August 22, 1996, and who otherwise meet the eligibility requirements
16.1of this chapter are eligible for medical assistance with federal participation for five years
16.2if they meet one of the following criteria:
16.3(1) refugees admitted to the United States according to United States Code, title 8,
16.4section 1157;
16.5(2) persons granted asylum according to United States Code, title 8, section 1158;
16.6(3) persons granted withholding of deportation according to United States Code,
16.7title 8, section 1253(h);
16.8(4) veterans of the United States armed forces with an honorable discharge for
16.9a reason other than noncitizen status, their spouses and unmarried minor dependent
16.10children; or
16.11(5) persons on active duty in the United States armed forces, other than for training,
16.12their spouses and unmarried minor dependent children.
16.13 Beginning July 1, 2010, children and pregnant women who are noncitizens
16.14described in paragraph (b) or who are lawfully present in the United States as defined
16.15in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
16.16eligibility requirements of this chapter, are eligible for medical assistance with federal
16.17financial participation as provided by the federal Children's Health Insurance Program
16.18Reauthorization Act of 2009, Public Law 111-3.
16.19(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
16.20are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
16.21subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
16.22Code, title 8, section 1101(a)(15).
16.23(f) Payment shall also be made for care and services that are furnished to noncitizens,
16.24regardless of immigration status, who otherwise meet the eligibility requirements of
16.25this chapter, if such care and services are necessary for the treatment of an emergency
16.26medical condition.
16.27(g) For purposes of this subdivision, the term "emergency medical condition" means
16.28a medical condition that meets the requirements of United States Code, title 42, section
16.291396b(v).
16.30(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
16.31of an emergency medical condition are limited to the following:
16.32(i) services delivered in an emergency room or by an ambulance service licensed
16.33under chapter 144E that are directly related to the treatment of an emergency medical
16.34condition;
16.35(ii) services delivered in an inpatient hospital setting following admission from an
16.36emergency room or clinic for an acute emergency condition; and
17.1(iii) follow-up services that are directly related to the original service provided
17.2to treat the emergency medical condition and are covered by the global payment made
17.3to the provider.
17.4    (2) Services for the treatment of emergency medical conditions do not include:
17.5(i) services delivered in an emergency room or inpatient setting to treat a
17.6nonemergency condition;
17.7(ii) organ transplants, stem cell transplants, and related care;
17.8(iii) services for routine prenatal care;
17.9(iv) continuing care, including long-term care, nursing facility services, home health
17.10care, adult day care, day training, or supportive living services;
17.11(v) elective surgery;
17.12(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
17.13part of an emergency room visit;
17.14(vii) preventative health care and family planning services;
17.15(viii) dialysis;
17.16(ix) chemotherapy or therapeutic radiation services;
17.17(x) rehabilitation services;
17.18(xi) physical, occupational, or speech therapy;
17.19(xii) transportation services;
17.20(xiii) case management;
17.21(xiv) prosthetics, orthotics, durable medical equipment, or medical supplies;
17.22(xv) dental services;
17.23(xvi) hospice care;
17.24(xvii) audiology services and hearing aids;
17.25(xviii) podiatry services;
17.26(xix) chiropractic services;
17.27(xx) immunizations;
17.28(xxi) vision services and eyeglasses;
17.29(xxii) waiver services;
17.30(xxiii) individualized education programs; or
17.31(xxiv) chemical dependency treatment.
17.32(i) Beginning July 1, 2009, Pregnant noncitizens who are undocumented,
17.33nonimmigrants, or lawfully present in the United States as defined in Code of Federal
17.34Regulations, title 8, section 103.12, ineligible for federally funded medical assistance
17.35 are not covered by a group health plan or health insurance coverage according to Code
17.36of Federal Regulations, title 42, section 457.310, and who otherwise meet the eligibility
18.1requirements of this chapter, are eligible for medical assistance through the period of
18.2pregnancy, including labor and delivery, and 60 days postpartum, to the extent federal
18.3funds are available under title XXI of the Social Security Act, and the state children's
18.4health insurance program.
18.5(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
18.6services from a nonprofit center established to serve victims of torture and are otherwise
18.7ineligible for medical assistance under this chapter are eligible for medical assistance
18.8without federal financial participation. These individuals are eligible only for the period
18.9during which they are receiving services from the center. Individuals eligible under this
18.10paragraph shall not be required to participate in prepaid medical assistance.
18.11(k) Noncitizens who are lawfully present in the United States as defined in Code
18.12of Federal Regulations, title 8, section 103.12, who are not children or pregnant women
18.13as defined in paragraph (d), and who otherwise meet the eligibility requirements of this
18.14chapter, are eligible for medical assistance without federal financial participation. These
18.15individuals must cooperate with the United States Citizenship and Immigration Services to
18.16pursue any applicable immigration status, including citizenship, that would qualify them
18.17for medical assistance with federal financial participation.
18.18EFFECTIVE DATE.This section is effective January 1, 2014.

18.19    Sec. 25. Minnesota Statutes 2012, section 256B.0755, subdivision 3, is amended to read:
18.20    Subd. 3. Accountability. (a) Health care delivery systems must accept responsibility
18.21for the quality of care based on standards established under subdivision 1, paragraph (b),
18.22clause (10), and the cost of care or utilization of services provided to its enrollees under
18.23subdivision 1, paragraph (b), clause (1).
18.24(b) A health care delivery system may contract and coordinate with providers and
18.25clinics for the delivery of services and shall contract with community health clinics,
18.26federally qualified health centers, community mental health centers or programs, county
18.27agencies, and rural clinics to the extent practicable.
18.28(c) A health care delivery system must demonstrate how its services will be
18.29coordinated with other services affecting its attributed patients' health, quality of care, and
18.30cost of care that are provided by other providers and county agencies in the local service.
18.31The health care delivery system must: (1) document how other providers and counties,
18.32including county-based purchasing plans, will provide services to persons attributed to the
18.33health care delivery system; (2) document how other providers and counties, including
18.34county-based purchasing plans, participated in developing the application; (3) provide
18.35verification that other providers and counties, including county-based purchasing plans,
19.1support the project and are willing to participate; and (4) document how it will address
19.2applicable local needs, priorities, and public health goals.
19.3EFFECTIVE DATE.This section applies to health care delivery system contracts
19.4entered into or renewed on or after July 1, 2013.

19.5    Sec. 26. Minnesota Statutes 2012, section 256B.694, is amended to read:
19.6256B.694 SOLE-SOURCE OR SINGLE-PLAN MANAGED CARE
19.7CONTRACT.
19.8    (a) MS 2010 [Expired, 2008 c 364 s 10]
19.9    (b) The commissioner shall consider, and may approve, contracting on a
19.10single-health plan basis with other county-based purchasing plans, or with other qualified
19.11health plans that have coordination arrangements with counties, to serve persons with
19.12a disability who voluntarily enroll enrolled in state health care programs, in order to
19.13promote better coordination or integration of health care services, social services and
19.14other community-based services, provided that all requirements applicable to health plan
19.15purchasing, including those in section 256B.69, subdivision 23, are satisfied. Nothing in
19.16this paragraph supersedes or modifies the requirements in paragraph (a).

19.17    Sec. 27. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
19.18to read:
19.19    Subd. 1b. Affordable Care Act. "Affordable Care Act" means Public Law 111-148,
19.20as amended by the federal Health Care and Education Reconciliation Act of 2010, Public
19.21Law 111-152, and any amendments to, or regulations or guidance issued under, those acts.

19.22    Sec. 28. Minnesota Statutes 2012, section 256L.01, subdivision 3a, is amended to read:
19.23    Subd. 3a. Family with children. (a) "Family with children" means:
19.24(1) parents and their children residing in the same household; or
19.25(2) grandparents, foster parents, relative caretakers as defined in the medical
19.26assistance program, or legal guardians; and their wards who are children residing in the
19.27same household. "Family" has the meaning given for family and family size as defined
19.28in Code of Federal Regulations, title 26, section 1.36B-1.
19.29(b) The term includes children who are temporarily absent from the household in
19.30settings such as schools, camps, or parenting time with noncustodial parents.
20.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
20.2approval, whichever is later. The commissioner of human services shall notify the revisor
20.3of statutes when federal approval is obtained.

20.4    Sec. 29. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
20.5to read:
20.6    Subd. 4b. Minnesota Insurance Marketplace. "Minnesota Insurance Marketplace"
20.7means the Minnesota Insurance Marketplace as defined in Minnesota Statutes, section
20.862V.02.

20.9    Sec. 30. Minnesota Statutes 2012, section 256L.01, subdivision 5, is amended to read:
20.10    Subd. 5. Income. (a) "Income" has the meaning given for earned and unearned
20.11income for families and children in the medical assistance program, according to the
20.12state's aid to families with dependent children plan in effect as of July 16, 1996. The
20.13definition does not include medical assistance income methodologies and deeming
20.14requirements. The earned income of full-time and part-time students under age 19 is
20.15not counted as income. Public assistance payments and supplemental security income
20.16are not excluded income modified adjusted gross income, as defined in Code of Federal
20.17Regulations, title 26, section 1.36B-1.
20.18(b) For purposes of this subdivision, and unless otherwise specified in this section,
20.19the commissioner shall use reasonable methods to calculate gross earned and unearned
20.20income including, but not limited to, projecting income based on income received within
20.21the past 30 days, the last 90 days, or the last 12 months.
20.22EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
20.23approval, whichever is later. The commissioner of human services shall notify the revisor
20.24of statutes when federal approval is obtained.

20.25    Sec. 31. Minnesota Statutes 2012, section 256L.01, is amended by adding a subdivision
20.26to read:
20.27    Subd. 8. Participating entity. "Participating entity" means a health carrier as
20.28defined in section 62A.011, subdivision 2; a county-based purchasing plan established
20.29under section 256B.692; an accountable care organization or other entity operating a
20.30health care delivery systems demonstration project authorized under section 256B.0755;
20.31an entity operating a county integrated health care delivery network pilot project
20.32authorized under section 256B.0756; or a network of health care providers established to
20.33offer services under MinnesotaCare.
21.1EFFECTIVE DATE.This section is effective January 1, 2015.

21.2    Sec. 32. Minnesota Statutes 2012, section 256L.02, subdivision 2, is amended to read:
21.3    Subd. 2. Commissioner's duties. The commissioner shall establish an office for the
21.4state administration of this plan. The plan shall be used to provide covered health services
21.5for eligible persons. Payment for these services shall be made to all eligible providers
21.6 participating entities under contract with the commissioner. The commissioner shall
21.7adopt rules to administer the MinnesotaCare program. Nothing in this chapter is intended
21.8to violate the requirements of the Affordable Care Act. The commissioner shall not
21.9implement any provision of this chapter if the provision is found to violate the Affordable
21.10Care Act. The commissioner shall establish marketing efforts to encourage potentially
21.11eligible persons to receive information about the program and about other medical care
21.12programs administered or supervised by the Department of Human Services. A toll-free
21.13telephone number and Web site must be used to provide information about medical
21.14programs and to promote access to the covered services.
21.15EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
21.16approval, whichever is later, except that the amendment related to "participating entities"
21.17is effective January 1, 2015. The commissioner of human services shall notify the revisor
21.18when federal approval is obtained.

21.19    Sec. 33. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
21.20to read:
21.21    Subd. 6. Federal approval. (a) The commissioner of human services shall seek
21.22federal approval to implement the MinnesotaCare program under this chapter as a basic
21.23health program. In any agreement with the Centers for Medicare and Medicaid Services
21.24to operate MinnesotaCare as a basic health program, the commissioner shall seek to
21.25include procedures to ensure that federal funding is predictable, stable, and sufficient
21.26to sustain ongoing operation of MinnesotaCare. These procedures must address issues
21.27related to the timing of federal payments, payment reconciliation, enrollee risk adjustment,
21.28and minimization of state financial risk. The commissioner shall consult with the
21.29commissioner of management and budget when developing the proposal for establishing
21.30MinnesotaCare as a basic health program to be submitted to the Centers for Medicare
21.31and Medicaid Services.
21.32(b) The commissioner of human services, in consultation with the commissioner of
21.33management and budget, shall work with the Centers for Medicare and Medicaid Services
21.34to establish a process for reconciliation and adjustment of federal payments that balances
22.1state and federal liability over time. The commissioner of human services shall request that
22.2the secretary of health and human services hold the state, and enrollees, harmless in the
22.3reconciliation process for the first three years, to allow the state to develop a statistically
22.4valid methodology for predicting enrollment trends and their net effect on federal payments.
22.5(c) The commissioner of human services, through December 31, 2015, may modify
22.6the MinnesotaCare program as specified in this chapter, if it is necessary to enhance
22.7health benefits, expand provider access, or reduce cost-sharing and premiums in order
22.8to comply with the terms and conditions of federal approval as a basic health program.
22.9The commissioner may not reduce benefits, impose greater limits on access to providers,
22.10or increase cost-sharing and premiums by enrollees under the authority granted by this
22.11paragraph. If the commissioner modifies the terms and requirements for MinnesotaCare
22.12under this paragraph, the commissioner shall provide the legislature with notice of
22.13implementation of the modifications at least ten working days before notifying enrollees
22.14and participating entities. The costs of any changes to the program necessary to comply
22.15with federal approval shall become part of the program's base funding for purposes of
22.16future budget forecasts.
22.17EFFECTIVE DATE.This section is effective the day following final enactment.

22.18    Sec. 34. Minnesota Statutes 2012, section 256L.02, is amended by adding a subdivision
22.19to read:
22.20    Subd. 7. Coordination with Minnesota Insurance Marketplace. MinnesotaCare
22.21shall be considered a public health care program for purposes of Minnesota Statutes,
22.22chapter 62V.
22.23EFFECTIVE DATE.This section is effective January 1, 2014.

22.24    Sec. 35. Minnesota Statutes 2012, section 256L.03, subdivision 1, is amended to read:
22.25    Subdivision 1. Covered health services. (a) "Covered health services" means the
22.26health services reimbursed under chapter 256B, and all essential health benefits required
22.27under section 1302 of the Affordable Care Act, with the exception of inpatient hospital
22.28services, special education services, private duty nursing services, adult dental care
22.29services other than services covered under section 256B.0625, subdivision 9, orthodontic
22.30services, nonemergency medical transportation services, personal care assistance and case
22.31management services, and nursing home or intermediate care facilities services, inpatient
22.32mental health services, and chemical dependency services.
23.1    (b) No public funds shall be used for coverage of abortion under MinnesotaCare
23.2except where the life of the female would be endangered or substantial and irreversible
23.3impairment of a major bodily function would result if the fetus were carried to term; or
23.4where the pregnancy is the result of rape or incest.
23.5    (c) Covered health services shall be expanded as provided in this section.
23.6EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
23.7approval, whichever is later. The commissioner of human services shall notify the revisor
23.8of statutes when federal approval is obtained.

23.9    Sec. 36. Minnesota Statutes 2012, section 256L.03, subdivision 1a, is amended to read:
23.10    Subd. 1a. Pregnant women and Children; MinnesotaCare health care reform
23.11waiver. Beginning January 1, 1999, Children and pregnant women are eligible for coverage
23.12of all services that are eligible for reimbursement under the medical assistance program
23.13according to chapter 256B, except that abortion services under MinnesotaCare shall be
23.14limited as provided under subdivision 1. Pregnant women and Children are exempt from
23.15the provisions of subdivision 5, regarding co-payments. Pregnant women and Children
23.16who are lawfully residing in the United States but who are not "qualified noncitizens" under
23.17title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
23.18Public Law 104-193, Statutes at Large, volume 110, page 2105, are eligible for coverage
23.19of all services provided under the medical assistance program according to chapter 256B.
23.20EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
23.21approval, whichever is later. The commissioner of human services shall notify the revisor
23.22of statutes when federal approval is obtained.

23.23    Sec. 37. Minnesota Statutes 2012, section 256L.03, subdivision 3, is amended to read:
23.24    Subd. 3. Inpatient hospital services. (a) Covered health services shall include
23.25inpatient hospital services, including inpatient hospital mental health services and inpatient
23.26hospital and residential chemical dependency treatment, subject to those limitations
23.27necessary to coordinate the provision of these services with eligibility under the medical
23.28assistance spenddown. The inpatient hospital benefit for adult enrollees who qualify under
23.29section 256L.04, subdivision 7, or who qualify under section 256L.04, subdivisions 1 and
23.302 , with family gross income that exceeds 200 percent of the federal poverty guidelines or
23.31215 percent of the federal poverty guidelines on or after July 1, 2009, and who are not
23.32pregnant, is subject to an annual limit of $10,000.
24.1    (b) Admissions for inpatient hospital services paid for under section 256L.11,
24.2subdivision 3 , must be certified as medically necessary in accordance with Minnesota
24.3Rules, parts 9505.0500 to 9505.0540, except as provided in clauses (1) and (2):
24.4    (1) all admissions must be certified, except those authorized under rules established
24.5under section 254A.03, subdivision 3, or approved under Medicare; and
24.6    (2) payment under section 256L.11, subdivision 3, shall be reduced by five percent
24.7for admissions for which certification is requested more than 30 days after the day of
24.8admission. The hospital may not seek payment from the enrollee for the amount of the
24.9payment reduction under this clause.
24.10EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
24.11approval, whichever is later. The commissioner of human services shall notify the revisor
24.12of statutes when federal approval is obtained.

24.13    Sec. 38. Minnesota Statutes 2012, section 256L.03, is amended by adding a subdivision
24.14to read:
24.15    Subd. 4b. Loss ratio. Health coverage provided through the MinnesotaCare
24.16program must have a medical loss ratio of at least 85 percent, as defined using the loss
24.17ratio methodology described in section 1001 of the Affordable Care Act.
24.18EFFECTIVE DATE.This section is effective January 1, 2015.

24.19    Sec. 39. Minnesota Statutes 2012, section 256L.03, subdivision 5, is amended to read:
24.20    Subd. 5. Cost-sharing. (a) Except as otherwise provided in paragraphs (b) and (c)
24.21 this subdivision, the MinnesotaCare benefit plan shall include the following cost-sharing
24.22requirements for all enrollees:
24.23    (1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
24.24subject to an annual inpatient out-of-pocket maximum of $1,000 per individual;
24.25    (2) $3 per prescription for adult enrollees;
24.26    (3) $25 for eyeglasses for adult enrollees;
24.27    (4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
24.28episode of service which is required because of a recipient's symptoms, diagnosis, or
24.29established illness, and which is delivered in an ambulatory setting by a physician or
24.30physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
24.31audiologist, optician, or optometrist;
24.32    (5) $6 for nonemergency visits to a hospital-based emergency room for services
24.33provided through December 31, 2010, and $3.50 effective January 1, 2011; and
25.1(6) a family deductible equal to the maximum amount allowed under Code of
25.2Federal Regulations, title 42, part 447.54.
25.3    (b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
25.4 families with children under the age of 21.
25.5    (c) Paragraph (a) does not apply to pregnant women and children under the age of 21.
25.6    (d) Paragraph (a), clause (4), does not apply to mental health services.
25.7    (e) Adult enrollees with family gross income that exceeds 200 percent of the federal
25.8poverty guidelines or 215 percent of the federal poverty guidelines on or after July 1, 2009,
25.9and who are not pregnant shall be financially responsible for the coinsurance amount, if
25.10applicable, and amounts which exceed the $10,000 inpatient hospital benefit limit.
25.11    (f) (e) When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
25.12or changes from one prepaid health plan to another during a calendar year, any charges
25.13submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
25.14expenses incurred by the enrollee for inpatient services, that were submitted or incurred
25.15prior to enrollment, or prior to the change in health plans, shall be disregarded.
25.16(g) (f) MinnesotaCare reimbursements to fee-for-service providers and payments to
25.17managed care plans or county-based purchasing plans shall not be increased as a result of
25.18the reduction of the co-payments in paragraph (a), clause (5), effective January 1, 2011.
25.19(h) (g) The commissioner, through the contracting process under section 256L.12,
25.20may allow managed care plans and county-based purchasing plans to waive the family
25.21deductible under paragraph (a), clause (6). The value of the family deductible shall not be
25.22included in the capitation payment to managed care plans and county-based purchasing
25.23plans. Managed care plans and county-based purchasing plans shall certify annually to the
25.24commissioner the dollar value of the family deductible.
25.25EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
25.26approval, whichever is later. The commissioner of human services shall notify the revisor
25.27of statutes when federal approval is obtained.

25.28    Sec. 40. Minnesota Statutes 2012, section 256L.03, subdivision 6, is amended to read:
25.29    Subd. 6. Lien. When the state agency provides, pays for, or becomes liable for
25.30covered health services, the agency shall have a lien for the cost of the covered health
25.31services upon any and all causes of action accruing to the enrollee, or to the enrollee's
25.32legal representatives, as a result of the occurrence that necessitated the payment for the
25.33covered health services. All liens under this section shall be subject to the provisions
25.34of section 256.015. For purposes of this subdivision, "state agency" includes prepaid
25.35health plans participating entities, under contract with the commissioner according to
26.1sections 256B.69, 256D.03, subdivision 4, paragraph (c), and 256L.12; and county-based
26.2purchasing entities under section 256B.692 section 256L.121.
26.3EFFECTIVE DATE.This section is effective January 1, 2015.

26.4    Sec. 41. Minnesota Statutes 2012, section 256L.04, subdivision 1, is amended to read:
26.5    Subdivision 1. Families with children. (a) Families with children with family
26.6income above 133 percent of the federal poverty guidelines and equal to or less than
26.7275 200 percent of the federal poverty guidelines for the applicable family size shall be
26.8eligible for MinnesotaCare according to this section. All other provisions of sections
26.9256L.01 to 256L.18, including the insurance-related barriers to enrollment under section
26.10256L.07, shall apply unless otherwise specified.
26.11    (b) Parents who enroll in the MinnesotaCare program must also enroll their children,
26.12if the children are eligible. Children may be enrolled separately without enrollment by
26.13parents. However, if one parent in the household enrolls, both parents must enroll, unless
26.14other insurance is available. If one child from a family is enrolled, all children must
26.15be enrolled, unless other insurance is available. If one spouse in a household enrolls,
26.16the other spouse in the household must also enroll, unless other insurance is available.
26.17Families cannot choose to enroll only certain uninsured members.
26.18    (c) Beginning October 1, 2003, the dependent sibling definition no longer applies
26.19to the MinnesotaCare program. These persons are no longer counted in the parental
26.20household and may apply as a separate household.
26.21    (d) Parents are not eligible for MinnesotaCare if their gross income exceeds $57,500.
26.22(e) Children deemed eligible for MinnesotaCare under section 256L.07, subdivision
26.238 , are exempt from the eligibility requirements of this subdivision.
26.24EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
26.25approval, whichever is later. The commissioner of human services shall notify the revisor
26.26of statutes when federal approval is obtained.

26.27    Sec. 42. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
26.28to read:
26.29    Subd. 1c. General requirements. To be eligible for coverage under MinnesotaCare,
26.30a person must meet the eligibility requirements of this section. A person eligible for
26.31MinnesotaCare shall not be treated as a qualified individual under section 1312 of the
26.32Affordable Care Act, and is not eligible for enrollment in a qualified health plan offered
26.33through the health benefit exchange under section 1331 of the Affordable Care Act.
27.1EFFECTIVE DATE.This section is effective January 1, 2015.

27.2    Sec. 43. Minnesota Statutes 2012, section 256L.04, subdivision 7, is amended to read:
27.3    Subd. 7. Single adults and households with no children. (a) The definition of
27.4eligible persons includes all individuals and households families with no children who
27.5have gross family incomes that are above 133 percent and equal to or less than 200 percent
27.6of the federal poverty guidelines for the applicable family size.
27.7    (b) Effective July 1, 2009, the definition of eligible persons includes all individuals
27.8and households with no children who have gross family incomes that are equal to or less
27.9than 250 percent of the federal poverty guidelines.
27.10EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
27.11approval, whichever is later. The commissioner of human services shall notify the revisor
27.12of statutes when federal approval is obtained.

27.13    Sec. 44. Minnesota Statutes 2012, section 256L.04, subdivision 8, is amended to read:
27.14    Subd. 8. Applicants potentially eligible for medical assistance. (a) Individuals
27.15who receive supplemental security income or retirement, survivors, or disability benefits
27.16due to a disability, or other disability-based pension, who qualify under subdivision 7, but
27.17who are potentially eligible for medical assistance without a spenddown shall be allowed
27.18to enroll in MinnesotaCare for a period of 60 days, so long as the applicant meets all other
27.19conditions of eligibility. The commissioner shall identify and refer the applications of
27.20such individuals to their county social service agency. The county and the commissioner
27.21shall cooperate to ensure that the individuals obtain medical assistance coverage for any
27.22months for which they are eligible.
27.23(b) The enrollee must cooperate with the county social service agency in determining
27.24medical assistance eligibility within the 60-day enrollment period. Enrollees who do not
27.25cooperate with medical assistance within the 60-day enrollment period shall be disenrolled
27.26from the plan within one calendar month. Persons disenrolled for nonapplication for
27.27medical assistance may not reenroll until they have obtained a medical assistance
27.28eligibility determination. Persons disenrolled for noncooperation with medical assistance
27.29may not reenroll until they have cooperated with the county agency and have obtained a
27.30medical assistance eligibility determination.
27.31(c) Beginning January 1, 2000, counties that choose to become MinnesotaCare
27.32enrollment sites shall consider MinnesotaCare applications to also be applications for
27.33medical assistance. Applicants who are potentially eligible for medical assistance, except
28.1for those described in paragraph (a), may choose to enroll in either MinnesotaCare or
28.2medical assistance.
28.3(d) The commissioner shall redetermine provider payments made under
28.4MinnesotaCare to the appropriate medical assistance payments for those enrollees who
28.5subsequently become eligible for medical assistance.
28.6EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
28.7approval, whichever is later. The commissioner of human services shall notify the revisor
28.8of statutes when federal approval is obtained.

28.9    Sec. 45. Minnesota Statutes 2012, section 256L.04, subdivision 10, is amended to read:
28.10    Subd. 10. Citizenship requirements. (a) Eligibility for MinnesotaCare is limited to
28.11citizens or nationals of the United States, qualified noncitizens, and other persons residing
28.12 and lawfully in the United States present noncitizens as defined in Code of Federal
28.13Regulations, title 8, section 103.12. Undocumented noncitizens and nonimmigrants
28.14 are ineligible for MinnesotaCare. For purposes of this subdivision, a nonimmigrant
28.15is an individual in one or more of the classes listed in United States Code, title 8,
28.16section 1101(a)(15), and an undocumented noncitizen is an individual who resides in the
28.17United States without the approval or acquiescence of the United States Citizenship and
28.18Immigration Services. Families with children who are citizens or nationals of the United
28.19States must cooperate in obtaining satisfactory documentary evidence of citizenship or
28.20nationality according to the requirements of the federal Deficit Reduction Act of 2005,
28.21Public Law 109-171.
28.22(b) Eligible persons include individuals who are lawfully present and ineligible for
28.23medical assistance by reason of immigration status, who have family income equal to or
28.24less than 200 percent of the federal poverty guidelines for the applicable family size.
28.25EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
28.26approval, whichever is later. The commissioner of human services shall notify the revisor
28.27of statutes when federal approval is obtained.

28.28    Sec. 46. Minnesota Statutes 2012, section 256L.04, is amended by adding a subdivision
28.29to read:
28.30    Subd. 14. Coordination with medical assistance. (a) Individuals eligible for
28.31medical assistance under chapter 256B are not eligible for MinnesotaCare under this
28.32section.
29.1(b) The commissioner shall coordinate eligibility and coverage to ensure that
29.2individuals transitioning between medical assistance and MinnesotaCare have seamless
29.3eligibility and access to health care services.
29.4EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
29.5approval, whichever is later. The commissioner of human services shall notify the revisor
29.6of statutes when federal approval is obtained.

29.7    Sec. 47. Minnesota Statutes 2012, section 256L.05, subdivision 1, is amended to read:
29.8    Subdivision 1. Application assistance and information availability. (a) Applicants
29.9may submit applications online, in person, by mail, or by phone in accordance with the
29.10Affordable Care Act, and by any other means by which medical assistance applications
29.11may be submitted. Applicants may submit applications through the Minnesota Insurance
29.12Marketplace or through the MinnesotaCare program. Applications and application
29.13assistance must be made available at provider offices, local human services agencies,
29.14school districts, public and private elementary schools in which 25 percent or more of
29.15the students receive free or reduced price lunches, community health offices, Women,
29.16Infants and Children (WIC) program sites, Head Start program sites, public housing
29.17councils, crisis nurseries, child care centers, early childhood education and preschool
29.18program sites, legal aid offices, and libraries, and at any other locations at which medical
29.19assistance applications must be made available. These sites may accept applications and
29.20forward the forms to the commissioner or local county human services agencies that
29.21choose to participate as an enrollment site. Otherwise, applicants may apply directly to the
29.22commissioner or to participating local county human services agencies.
29.23(b) Application assistance must be available for applicants choosing to file an online
29.24application through the Minnesota Insurance Marketplace.
29.25EFFECTIVE DATE.This section is effective January 1, 2014.

29.26    Sec. 48. Minnesota Statutes 2012, section 256L.05, subdivision 2, is amended to read:
29.27    Subd. 2. Commissioner's duties. The commissioner or county agency shall use
29.28electronic verification through the Minnesota Insurance Marketplace as the primary
29.29method of income verification. If there is a discrepancy between reported income
29.30and electronically verified income, an individual may be required to submit additional
29.31verification to the extent permitted under the Affordable Care Act. In addition, the
29.32commissioner shall perform random audits to verify reported income and eligibility. The
29.33commissioner may execute data sharing arrangements with the Department of Revenue
30.1and any other governmental agency in order to perform income verification related to
30.2eligibility and premium payment under the MinnesotaCare program.
30.3EFFECTIVE DATE.This section is effective January 1, 2014.

30.4    Sec. 49. Minnesota Statutes 2012, section 256L.05, subdivision 3, is amended to read:
30.5    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
30.6first day of the month following the month in which eligibility is approved and the first
30.7premium payment has been received. As provided in section 256B.057, coverage for
30.8newborns is automatic from the date of birth and must be coordinated with other health
30.9coverage. The effective date of coverage for eligible newly adoptive children added to a
30.10family receiving covered health services is the month of placement. The effective date
30.11of coverage for other new members added to the family is the first day of the month
30.12following the month in which the change is reported. All eligibility criteria must be met
30.13by the family at the time the new family member is added. The income of the new family
30.14member is included with the family's modified adjusted gross income and the adjusted
30.15premium begins in the month the new family member is added.
30.16(b) The initial premium must be received by the last working day of the month for
30.17coverage to begin the first day of the following month.
30.18(c) Benefits are not available until the day following discharge if an enrollee is
30.19hospitalized on the first day of coverage.
30.20(d) (c) Notwithstanding any other law to the contrary, benefits under sections
30.21256L.01 to 256L.18 are secondary to a plan of insurance or benefit program under which
30.22an eligible person may have coverage and the commissioner shall use cost avoidance
30.23techniques to ensure coordination of any other health coverage for eligible persons. The
30.24commissioner shall identify eligible persons who may have coverage or benefits under
30.25other plans of insurance or who become eligible for medical assistance.
30.26(e) (d) The effective date of coverage for individuals or families who are exempt
30.27from paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first
30.28day of the month following the month in which verification of American Indian status
30.29is received or eligibility is approved, whichever is later.
30.30(f) (e) The effective date of coverage for children eligible under section 256L.07,
30.31subdivision 8, is the first day of the month following the date of termination from foster
30.32care or release from a juvenile residential correctional facility.
31.1EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
31.2approval, whichever is later. The commissioner of human services shall notify the revisor
31.3of statutes when federal approval is obtained.

31.4    Sec. 50. Minnesota Statutes 2012, section 256L.06, subdivision 3, is amended to read:
31.5    Subd. 3. Commissioner's duties and payment. (a) Premiums are dedicated to the
31.6commissioner for MinnesotaCare.
31.7    (b) The commissioner shall develop and implement procedures to: (1) require
31.8enrollees to report changes in income; (2) adjust sliding scale premium payments, based
31.9upon both increases and decreases in enrollee income, at the time the change in income
31.10is reported; and (3) disenroll enrollees from MinnesotaCare for failure to pay required
31.11premiums. Failure to pay includes payment with a dishonored check, a returned automatic
31.12bank withdrawal, or a refused credit card or debit card payment. The commissioner may
31.13demand a guaranteed form of payment, including a cashier's check or a money order, as
31.14the only means to replace a dishonored, returned, or refused payment.
31.15    (c) Premiums are calculated on a calendar month basis and may be paid on a
31.16monthly, quarterly, or semiannual basis, with the first payment due upon notice from the
31.17commissioner of the premium amount required. The commissioner shall inform applicants
31.18and enrollees of these premium payment options. Premium payment is required before
31.19enrollment is complete and to maintain eligibility in MinnesotaCare. Premium payments
31.20received before noon are credited the same day. Premium payments received after noon
31.21are credited on the next working day.
31.22    (d) Nonpayment of the premium will result in disenrollment from the plan effective
31.23for the calendar month for which the premium was due. Persons disenrolled for
31.24nonpayment or who voluntarily terminate coverage from the program may not reenroll
31.25until four calendar months have elapsed. Persons disenrolled for nonpayment who pay
31.26all past due premiums as well as current premiums due, including premiums due for the
31.27period of disenrollment, within 20 days of disenrollment, shall be reenrolled retroactively
31.28to the first day of disenrollment. Persons disenrolled for nonpayment or who voluntarily
31.29terminate coverage from the program may not reenroll for four calendar months unless
31.30the person demonstrates good cause for nonpayment. Good cause does not exist if a
31.31person chooses to pay other family expenses instead of the premium. The commissioner
31.32shall define good cause in rule.
31.33EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
31.34approval, whichever is later. The commissioner of human services shall notify the revisor
31.35of statutes when federal approval is obtained.

32.1    Sec. 51. Minnesota Statutes 2012, section 256L.07, subdivision 1, is amended to read:
32.2    Subdivision 1. General requirements. (a) Children enrolled in the original
32.3children's health plan as of September 30, 1992, children who enrolled in the
32.4MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
32.5article 4, section 17, and children who have family gross incomes that are equal to or
32.6less than 200 percent of the federal poverty guidelines are eligible without meeting the
32.7requirements of subdivision 2 and the four-month requirement in subdivision 3, as long as
32.8they maintain continuous coverage in the MinnesotaCare program or medical assistance.
32.9    Parents Individuals enrolled in MinnesotaCare under section 256L.04, subdivision 1,
32.10and individuals enrolled in MinnesotaCare under section 256L.04, subdivision 7, whose
32.11income increases above 275 200 percent of the federal poverty guidelines, are no longer
32.12eligible for the program and shall be disenrolled by the commissioner. Beginning January
32.131, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
32.147 , whose income increases above 200 percent of the federal poverty guidelines or 250
32.15percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
32.16the program and shall be disenrolled by the commissioner. For persons disenrolled under
32.17this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
32.18following the month in which the commissioner determines that the income of a family or
32.19individual exceeds program income limits.
32.20    (b) Children may remain enrolled in MinnesotaCare if their gross family income as
32.21defined in section 256L.01, subdivision 4, is greater than 275 percent of federal poverty
32.22guidelines. The premium for children remaining eligible under this paragraph shall be the
32.23maximum premium determined under section 256L.15, subdivision 2, paragraph (b).
32.24    (c) Notwithstanding paragraph (a), parents are not eligible for MinnesotaCare if
32.25gross household income exceeds $57,500 for the 12-month period of eligibility.
32.26EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
32.27approval, whichever is later. The commissioner of human services shall notify the revisor
32.28of statutes when federal approval is obtained.

32.29    Sec. 52. Minnesota Statutes 2012, section 256L.07, subdivision 2, is amended to read:
32.30    Subd. 2. Must not have access to employer-subsidized minimum essential
32.31 coverage. (a) To be eligible, a family or individual must not have access to subsidized
32.32health coverage through an employer and must not have had access to employer-subsidized
32.33coverage through a current employer for 18 months prior to application or reapplication.
32.34A family or individual whose employer-subsidized coverage is lost due to an employer
32.35terminating health care coverage as an employee benefit during the previous 18 months is
33.1not eligible that is affordable and provides minimum value as defined in Code of Federal
33.2Regulations, title 26, section 1.36B-2.
33.3(b) This subdivision does not apply to a family or individual who was enrolled
33.4in MinnesotaCare within six months or less of reapplication and who no longer has
33.5employer-subsidized coverage due to the employer terminating health care coverage as an
33.6employee benefit. This subdivision does not apply to children with family gross incomes
33.7that are equal to or less than 200 percent of federal poverty guidelines.
33.8(c) For purposes of this requirement, subsidized health coverage means health
33.9coverage for which the employer pays at least 50 percent of the cost of coverage for
33.10the employee or dependent, or a higher percentage as specified by the commissioner.
33.11Children are eligible for employer-subsidized coverage through either parent, including
33.12the noncustodial parent. The commissioner must treat employer contributions to Internal
33.13Revenue Code Section 125 plans and any other employer benefits intended to pay
33.14health care costs as qualified employer subsidies toward the cost of health coverage for
33.15employees for purposes of this subdivision.
33.16EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
33.17approval, whichever is later. The commissioner of human services shall notify the revisor
33.18of statutes when federal approval is obtained.

33.19    Sec. 53. Minnesota Statutes 2012, section 256L.07, subdivision 3, is amended to read:
33.20    Subd. 3. Other health coverage. (a) Families and individuals enrolled in the
33.21MinnesotaCare program must have no To be eligible, a family must not have minimum
33.22essential health coverage while enrolled, as defined by section 5000A of the Internal
33.23Revenue Code. Children with family gross incomes equal to or greater than 200 percent
33.24of federal poverty guidelines, and adults, must have had no health coverage for at least
33.25four months prior to application and renewal. Children enrolled in the original children's
33.26health plan and children in families with income equal to or less than 200 percent of the
33.27federal poverty guidelines, who have other health insurance, are eligible if the coverage:
33.28(1) lacks two or more of the following:
33.29(i) basic hospital insurance;
33.30(ii) medical-surgical insurance;
33.31(iii) prescription drug coverage;
33.32(iv) dental coverage; or
33.33(v) vision coverage;
33.34(2) requires a deductible of $100 or more per person per year; or
34.1(3) lacks coverage because the child has exceeded the maximum coverage for a
34.2particular diagnosis or the policy excludes a particular diagnosis.
34.3The commissioner may change this eligibility criterion for sliding scale premiums
34.4in order to remain within the limits of available appropriations. The requirement of no
34.5health coverage does not apply to newborns.
34.6(b) Coverage purchased as provided under section 256L.031, subdivision 2, medical
34.7assistance, and the Civilian Health and Medical Program of the Uniformed Service,
34.8CHAMPUS, or other coverage provided under United States Code, title 10, subtitle A,
34.9part II, chapter 55, are not considered insurance or health coverage for purposes of the
34.10four-month requirement described in this subdivision.
34.11(c) (b) For purposes of this subdivision, an applicant or enrollee who is entitled to
34.12Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
34.13Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered
34.14to have minimum essential health coverage. An applicant or enrollee who is entitled to
34.15premium-free Medicare Part A may not refuse to apply for or enroll in Medicare coverage
34.16to establish eligibility for MinnesotaCare.
34.17(d) Applicants who were recipients of medical assistance within one month of
34.18application must meet the provisions of this subdivision and subdivision 2.
34.19(e) Cost-effective health insurance that was paid for by medical assistance is not
34.20considered health coverage for purposes of the four-month requirement under this
34.21section, except if the insurance continued after medical assistance no longer considered it
34.22cost-effective or after medical assistance closed.
34.23EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
34.24approval, whichever is later. The commissioner of human services shall notify the revisor
34.25of statutes when federal approval is obtained.

34.26    Sec. 54. Minnesota Statutes 2012, section 256L.09, subdivision 2, is amended to read:
34.27    Subd. 2. Residency requirement. To be eligible for health coverage under the
34.28MinnesotaCare program, pregnant women, individuals, and families with children must
34.29meet the residency requirements as provided by Code of Federal Regulations, title 42,
34.30section 435.403, except that the provisions of section 256B.056, subdivision 1, shall apply
34.31upon receipt of federal approval.
34.32EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
34.33approval, whichever is later. The commissioner of human services shall notify the revisor
34.34of statutes when federal approval is obtained.

35.1    Sec. 55. Minnesota Statutes 2012, section 256L.11, subdivision 6, is amended to read:
35.2    Subd. 6. Enrollees 18 or older Reimbursement of inpatient hospital services.
35.3Payment by the MinnesotaCare program for inpatient hospital services provided to
35.4MinnesotaCare enrollees eligible under section 256L.04, subdivision 7, or who qualify
35.5under section 256L.04, subdivisions subdivision 1 and 2, with family gross income that
35.6exceeds 175 percent of the federal poverty guidelines and who are not pregnant, who
35.7are 18 years old or older on the date of admission to the inpatient hospital must be in
35.8accordance with paragraphs (a) and (b). Payment for adults who are not pregnant and are
35.9eligible under section 256L.04, subdivisions 1 and 2, and whose incomes are equal to or
35.10less than 175 percent of the federal poverty guidelines, shall be as provided for under
35.11paragraph (c)., shall be at the medical assistance rate minus any co-payment required
35.12under section 256L.03, subdivision 5. The hospital must not seek payment from the
35.13enrollee in addition to the co-payment. The MinnesotaCare payment plus the co-payment
35.14must be treated as payment in full.
35.15(a) If the medical assistance rate minus any co-payment required under section
35.16256L.03, subdivision 4, is less than or equal to the amount remaining in the enrollee's
35.17benefit limit under section 256L.03, subdivision 3, payment must be the medical
35.18assistance rate minus any co-payment required under section 256L.03, subdivision 4. The
35.19hospital must not seek payment from the enrollee in addition to the co-payment. The
35.20MinnesotaCare payment plus the co-payment must be treated as payment in full.
35.21(b) If the medical assistance rate minus any co-payment required under section
35.22256L.03, subdivision 4, is greater than the amount remaining in the enrollee's benefit limit
35.23under section 256L.03, subdivision 3, payment must be the lesser of:
35.24(1) the amount remaining in the enrollee's benefit limit; or
35.25(2) charges submitted for the inpatient hospital services less any co-payment
35.26established under section 256L.03, subdivision 4.
35.27The hospital may seek payment from the enrollee for the amount by which usual and
35.28customary charges exceed the payment under this paragraph. If payment is reduced under
35.29section 256L.03, subdivision 3, paragraph (b), the hospital may not seek payment from the
35.30enrollee for the amount of the reduction.
35.31(c) For admissions occurring on or after July 1, 2011, for single adults and
35.32households without children who are eligible under section 256L.04, subdivision 7, the
35.33commissioner shall pay hospitals directly, up to the medical assistance payment rate,
35.34for inpatient hospital benefits up to the $10,000 annual inpatient benefit limit, minus
35.35any co-payment required under section 256L.03, subdivision 5. Inpatient services paid
36.1directly by the commissioner under this paragraph do not include chemical dependency
36.2hospital-based and residential treatment.
36.3EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
36.4approval, whichever is later. The commissioner of human services shall notify the revisor
36.5of statutes when federal approval is obtained.

36.6    Sec. 56. [256L.121] SERVICE DELIVERY.
36.7    Subdivision 1. Competitive process. The commissioner of human services shall
36.8establish a competitive process for entering into contracts with participating entities for
36.9the offering of standard health plans through MinnesotaCare. Coverage through standard
36.10health plans must be available to enrollees beginning January 1, 2015. Each standard
36.11health plan must cover the health services listed in and meet the requirements of section
36.12256L.03. The competitive process must meet the requirements of section 1331 of the
36.13Affordable Care Act and be designed to ensure enrollee access to high-quality health care
36.14coverage options. The commissioner, to the extent feasible, shall seek to ensure that
36.15enrollees have a choice of coverage from more than one participating entity within a
36.16geographic area. In rural areas other than metropolitan statistical areas, the commissioner
36.17shall use the medical assistance competitive procurement process under section 256B.69,
36.18subdivisions 1 to 32, under which selection of entities is based on criteria related to
36.19provider network access, coordination of health care with other local services, alignment
36.20with local public health goals, and other factors.
36.21    Subd. 2. Other requirements for participating entities. The commissioner shall
36.22require participating entities, as a condition of contract, to document to the commissioner:
36.23(1) the provision of culturally and linguistically appropriate services, including
36.24marketing materials, to MinnesotaCare enrollees; and
36.25(2) the inclusion in provider networks of providers designated as essential
36.26community providers under section 62Q.19.
36.27    Subd. 3. Coordination with state-administered health programs. The
36.28commissioner shall coordinate the administration of the MinnesotaCare program with
36.29medical assistance to maximize efficiency and improve the continuity of care. This
36.30includes, but is not limited to:
36.31(1) establishing geographic areas for MinnesotaCare that are consistent with the
36.32geographic areas of the medical assistance program, within which participating entities
36.33may offer health plans;
36.34(2) requiring, as a condition of participation in MinnesotaCare, participating entities
36.35to also participate in the medical assistance program;
37.1(3) complying with sections 256B.69, subdivision 3a; 256B.692, subdivision 1; and
37.2256B.694, when contracting with MinnesotaCare participating entities;
37.3(4) providing MinnesotaCare enrollees, to the extent possible, with the option to
37.4remain in the same health plan and provider network, if they later become eligible for
37.5medical assistance or coverage through the Minnesota health benefit exchange; and
37.6(5) establishing requirements and criteria for selection that ensure that covered
37.7health care services will be coordinated with local public health services, social services,
37.8long-term care services, mental health services, and other local services affecting
37.9enrollees' health, access, and quality of care.
37.10EFFECTIVE DATE.This section is effective the day following final enactment.

37.11    Sec. 57. Minnesota Statutes 2012, section 256L.15, subdivision 1, is amended to read:
37.12    Subdivision 1. Premium determination. (a) Families with children and individuals
37.13shall pay a premium determined according to subdivision 2.
37.14    (b) Pregnant women and children under age two are exempt from the provisions
37.15of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
37.16for failure to pay premiums. For pregnant women, this exemption continues until the
37.17first day of the month following the 60th day postpartum. Women who remain enrolled
37.18during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
37.19disenrolled on the first of the month following the 60th day postpartum for the penalty
37.20period that otherwise applies under section 256L.06, unless they begin paying premiums.
37.21    (c) (b) Members of the military and their families who meet the eligibility criteria
37.22for MinnesotaCare upon eligibility approval made within 24 months following the end
37.23of the member's tour of active duty shall have their premiums paid by the commissioner.
37.24The effective date of coverage for an individual or family who meets the criteria of this
37.25paragraph shall be the first day of the month following the month in which eligibility is
37.26approved. This exemption applies for 12 months.
37.27(d) (c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and
37.28their families shall have their premiums waived by the commissioner in accordance with
37.29section 5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5.
37.30An individual must document status as an American Indian, as defined under Code of
37.31Federal Regulations, title 42, section 447.50, to qualify for the waiver of premiums.
37.32EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
37.33approval, whichever is later. The commissioner of human services shall notify the revisor
37.34of statutes when federal approval is obtained.

38.1    Sec. 58. Minnesota Statutes 2012, section 256L.15, subdivision 2, is amended to read:
38.2    Subd. 2. Sliding fee scale; monthly gross individual or family income. (a) The
38.3commissioner shall establish a sliding fee scale to determine the percentage of monthly
38.4gross individual or family income that households at different income levels must pay to
38.5obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
38.6on the enrollee's monthly gross individual or family income. The sliding fee scale must
38.7contain separate tables based on enrollment of one, two, or three or more persons. Until
38.8June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
38.9individual or family income for individuals or families with incomes below the limits for
38.10the medical assistance program for families and children in effect on January 1, 1999, and
38.11proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
38.128.8 percent. These percentages are matched to evenly spaced income steps ranging from
38.13the medical assistance income limit for families and children in effect on January 1, 1999,
38.14to 275 percent of the federal poverty guidelines for the applicable family size, up to a
38.15family size of five. The sliding fee scale for a family of five must be used for families of
38.16more than five. The sliding fee scale and percentages are not subject to the provisions of
38.17chapter 14. If a family or individual reports increased income after enrollment, premiums
38.18shall be adjusted at the time the change in income is reported.
38.19    (b) Children in families whose gross income is above 275 percent of the federal
38.20poverty guidelines shall pay the maximum premium. The maximum premium is defined
38.21as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
38.22cases paid the maximum premium, the total revenue would equal the total cost of
38.23MinnesotaCare medical coverage and administration. In this calculation, administrative
38.24costs shall be assumed to equal ten percent of the total. The costs of medical coverage
38.25for pregnant women and children under age two and the enrollees in these groups shall
38.26be excluded from the total. The maximum premium for two enrollees shall be twice the
38.27maximum premium for one, and the maximum premium for three or more enrollees shall
38.28be three times the maximum premium for one.
38.29    (c) (b) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums
38.30according to the premium scale specified in paragraph (d) (c) with the exception that
38.31children in families with income at or below 200 percent of the federal poverty guidelines
38.32shall pay no premiums. For purposes of paragraph (d) (c), "minimum" means a monthly
38.33premium of $4.
38.34    (d) (c) The following premium scale is established for individuals and families with
38.35gross family incomes of 275 200 percent of the federal poverty guidelines or less:

39.1	Federal Poverty Guideline Range	Percent of Average Gross Monthly Income
39.2	0-45%	minimum
39.3 39.4	46-54%	$4 or 1.1% of family income, whichever is greater
39.5	55-81%	1.6%
39.6	82-109%	2.2%
39.7	110-136%	2.9%
39.8	137-164%	3.6%
39.9 39.10	165-191 165-200%	4.6%
39.11	192-219%	5.6%
39.12	220-248%	6.5%
39.13	249-275%	7.2%

39.14EFFECTIVE DATE.This section is effective January 1, 2014, or upon federal
39.15approval, whichever is later. The commissioner of human services shall notify the revisor
39.16of statutes when federal approval is obtained.

39.17    Sec. 59. DETERMINATION OF FUNDING ADEQUACY.
39.18The commissioners of revenue and management and budget, in consultation with
39.19the commissioner of human services, shall conduct an assessment of health care taxes,
39.20including the gross premiums tax, the provider tax, and Medicaid surcharges, and their
39.21relationship to the long-term solvency of the health care access fund, as part of the state
39.22revenue and expenditure forecast in November 2013. The commissioners shall determine
39.23the amount of state funding that will be required after December 31, 2019, in addition to
39.24the federal payments made available under section 1331 of the Affordable Care Act, for
39.25the MinnesotaCare program. The commissioners shall evaluate the stability and likelihood
39.26of long-term federal funding for the MinnesotaCare program under section 1331. The
39.27commissioners shall report the results of this assessment to the legislature by January 15,
39.282014, along with recommendations for changes to state revenue for the health care access
39.29fund, if state funding will continue to be required beyond December 31, 2019.

39.30    Sec. 60. STATE-BASED RISK ADJUSTMENT SYSTEM ASSESSMENT.
39.31(a) The commissioners of health, human services, and commerce, and the board of
39.32MNsure, shall study whether Minnesota-based risk adjustment of the individual and small
39.33group insurance market, using either the federal risk adjustment model or a state-based
39.34alternative, can be more cost-effective and perform better than risk adjustment conducted
39.35by federal agencies. The study shall assess the policies, infrastructure, and resources
39.36necessary to satisfy the requirements of Code of Federal Regulations, title 45, section
40.1153, subpart D. The study shall also evaluate the extent to which Minnesota-based risk
40.2adjustment could meet requirements established in Code of Federal Regulations, title
40.345, section 153.330, including:
40.4(1) explaining the variation in health care costs of a given population;
40.5(2) linking risk factors to daily clinical practices and that which is clinically
40.6meaningful to providers;
40.7(3) encouraging favorable behavior among health care market participants and
40.8discouraging unfavorable behavior;
40.9(4) whether risk adjustment factors are relatively easy for stakeholders to understand
40.10and participate in;
40.11(5) providing stable risk scores over time and across health plan products;
40.12(6) minimizing administrative costs;
40.13(7) accounting for risk selection across metal levels;
40.14(8) aligning each of the elements of the methodology; and
40.15(9) can be conducted at a per-member cost equal to or lower than the projected
40.16cost of the federal risk adjustment model.
40.17(b) In conducting the study, and notwithstanding Minnesota Rules, chapter 4653,
40.18and as part of responsibilities under Minnesota Statutes, section 62U.04, subdivision
40.194, paragraph (b), the commissioner of health shall collect from health carriers in the
40.20individual and small group health insurance market, beginning on January 1, 2014, and for
40.21service dates in calendar year 2014, all data required for conducting risk adjustment with
40.22standard risk adjusters such as the Adjusted Clinical Groups or the Hierarchical Condition
40.23Category System, including but not limited to:
40.24(1) an indicator identifying the health plan product under which an enrollee is covered;
40.25(2) an indicator identifying whether an enrollee's policy is an individual or small
40.26group market policy;
40.27(3) an indicator identifying, if applicable, the metal level of an enrollee's health plan
40.28product, and whether the policy is a catastrophic policy; and
40.29(4) additional identified demographic data necessary to link individuals' data across
40.30carriers and insurance affordability programs with 95 percent accuracy. The commissioner
40.31shall not collect more than the last four digits of an individual's social security number.
40.32(c) The commissioner of health shall also asses the extent to which data collected
40.33under paragraph (b) and under Minnesota Statutes, section 62U.04, subdivision 4,
40.34paragraph (a), are sufficient for developing and operating a state alternative risk adjustment
40.35methodology consistent with applicable federal rules by evaluating:
40.36(1) if the data submitted are adequately complete, accurate, and timely;
41.1(2) if the data should be further enriched by nontraditional risk adjusters that help
41.2in better explaining variation in health care costs of a given population and account for
41.3risk selection across metal levels;
41.4(3) whether additional data or identifiers have the potential to strengthen a
41.5Minnesota-based risk adjustment approach; and
41.6(4) what if any changes to the technical infrastructure will be necessary to effectively
41.7perform state-based risk adjustment.
41.8For purposes of this paragraph, the commissioner of health shall have the authority to
41.9use identified data to validate and audit a statistically valid sample of data for each
41.10health carrier in the individual and small group market. In conducting the study, the
41.11commissioners shall contract with entities that do not have an economic interest in the
41.12outcome of Minnesota-based risk adjustment but do have demonstrated expertise in
41.13actuarial science or health economics and demonstrated experience with designing and
41.14implementing risk adjustment models.
41.15(d) The commissioner of human services shall evaluate opportunities to maximize
41.16federal funding under section 1331 of the federal Patient and Protection and Affordable
41.17Care Act, Public Law 111-148, and further defined through amendments to the act and
41.18regulations issued under the act. The commissioner of human services shall make
41.19recommendations on risk adjustment strategies to maximize federal funding to the state
41.20of Minnesota.
41.21(e) The commissioners and board of MNsure shall submit to the legislature by March
41.2215, 2014, an interim report with preliminary findings from the assessment conducted in
41.23paragraphs (c) and (d). The interim report shall include legislative recommendations
41.24for any necessary changes to Minnesota Statutes, section 62Q.03. A final report shall
41.25be submitted by the commissioners and board of MNsure to the legislature by October
41.261, 2015. The final report must include findings from the overall assessment and a
41.27recommendation whether to conduct state-based risk adjustment.
41.28(f) For purposes of this section, the board of MNsure means the board established
41.29under Minnesota Statutes, section 62V.03.

41.30    Sec. 61. REVISOR'S INSTRUCTION.
41.31The revisor shall remove cross-references to the sections repealed in this article
41.32wherever they appear in Minnesota Statutes and Minnesota Rules and make changes
41.33necessary to correct the punctuation, grammar, or structure of the remaining text and
41.34preserve its meaning.

42.1    Sec. 62. REPEALER.
42.2(a) Minnesota Statutes 2012, sections 256L.01, subdivision 4a; 256L.031; 256L.04,
42.3subdivisions 1b, 9, and 10a; 256L.05, subdivision 3b; 256L.07, subdivisions 5, 8, and 9;
42.4256L.11, subdivision 5; and 256L.17, subdivisions 1, 2, 3, 4, and 5, are repealed effective
42.5January 1, 2014.
42.6(b) Minnesota Statutes 2012, section 256L.12, is repealed effective January 1, 2015.


42.9    Section 1. Minnesota Statutes 2012, section 144.0724, subdivision 4, is amended to read:
42.10    Subd. 4. Resident assessment schedule. (a) A facility must conduct and
42.11electronically submit to the commissioner of health case mix assessments that conform
42.12with the assessment schedule defined by Code of Federal Regulations, title 42, section
42.13483.20, and published by the United States Department of Health and Human Services,
42.14Centers for Medicare and Medicaid Services, in the Long Term Care Assessment
42.15Instrument User's Manual, version 3.0, and subsequent updates when issued by the
42.16Centers for Medicare and Medicaid Services. The commissioner of health may substitute
42.17successor manuals or question and answer documents published by the United States
42.18Department of Health and Human Services, Centers for Medicare and Medicaid Services,
42.19to replace or supplement the current version of the manual or document.
42.20(b) The assessments used to determine a case mix classification for reimbursement
42.21include the following:
42.22(1) a new admission assessment must be completed by day 14 following admission;
42.23(2) an annual assessment which must have an assessment reference date (ARD)
42.24within 366 days of the ARD of the last comprehensive assessment;
42.25(3) a significant change assessment must be completed within 14 days of the
42.26identification of a significant change; and
42.27(4) all quarterly assessments must have an assessment reference date (ARD) within
42.2892 days of the ARD of the previous assessment.
42.29(c) In addition to the assessments listed in paragraph (b), the assessments used to
42.30determine nursing facility level of care include the following:
42.31(1) preadmission screening completed under section 256B.0911, subdivision 4a, by a
42.32county, tribe, or managed care organization under contract with the Department of Human
42.33Services 256.975, subdivision 7a, by the Senior LinkAge Line or Disability Linkage Line
42.34or other organization under contract with the Minnesota Board on Aging; and
43.1(2) a nursing facility level of care determination as provided for under section
43.2256B.0911, subdivision 4e, as part of a face-to-face long-term care consultation assessment
43.3completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
43.4managed care organization under contract with the Department of Human Services.

43.5    Sec. 2. Minnesota Statutes 2012, section 144A.351, is amended to read:
43.6144A.351 BALANCING LONG-TERM CARE SERVICES AND SUPPORTS:
43.7REPORT AND STUDY REQUIRED.
43.8    Subdivision 1. Report requirements. The commissioners of health and human
43.9services, with the cooperation of counties and in consultation with stakeholders, including
43.10persons who need or are using long-term care services and supports, lead agencies,
43.11regional entities, senior, disability, and mental health organization representatives, service
43.12providers, and community members shall prepare a report to the legislature by August 15,
43.132013, and biennially thereafter, regarding the status of the full range of long-term care
43.14services and supports for the elderly and children and adults with disabilities and mental
43.15illnesses in Minnesota. The report shall address:
43.16    (1) demographics and need for long-term care services and supports in Minnesota;
43.17    (2) summary of county and regional reports on long-term care gaps, surpluses,
43.18imbalances, and corrective action plans;
43.19    (3) status of long-term care services and related mental health services, housing
43.20options, and supports by county and region including:
43.21    (i) changes in availability of the range of long-term care services and housing options;
43.22    (ii) access problems, including access to the least restrictive and most integrated
43.23services and settings, regarding long-term care services; and
43.24    (iii) comparative measures of long-term care services availability, including serving
43.25people in their home areas near family, and changes over time; and
43.26    (4) recommendations regarding goals for the future of long-term care services and
43.27supports, policy and fiscal changes, and resource development and transition needs.
43.28    Subd. 2. Critical access study. The commissioner shall conduct a onetime study to
43.29assess local capacity and availability of home and community-based services for older
43.30adults, people with disabilities, and people with mental illnesses. The study must assess
43.31critical access at the community level and identify potential strategies to build home and
43.32community-based service capacity in critical access areas. The report shall be submitted
43.33to the legislature no later than August 15, 2015.

43.34    Sec. 3. Minnesota Statutes 2012, section 148E.065, subdivision 4a, is amended to read:
44.1    Subd. 4a. City, county, and state social workers. (a) Beginning July 1, 2016, the
44.2licensure of city, county, and state agency social workers is voluntary, except an individual
44.3who is newly employed by a city or state agency after July 1, 2016, must be licensed
44.4if the individual who provides social work services, as those services are defined in
44.5section 148E.010, subdivision 11, paragraph (b), is presented to the public by any title
44.6incorporating the words "social work" or "social worker."
44.7(b) City, county, and state agencies employing social workers and staff who are
44.8designated to perform mandated duties under sections 256.975, subdivisions 7 to 7c and
44.9256.01, subdivision 24, are not required to employ licensed social workers.

44.10    Sec. 4. Minnesota Statutes 2012, section 256.01, subdivision 2, is amended to read:
44.11    Subd. 2. Specific powers. Subject to the provisions of section 241.021, subdivision
44.122 , the commissioner of human services shall carry out the specific duties in paragraphs (a)
44.13through (cc) (dd):
44.14    (a) Administer and supervise all forms of public assistance provided for by state law
44.15and other welfare activities or services as are vested in the commissioner. Administration
44.16and supervision of human services activities or services includes, but is not limited to,
44.17assuring timely and accurate distribution of benefits, completeness of service, and quality
44.18program management. In addition to administering and supervising human services
44.19activities vested by law in the department, the commissioner shall have the authority to:
44.20    (1) require county agency participation in training and technical assistance programs
44.21to promote compliance with statutes, rules, federal laws, regulations, and policies
44.22governing human services;
44.23    (2) monitor, on an ongoing basis, the performance of county agencies in the
44.24operation and administration of human services, enforce compliance with statutes, rules,
44.25federal laws, regulations, and policies governing welfare services and promote excellence
44.26of administration and program operation;
44.27    (3) develop a quality control program or other monitoring program to review county
44.28performance and accuracy of benefit determinations;
44.29    (4) require county agencies to make an adjustment to the public assistance benefits
44.30issued to any individual consistent with federal law and regulation and state law and rule
44.31and to issue or recover benefits as appropriate;
44.32    (5) delay or deny payment of all or part of the state and federal share of benefits and
44.33administrative reimbursement according to the procedures set forth in section 256.017;
44.34    (6) make contracts with and grants to public and private agencies and organizations,
44.35both profit and nonprofit, and individuals, using appropriated funds; and
45.1    (7) enter into contractual agreements with federally recognized Indian tribes with
45.2a reservation in Minnesota to the extent necessary for the tribe to operate a federally
45.3approved family assistance program or any other program under the supervision of the
45.4commissioner. The commissioner shall consult with the affected county or counties in
45.5the contractual agreement negotiations, if the county or counties wish to be included,
45.6in order to avoid the duplication of county and tribal assistance program services. The
45.7commissioner may establish necessary accounts for the purposes of receiving and
45.8disbursing funds as necessary for the operation of the programs.
45.9    (b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
45.10regulation, and policy necessary to county agency administration of the programs.
45.11    (c) Administer and supervise all child welfare activities; promote the enforcement of
45.12laws protecting disabled, dependent, neglected and delinquent children, and children born
45.13to mothers who were not married to the children's fathers at the times of the conception
45.14nor at the births of the children; license and supervise child-caring and child-placing
45.15agencies and institutions; supervise the care of children in boarding and foster homes or
45.16in private institutions; and generally perform all functions relating to the field of child
45.17welfare now vested in the State Board of Control.
45.18    (d) Administer and supervise all noninstitutional service to disabled persons,
45.19including those who are visually impaired, hearing impaired, or physically impaired
45.20or otherwise disabled. The commissioner may provide and contract for the care and
45.21treatment of qualified indigent children in facilities other than those located and available
45.22at state hospitals when it is not feasible to provide the service in state hospitals.
45.23    (e) Assist and actively cooperate with other departments, agencies and institutions,
45.24local, state, and federal, by performing services in conformity with the purposes of Laws
45.251939, chapter 431.
45.26    (f) Act as the agent of and cooperate with the federal government in matters of
45.27mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
45.28431, including the administration of any federal funds granted to the state to aid in the
45.29performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
45.30and including the promulgation of rules making uniformly available medical care benefits
45.31to all recipients of public assistance, at such times as the federal government increases its
45.32participation in assistance expenditures for medical care to recipients of public assistance,
45.33the cost thereof to be borne in the same proportion as are grants of aid to said recipients.
45.34    (g) Establish and maintain any administrative units reasonably necessary for the
45.35performance of administrative functions common to all divisions of the department.
46.1    (h) Act as designated guardian of both the estate and the person of all the wards of
46.2the state of Minnesota, whether by operation of law or by an order of court, without any
46.3further act or proceeding whatever, except as to persons committed as developmentally
46.4disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
46.5recognized by the Secretary of the Interior whose interests would be best served by
46.6adoptive placement, the commissioner may contract with a licensed child-placing agency
46.7or a Minnesota tribal social services agency to provide adoption services. A contract
46.8with a licensed child-placing agency must be designed to supplement existing county
46.9efforts and may not replace existing county programs or tribal social services, unless the
46.10replacement is agreed to by the county board and the appropriate exclusive bargaining
46.11representative, tribal governing body, or the commissioner has evidence that child
46.12placements of the county continue to be substantially below that of other counties. Funds
46.13encumbered and obligated under an agreement for a specific child shall remain available
46.14until the terms of the agreement are fulfilled or the agreement is terminated.
46.15    (i) Act as coordinating referral and informational center on requests for service for
46.16newly arrived immigrants coming to Minnesota.
46.17    (j) The specific enumeration of powers and duties as hereinabove set forth shall in no
46.18way be construed to be a limitation upon the general transfer of powers herein contained.
46.19    (k) Establish county, regional, or statewide schedules of maximum fees and charges
46.20which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
46.21nursing home care and medicine and medical supplies under all programs of medical
46.22care provided by the state and for congregate living care under the income maintenance
46.23programs.
46.24    (l) Have the authority to conduct and administer experimental projects to test methods
46.25and procedures of administering assistance and services to recipients or potential recipients
46.26of public welfare. To carry out such experimental projects, it is further provided that the
46.27commissioner of human services is authorized to waive the enforcement of existing specific
46.28statutory program requirements, rules, and standards in one or more counties. The order
46.29establishing the waiver shall provide alternative methods and procedures of administration,
46.30shall not be in conflict with the basic purposes, coverage, or benefits provided by law, and
46.31in no event shall the duration of a project exceed four years. It is further provided that no
46.32order establishing an experimental project as authorized by the provisions of this section
46.33shall become effective until the following conditions have been met:
46.34    (1) the secretary of health and human services of the United States has agreed, for
46.35the same project, to waive state plan requirements relative to statewide uniformity; and
47.1    (2) a comprehensive plan, including estimated project costs, shall be approved by
47.2the Legislative Advisory Commission and filed with the commissioner of administration.
47.3    (m) According to federal requirements, establish procedures to be followed by
47.4local welfare boards in creating citizen advisory committees, including procedures for
47.5selection of committee members.
47.6    (n) Allocate federal fiscal disallowances or sanctions which are based on quality
47.7control error rates for the aid to families with dependent children program formerly
47.8codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
47.9following manner:
47.10    (1) one-half of the total amount of the disallowance shall be borne by the county
47.11boards responsible for administering the programs. For the medical assistance and the
47.12AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
47.13shared by each county board in the same proportion as that county's expenditures for the
47.14sanctioned program are to the total of all counties' expenditures for the AFDC program
47.15formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
47.16food stamp program, sanctions shall be shared by each county board, with 50 percent of
47.17the sanction being distributed to each county in the same proportion as that county's
47.18administrative costs for food stamps are to the total of all food stamp administrative costs
47.19for all counties, and 50 percent of the sanctions being distributed to each county in the
47.20same proportion as that county's value of food stamp benefits issued are to the total of
47.21all benefits issued for all counties. Each county shall pay its share of the disallowance
47.22to the state of Minnesota. When a county fails to pay the amount due hereunder, the
47.23commissioner may deduct the amount from reimbursement otherwise due the county, or
47.24the attorney general, upon the request of the commissioner, may institute civil action
47.25to recover the amount due; and
47.26    (2) notwithstanding the provisions of clause (1), if the disallowance results from
47.27knowing noncompliance by one or more counties with a specific program instruction, and
47.28that knowing noncompliance is a matter of official county board record, the commissioner
47.29may require payment or recover from the county or counties, in the manner prescribed in
47.30clause (1), an amount equal to the portion of the total disallowance which resulted from the
47.31noncompliance, and may distribute the balance of the disallowance according to clause (1).
47.32    (o) Develop and implement special projects that maximize reimbursements and
47.33result in the recovery of money to the state. For the purpose of recovering state money,
47.34the commissioner may enter into contracts with third parties. Any recoveries that result
47.35from projects or contracts entered into under this paragraph shall be deposited in the
47.36state treasury and credited to a special account until the balance in the account reaches
48.1$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
48.2transferred and credited to the general fund. All money in the account is appropriated to
48.3the commissioner for the purposes of this paragraph.
48.4    (p) Have the authority to make direct payments to facilities providing shelter
48.5to women and their children according to section 256D.05, subdivision 3. Upon
48.6the written request of a shelter facility that has been denied payments under section
48.7256D.05, subdivision 3 , the commissioner shall review all relevant evidence and make
48.8a determination within 30 days of the request for review regarding issuance of direct
48.9payments to the shelter facility. Failure to act within 30 days shall be considered a
48.10determination not to issue direct payments.
48.11    (q) Have the authority to establish and enforce the following county reporting
48.12requirements:
48.13    (1) the commissioner shall establish fiscal and statistical reporting requirements
48.14necessary to account for the expenditure of funds allocated to counties for human
48.15services programs. When establishing financial and statistical reporting requirements, the
48.16commissioner shall evaluate all reports, in consultation with the counties, to determine if
48.17the reports can be simplified or the number of reports can be reduced;
48.18    (2) the county board shall submit monthly or quarterly reports to the department
48.19as required by the commissioner. Monthly reports are due no later than 15 working days
48.20after the end of the month. Quarterly reports are due no later than 30 calendar days after
48.21the end of the quarter, unless the commissioner determines that the deadline must be
48.22shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
48.23or risking a loss of federal funding. Only reports that are complete, legible, and in the
48.24required format shall be accepted by the commissioner;
48.25    (3) if the required reports are not received by the deadlines established in clause (2),
48.26the commissioner may delay payments and withhold funds from the county board until
48.27the next reporting period. When the report is needed to account for the use of federal
48.28funds and the late report results in a reduction in federal funding, the commissioner shall
48.29withhold from the county boards with late reports an amount equal to the reduction in
48.30federal funding until full federal funding is received;
48.31    (4) a county board that submits reports that are late, illegible, incomplete, or not
48.32in the required format for two out of three consecutive reporting periods is considered
48.33noncompliant. When a county board is found to be noncompliant, the commissioner
48.34shall notify the county board of the reason the county board is considered noncompliant
48.35and request that the county board develop a corrective action plan stating how the
48.36county board plans to correct the problem. The corrective action plan must be submitted
49.1to the commissioner within 45 days after the date the county board received notice
49.2of noncompliance;
49.3    (5) the final deadline for fiscal reports or amendments to fiscal reports is one year
49.4after the date the report was originally due. If the commissioner does not receive a report
49.5by the final deadline, the county board forfeits the funding associated with the report for
49.6that reporting period and the county board must repay any funds associated with the
49.7report received for that reporting period;
49.8    (6) the commissioner may not delay payments, withhold funds, or require repayment
49.9under clause (3) or (5) if the county demonstrates that the commissioner failed to
49.10provide appropriate forms, guidelines, and technical assistance to enable the county to
49.11comply with the requirements. If the county board disagrees with an action taken by the
49.12commissioner under clause (3) or (5), the county board may appeal the action according
49.13to sections 14.57 to 14.69; and
49.14    (7) counties subject to withholding of funds under clause (3) or forfeiture or
49.15repayment of funds under clause (5) shall not reduce or withhold benefits or services to
49.16clients to cover costs incurred due to actions taken by the commissioner under clause
49.17(3) or (5).
49.18    (r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
49.19federal fiscal disallowances or sanctions are based on a statewide random sample in direct
49.20proportion to each county's claim for that period.
49.21    (s) Be responsible for ensuring the detection, prevention, investigation, and
49.22resolution of fraudulent activities or behavior by applicants, recipients, and other
49.23participants in the human services programs administered by the department.
49.24    (t) Require county agencies to identify overpayments, establish claims, and utilize
49.25all available and cost-beneficial methodologies to collect and recover these overpayments
49.26in the human services programs administered by the department.
49.27    (u) Have the authority to administer a drug rebate program for drugs purchased
49.28pursuant to the prescription drug program established under section 256.955 after the
49.29beneficiary's satisfaction of any deductible established in the program. The commissioner
49.30shall require a rebate agreement from all manufacturers of covered drugs as defined in
49.31section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
49.32or after July 1, 2002, must include rebates for individuals covered under the prescription
49.33drug program who are under 65 years of age. For each drug, the amount of the rebate shall
49.34be equal to the rebate as defined for purposes of the federal rebate program in United
49.35States Code, title 42, section 1396r-8. The manufacturers must provide full payment
49.36within 30 days of receipt of the state invoice for the rebate within the terms and conditions
50.1used for the federal rebate program established pursuant to section 1927 of title XIX of
50.2the Social Security Act. The manufacturers must provide the commissioner with any
50.3information necessary to verify the rebate determined per drug. The rebate program shall
50.4utilize the terms and conditions used for the federal rebate program established pursuant to
50.5section 1927 of title XIX of the Social Security Act.
50.6    (v) Have the authority to administer the federal drug rebate program for drugs
50.7purchased under the medical assistance program as allowed by section 1927 of title XIX
50.8of the Social Security Act and according to the terms and conditions of section 1927.
50.9Rebates shall be collected for all drugs that have been dispensed or administered in an
50.10outpatient setting and that are from manufacturers who have signed a rebate agreement
50.11with the United States Department of Health and Human Services.
50.12    (w) Have the authority to administer a supplemental drug rebate program for drugs
50.13purchased under the medical assistance program. The commissioner may enter into
50.14supplemental rebate contracts with pharmaceutical manufacturers and may require prior
50.15authorization for drugs that are from manufacturers that have not signed a supplemental
50.16rebate contract. Prior authorization of drugs shall be subject to the provisions of section
50.17256B.0625, subdivision 13 .
50.18    (x) Operate the department's communication systems account established in Laws
50.191993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
50.20communication costs necessary for the operation of the programs the commissioner
50.21supervises. A communications account may also be established for each regional
50.22treatment center which operates communications systems. Each account must be used
50.23to manage shared communication costs necessary for the operations of the programs the
50.24commissioner supervises. The commissioner may distribute the costs of operating and
50.25maintaining communication systems to participants in a manner that reflects actual usage.
50.26Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
50.27other costs as determined by the commissioner. Nonprofit organizations and state, county,
50.28and local government agencies involved in the operation of programs the commissioner
50.29supervises may participate in the use of the department's communications technology and
50.30share in the cost of operation. The commissioner may accept on behalf of the state any
50.31gift, bequest, devise or personal property of any kind, or money tendered to the state for
50.32any lawful purpose pertaining to the communication activities of the department. Any
50.33money received for this purpose must be deposited in the department's communication
50.34systems accounts. Money collected by the commissioner for the use of communication
50.35systems must be deposited in the state communication systems account and is appropriated
50.36to the commissioner for purposes of this section.
51.1    (y) Receive any federal matching money that is made available through the medical
51.2assistance program for the consumer satisfaction survey. Any federal money received for
51.3the survey is appropriated to the commissioner for this purpose. The commissioner may
51.4expend the federal money received for the consumer satisfaction survey in either year of
51.5the biennium.
51.6    (z) Designate community information and referral call centers and incorporate
51.7cost reimbursement claims from the designated community information and referral
51.8call centers into the federal cost reimbursement claiming processes of the department
51.9according to federal law, rule, and regulations. Existing information and referral centers
51.10provided by Greater Twin Cities United Way or existing call centers for which Greater
51.11Twin Cities United Way has legal authority to represent, shall be included in these
51.12designations upon review by the commissioner and assurance that these services are
51.13accredited and in compliance with national standards. Any reimbursement is appropriated
51.14to the commissioner and all designated information and referral centers shall receive
51.15payments according to normal department schedules established by the commissioner
51.16upon final approval of allocation methodologies from the United States Department of
51.17Health and Human Services Division of Cost Allocation or other appropriate authorities.
51.18    (aa) Develop recommended standards for foster care homes that address the
51.19components of specialized therapeutic services to be provided by foster care homes with
51.20those services.
51.21    (bb) Authorize the method of payment to or from the department as part of the
51.22human services programs administered by the department. This authorization includes the
51.23receipt or disbursement of funds held by the department in a fiduciary capacity as part of
51.24the human services programs administered by the department.
51.25    (cc) Have the authority to administer a drug rebate program for drugs purchased for
51.26persons eligible for general assistance medical care under section 256D.03, subdivision 3.
51.27For manufacturers that agree to participate in the general assistance medical care rebate
51.28program, the commissioner shall enter into a rebate agreement for covered drugs as
51.29defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
51.30rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
51.31United States Code, title 42, section 1396r-8. The manufacturers must provide payment
51.32within the terms and conditions used for the federal rebate program established under
51.33section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
51.34the terms and conditions used for the federal rebate program established under section
51.351927 of title XIX of the Social Security Act.
52.1    Effective January 1, 2006, drug coverage under general assistance medical care shall
52.2be limited to those prescription drugs that:
52.3    (1) are covered under the medical assistance program as described in section
52.4256B.0625, subdivisions 13 and 13d ; and
52.5    (2) are provided by manufacturers that have fully executed general assistance
52.6medical care rebate agreements with the commissioner and comply with such agreements.
52.7Prescription drug coverage under general assistance medical care shall conform to
52.8coverage under the medical assistance program according to section 256B.0625,
52.9subdivisions 13 to 13g .
52.10    The rebate revenues collected under the drug rebate program are deposited in the
52.11general fund.
52.12(dd) Designate the agencies that operate the Senior LinkAge Line under section
52.13256.975, subdivision 7, and the Disability Linkage Line under subdivision 24 as the state
52.14of Minnesota Aging and the Disability Resource Centers under United States Code, title
52.1542, section 3001, the Older Americans Act Amendments of 2006 and incorporate cost
52.16reimbursement claims from the designated centers into the federal cost reimbursement
52.17claiming processes of the department according to federal law, rule, and regulations. Any
52.18reimbursement must be appropriated to the commissioner and all Aging and Disability
52.19Resource Center designated agencies shall receive payments of grant funding that supports
52.20the activity and generates the federal financial participation according to Board on Aging
52.21administrative granting mechanisms.

52.22    Sec. 5. Minnesota Statutes 2012, section 256.01, subdivision 24, is amended to read:
52.23    Subd. 24. Disability Linkage Line. The commissioner shall establish the Disability
52.24Linkage Line, to who shall serve people with disabilities as the designated Aging and
52.25Disability Resource Center under United States Code, title 42, section 3001, the Older
52.26Americans Act Amendments of 2006 in partnership with the Senior LinkAge Line and
52.27shall serve as Minnesota's neutral access point for statewide disability information and
52.28assistance and must be available during business hours through a statewide toll-free
52.29number and the internet. The Disability Linkage Line shall:
52.30(1) deliver information and assistance based on national and state standards;
52.31    (2) provide information about state and federal eligibility requirements, benefits,
52.32and service options;
52.33(3) provide benefits and options counseling;
52.34    (4) make referrals to appropriate support entities;
53.1    (5) educate people on their options so they can make well-informed choices and link
53.2them to quality profiles;
53.3    (6) help support the timely resolution of service access and benefit issues;
53.4(7) inform people of their long-term community services and supports;
53.5(8) provide necessary resources and supports that can lead to employment and
53.6increased economic stability of people with disabilities; and
53.7(9) serve as the technical assistance and help center for the Web-based tool,
53.8Minnesota's Disability Benefits 101.org.; and
53.9(10) provide preadmission screening for individuals under 60 years of age using
53.10the procedures as defined in section 256.975, subdivisions 7a to 7c, and 256B.0911,
53.11subdivision 4d.

53.12    Sec. 6. Minnesota Statutes 2012, section 256.975, subdivision 7, is amended to read:
53.13    Subd. 7. Consumer information and assistance and long-term care options
53.14counseling; Senior LinkAge Line. (a) The Minnesota Board on Aging shall operate a
53.15statewide service to aid older Minnesotans and their families in making informed choices
53.16about long-term care options and health care benefits. Language services to persons
53.17with limited English language skills may be made available. The service, known as
53.18Senior LinkAge Line, shall serve older adults as the designated Aging and Disability
53.19Resource Center under United States Code, title 42, section 3001, the Older Americans
53.20Act Amendments of 2006 in partnership with the Disability LinkAge Line under section
53.21256.01, subdivision 24, and must be available during business hours through a statewide
53.22toll-free number and must also be available through the Internet. The Minnesota Board
53.23on Aging shall consult with, and when appropriate work through, the area agencies on
53.24aging to provide and maintain the telephony infrastructure and related support for the
53.25Aging and Disability Resource Center partners which agree by memorandum to access
53.26the infrastructure, including the designated providers of the Senior LinkAge Line and the
53.27Disability Linkage Line.
53.28    (b) The service must provide long-term care options counseling by assisting older
53.29adults, caregivers, and providers in accessing information and options counseling about
53.30choices in long-term care services that are purchased through private providers or available
53.31through public options. The service must:
53.32    (1) develop a comprehensive database that includes detailed listings in both
53.33consumer- and provider-oriented formats;
53.34    (2) make the database accessible on the Internet and through other telecommunication
53.35and media-related tools;
54.1    (3) link callers to interactive long-term care screening tools and make these tools
54.2available through the Internet by integrating the tools with the database;
54.3    (4) develop community education materials with a focus on planning for long-term
54.4care and evaluating independent living, housing, and service options;
54.5    (5) conduct an outreach campaign to assist older adults and their caregivers in
54.6finding information on the Internet and through other means of communication;
54.7    (6) implement a messaging system for overflow callers and respond to these callers
54.8by the next business day;
54.9    (7) link callers with county human services and other providers to receive more
54.10in-depth assistance and consultation related to long-term care options;
54.11    (8) link callers with quality profiles for nursing facilities and other home and
54.12community-based services providers developed by the commissioner commissioners of
54.13health and human services;
54.14    (9) incorporate information about the availability of housing options, as well as
54.15registered housing with services and consumer rights within the MinnesotaHelp.info
54.16network long-term care database to facilitate consumer comparison of services and costs
54.17among housing with services establishments and with other in-home services and to
54.18support financial self-sufficiency as long as possible. Housing with services establishments
54.19and their arranged home care providers shall provide information that will facilitate price
54.20comparisons, including delineation of charges for rent and for services available. The
54.21commissioners of health and human services shall align the data elements required by
54.22section 144G.06, the Uniform Consumer Information Guide, and this section to provide
54.23consumers standardized information and ease of comparison of long-term care options.
54.24The commissioner of human services shall provide the data to the Minnesota Board on
54.25Aging for inclusion in the MinnesotaHelp.info network long-term care database;
54.26(10) provide long-term care options counseling. Long-term care options counselors
54.27shall:
54.28(i) for individuals not eligible for case management under a public program or public
54.29funding source, provide interactive decision support under which consumers, family
54.30members, or other helpers are supported in their deliberations to determine appropriate
54.31long-term care choices in the context of the consumer's needs, preferences, values, and
54.32individual circumstances, including implementing a community support plan;
54.33(ii) provide Web-based educational information and collateral written materials to
54.34familiarize consumers, family members, or other helpers with the long-term care basics,
54.35issues to be considered, and the range of options available in the community;
55.1(iii) provide long-term care futures planning, which means providing assistance to
55.2individuals who anticipate having long-term care needs to develop a plan for the more
55.3distant future; and
55.4(iv) provide expertise in benefits and financing options for long-term care, including
55.5Medicare, long-term care insurance, tax or employer-based incentives, reverse mortgages,
55.6private pay options, and ways to access low or no-cost services or benefits through
55.7volunteer-based or charitable programs;
55.8(11) using risk management and support planning protocols, provide long-term care
55.9options counseling to current residents of nursing homes deemed appropriate for discharge
55.10by the commissioner and older adults who request service after consultation with the
55.11Senior LinkAge Line under clause (12). In order to meet this requirement, The Senior
55.12LinkAge Line shall also receive referrals from the residents or staff of nursing homes. The
55.13Senior LinkAge Line shall identify and contact residents deemed appropriate for discharge
55.14by developing targeting criteria in consultation with the commissioner who shall provide
55.15designated Senior LinkAge Line contact centers with a list of nursing home residents that
55.16meet the criteria as being appropriate for discharge planning via a secure Web portal.
55.17Senior LinkAge Line shall provide these residents, if they indicate a preference to
55.18receive long-term care options counseling, with initial assessment, review of risk factors,
55.19independent living support consultation, or and, if appropriate, a referral to:
55.20(i) long-term care consultation services under section 256B.0911;
55.21(ii) designated care coordinators of contracted entities under section 256B.035 for
55.22persons who are enrolled in a managed care plan; or
55.23(iii) the long-term care consultation team for those who are appropriate eligible
55.24 for relocation service coordination due to high-risk factors or psychological or physical
55.25disability; and
55.26(12) develop referral protocols and processes that will assist certified health care
55.27homes and hospitals to identify at-risk older adults and determine when to refer these
55.28individuals to the Senior LinkAge Line for long-term care options counseling under this
55.29section. The commissioner is directed to work with the commissioner of health to develop
55.30protocols that would comply with the health care home designation criteria and protocols
55.31available at the time of hospital discharge. The commissioner shall keep a record of the
55.32number of people who choose long-term care options counseling as a result of this section.

55.33    Sec. 7. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
55.34to read:
56.1    Subd. 7a. Preadmission screening activities related to nursing facility
56.2admissions. (a) All individuals seeking admission to Medicaid certified nursing facilities,
56.3including certified boarding care facilities, must be screened prior to admission regardless
56.4of income, assets, or funding sources for nursing facility care, except as described in
56.5subdivision 7b, paragraphs (a) and (b). The purpose of the screening is to determine the
56.6need for nursing facility level of care as described in section 256B.0911, subdivision
56.74e, and to complete activities required under federal law related to mental illness and
56.8developmental disability as outlined in paragraph (b).
56.9(b) A person who has a diagnosis or possible diagnosis of mental illness or
56.10developmental disability must receive a preadmission screening before admission
56.11regardless of the exemptions outlined in subdivision 7b, paragraphs (a) and (b), to identify
56.12the need for further evaluation and specialized services, unless the admission prior to
56.13screening is authorized by the local mental health authority or the local developmental
56.14disabilities case manager, or unless authorized by the county agency according to Public
56.15Law 101-508.
56.16(c) The following criteria apply to the preadmission screening:
56.17(1) requests for preadmission screenings must be submitted via an online form
56.18developed by the commissioner;
56.19(2) the Senior LinkAge Line must use forms and criteria developed by the
56.20commissioner to identify persons who require referral for further evaluation and
56.21determination of the need for specialized services; and
56.22(3) the evaluation and determination of the need for specialized services must be
56.23done by:
56.24(i) a qualified independent mental health professional, for persons with a primary or
56.25secondary diagnosis of a serious mental illness; or
56.26(ii) a qualified developmental disability professional, for persons with a primary or
56.27secondary diagnosis of developmental disability. For purposes of this requirement, a
56.28qualified developmental disability professional must meet the standards for a qualified
56.29developmental disability professional under Code of Federal Regulations, title 42, section
56.30483.430.
56.31(d) The local county mental health authority or the state developmental disability
56.32authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
56.33nursing facility if the individual does not meet the nursing facility level of care criteria or
56.34needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
56.35purposes of this section, "specialized services" for a person with developmental disability
57.1means active treatment as that term is defined under Code of Federal Regulations, title
57.242, section 483.440(a)(1).
57.3(e) In assessing a person's needs, the screener shall:
57.4(1) use an automated system designated by the commissioner;
57.5(2) consult with care transitions coordinators or physician; and
57.6(3) consider the assessment of the individual's physician.
57.7Other personnel may be included in the level of care determination as deemed
57.8necessary by the screener.
57.9EFFECTIVE DATE.This section is effective October 1, 2013.

57.10    Sec. 8. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
57.11to read:
57.12    Subd. 7b. Exemptions and emergency admissions. (a) Exemptions from the federal
57.13screening requirements outlined in subdivision 7a, paragraphs (b) and (c), are limited to:
57.14(1) a person who, having entered an acute care facility from a certified nursing
57.15facility, is returning to a certified nursing facility; or
57.16(2) a person transferring from one certified nursing facility in Minnesota to another
57.17certified nursing facility in Minnesota.
57.18(b) Persons who are exempt from preadmission screening for purposes of level of
57.19care determination include:
57.20(1) persons described in paragraph (a);
57.21(2) an individual who has a contractual right to have nursing facility care paid for
57.22indefinitely by the Veterans' Administration;
57.23(3) an individual enrolled in a demonstration project under section 256B.69,
57.24subdivision 8, at the time of application to a nursing facility; and
57.25(4) an individual currently being served under the alternative care program or under
57.26a home and community-based services waiver authorized under section 1915(c) of the
57.27federal Social Security Act.
57.28(c) Persons admitted to a Medicaid-certified nursing facility from the community
57.29on an emergency basis as described in paragraph (d) or from an acute care facility on a
57.30nonworking day must be screened the first working day after admission.
57.31(d) Emergency admission to a nursing facility prior to screening is permitted when
57.32all of the following conditions are met:
57.33(1) a person is admitted from the community to a certified nursing or certified
57.34boarding care facility during Senior LinkAge Line nonworking hours for ages 60 and
57.35older and Disability Linkage Line nonworking hours for under age 60;
58.1(2) a physician has determined that delaying admission until preadmission screening
58.2is completed would adversely affect the person's health and safety;
58.3(3) there is a recent precipitating event that precludes the client from living safely in
58.4the community, such as sustaining an injury, sudden onset of acute illness, or a caregiver's
58.5inability to continue to provide care;
58.6(4) the attending physician has authorized the emergency placement and has
58.7documented the reason that the emergency placement is recommended; and
58.8(5) the Senior LinkAge Line or Disability Linkage Line is contacted on the first
58.9working day following the emergency admission.
58.10Transfer of a patient from an acute care hospital to a nursing facility is not considered
58.11an emergency except for a person who has received hospital services in the following
58.12situations: hospital admission for observation, care in an emergency room without hospital
58.13admission, or following hospital 24-hour bed care and from whom admission is being
58.14sought on a nonworking day.
58.15(e) A nursing facility must provide written information to all persons admitted
58.16regarding the person's right to request and receive long-term care consultation services as
58.17defined in section 256B.0911, subdivision 1a. The information must be provided prior to
58.18the person's discharge from the facility and in a format specified by the commissioner.
58.19EFFECTIVE DATE.This section is effective October 1, 2013.

58.20    Sec. 9. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
58.21to read:
58.22    Subd. 7c. Screening requirements. (a) A person may be screened for nursing
58.23facility admission by telephone or in a face-to-face screening interview. The Senior
58.24LinkAge Line shall identify each individual's needs using the following categories:
58.25(1) the person needs no face-to-face long-term care consultation assessment
58.26completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county, tribe, or
58.27managed care organization under contract with the Department of Human Services to
58.28determine the need for nursing facility level of care based on information obtained from
58.29other health care professionals;
58.30(2) the person needs an immediate face-to-face long-term care consultation
58.31assessment completed under section 256B.0911, subdivision 3a, 3b, or 4d, by a county,
58.32tribe, or managed care organization under contract with the Department of Human
58.33Services to determine the need for nursing facility level of care and complete activities
58.34required under subdivision 7a; or
59.1(3) the person may be exempt from screening requirements as outlined in subdivision
59.27b, but will need transitional assistance after admission or in-person follow-along after
59.3a return home.
59.4(b) Individuals between the ages of 60 and 64 who are admitted to nursing facilities
59.5with only a telephone screening must receive a face-to-face assessment from the long-term
59.6care consultation team member of the county in which the facility is located or from the
59.7recipient's county case manager within 40 calendar days of admission as described in
59.8section 256B.0911, subdivision 4d, paragraph (c).
59.9(c) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
59.10facility must be screened prior to admission.
59.11(d) Screenings provided by the Senior LinkAge Line must include processes
59.12to identify persons who may require transition assistance described in subdivision 7,
59.13paragraph (b), clause (12), and section 256B.0911, subdivision 3b.
59.14EFFECTIVE DATE.This section is effective October 1, 2013.

59.15    Sec. 10. Minnesota Statutes 2012, section 256.975, is amended by adding a subdivision
59.16to read:
59.17    Subd. 7d. Payment for preadmission screening. Funding for preadmission
59.18screening shall be provided to the Minnesota Board on Aging for the population 60
59.19years of age and older by the Department of Human Services to cover screener salaries
59.20and expenses to provide the services described in subdivisions 7a to 7c. The Minnesota
59.21Board on Aging shall employ, or contract with other agencies to employ, within the limits
59.22of available funding, sufficient personnel to provide preadmission screening and level of
59.23care determination services and shall seek to maximize federal funding for the service as
59.24provided under section 256.01, subdivision 2, paragraph (dd).
59.25EFFECTIVE DATE.This section is effective October 1, 2013.

59.26    Sec. 11. Minnesota Statutes 2012, section 256.9754, is amended by adding a
59.27subdivision to read:
59.28    Subd. 3a. Priority for other grants. The commissioner of health shall give
59.29priority to a grantee selected under subdivision 3 when awarding technology-related
59.30grants, if the grantee is using technology as a part of a proposal. The commissioner
59.31of transportation shall give priority to a grantee selected under subdivision 3 when
59.32distributing transportation-related funds to create transportation options for older adults.

60.1    Sec. 12. Minnesota Statutes 2012, section 256.9754, is amended by adding a
60.2subdivision to read:
60.3    Subd. 3b. State waivers. The commissioner of health may waive applicable state
60.4laws and rules on a time-limited basis if the commissioner of health determines that a
60.5participating grantee requires a waiver in order to achieve demonstration project goals.

60.6    Sec. 13. Minnesota Statutes 2012, section 256.9754, subdivision 5, is amended to read:
60.7    Subd. 5. Grant preference. The commissioner of human services shall give
60.8preference when awarding grants under this section to areas where nursing facility
60.9closures have occurred or are occurring or areas with service needs identified by section
60.10144A.351. The commissioner may award grants to the extent grant funds are available
60.11and to the extent applications are approved by the commissioner. Denial of approval of an
60.12application in one year does not preclude submission of an application in a subsequent
60.13year. The maximum grant amount is limited to $750,000.

60.14    Sec. 14. Minnesota Statutes 2012, section 256B.021, is amended by adding a
60.15subdivision to read:
60.16    Subd. 4a. Evaluation. The commissioner shall evaluate the projects contained in
60.17subdivision 4, paragraphs (f), clauses (2) and (12), and (h). The evaluation must include:
60.18(1) an impact assessment focusing on program outcomes, especially those
60.19experienced directly by the person receiving services;
60.20(2) study samples drawn from the population of interest for each project; and
60.21(3) a time series analysis to examine aggregate trends in average monthly
60.22utilization, expenditures, and other outcomes in the targeted populations before and after
60.23implementation of the initiatives.

60.24    Sec. 15. Minnesota Statutes 2012, section 256B.021, is amended by adding a
60.25subdivision to read:
60.26    Subd. 6. Work, empower, and encourage independence. As provided under
60.27subdivision 4, paragraph (e), upon federal approval, the commissioner shall establish a
60.28demonstration project to provide navigation, employment supports, and benefits planning
60.29services to a targeted group of federally funded Medicaid recipients to begin July 1, 2014.
60.30This demonstration shall promote economic stability, increase independence, and reduce
60.31applications for disability benefits while providing a positive impact on the health and
60.32future of participants.

61.1    Sec. 16. Minnesota Statutes 2012, section 256B.021, is amended by adding a
61.2subdivision to read:
61.3    Subd. 7. Housing stabilization. As provided under subdivision 4, paragraph (e),
61.4upon federal approval, the commissioner shall establish a demonstration project to provide
61.5service coordination, outreach, in-reach, tenancy support, and community living assistance
61.6to a targeted group of federally funded Medicaid recipients to begin January 1, 2014. This
61.7demonstration shall promote housing stability, reduce costly medical interventions, and
61.8increase opportunities for independent community living.

61.9    Sec. 17. Minnesota Statutes 2012, section 256B.0911, subdivision 1, is amended to read:
61.10    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation
61.11services is to assist persons with long-term or chronic care needs in making care
61.12decisions and selecting support and service options that meet their needs and reflect
61.13their preferences. The availability of, and access to, information and other types of
61.14assistance, including assessment and support planning, is also intended to prevent or delay
61.15institutional placements and to provide access to transition assistance after admission.
61.16Further, the goal of these services is to contain costs associated with unnecessary
61.17institutional admissions. Long-term consultation services must be available to any person
61.18regardless of public program eligibility. The commissioner of human services shall seek
61.19to maximize use of available federal and state funds and establish the broadest program
61.20possible within the funding available.
61.21(b) These services must be coordinated with long-term care options counseling
61.22provided under subdivision 4d, section 256.975, subdivision subdivisions 7 to 7c, and
61.23section 256.01, subdivision 24. The lead agency providing long-term care consultation
61.24services shall encourage the use of volunteers from families, religious organizations, social
61.25clubs, and similar civic and service organizations to provide community-based services.

61.26    Sec. 18. Minnesota Statutes 2012, section 256B.0911, subdivision 1a, is amended to
61.27read:
61.28    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
61.29    (a) Until additional requirements apply under paragraph (b), "long-term care
61.30consultation services" means:
61.31    (1) intake for and access to assistance in identifying services needed to maintain an
61.32individual in the most inclusive environment;
61.33    (2) providing recommendations for and referrals to cost-effective community
61.34services that are available to the individual;
62.1    (3) development of an individual's person-centered community support plan;
62.2    (4) providing information regarding eligibility for Minnesota health care programs;
62.3    (5) face-to-face long-term care consultation assessments, which may be completed
62.4in a hospital, nursing facility, intermediate care facility for persons with developmental
62.5disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
62.6residence;
62.7    (6) federally mandated preadmission screening activities described under
62.8subdivisions 4a and 4b;
62.9    (7) (6) determination of home and community-based waiver and other service
62.10eligibility as required under sections 256B.0913, 256B.0915, and 256B.49, including level
62.11of care determination for individuals who need an institutional level of care as determined
62.12under section 256B.0911, subdivision 4a, paragraph (d) 4e, based on assessment and
62.13community support plan development, appropriate referrals to obtain necessary diagnostic
62.14information, and including an eligibility determination for consumer-directed community
62.15supports;
62.16    (8) (7) providing recommendations for institutional placement when there are no
62.17cost-effective community services available;
62.18    (9) (8) providing access to assistance to transition people back to community settings
62.19after institutional admission; and
62.20(10) (9) providing information about competitive employment, with or without
62.21supports, for school-age youth and working-age adults and referrals to the Disability
62.22Linkage Line and Disability Benefits 101 to ensure that an informed choice about
62.23competitive employment can be made. For the purposes of this subdivision, "competitive
62.24employment" means work in the competitive labor market that is performed on a full-time
62.25or part-time basis in an integrated setting, and for which an individual is compensated at or
62.26above the minimum wage, but not less than the customary wage and level of benefits paid
62.27by the employer for the same or similar work performed by individuals without disabilities.
62.28(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
62.292c, and 3a, "long-term care consultation services" also means:
62.30(1) service eligibility determination for state plan home care services identified in:
62.31(i) section 256B.0625, subdivisions 7, 19a, and 19c;
62.32(ii) section 256B.0657; or
62.33(iii) consumer support grants under section 256.476;
62.34(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
62.35determination of eligibility for case management services available under sections
63.1256B.0621, subdivision 2 , paragraph (4), and 256B.0924 and Minnesota Rules, part
63.29525.0016;
63.3(3) determination of institutional level of care, home and community-based service
63.4waiver, and other service eligibility as required under section 256B.092, determination
63.5of eligibility for family support grants under section 252.32, semi-independent living
63.6services under section 252.275, and day training and habilitation services under section
63.7256B.092 ; and
63.8(4) obtaining necessary diagnostic information to determine eligibility under clauses
63.9(2) and (3).
63.10    (c) "Long-term care options counseling" means the services provided by the linkage
63.11lines as mandated by sections 256.01, subdivision 24, and 256.975, subdivision 7, and
63.12also includes telephone assistance and follow up once a long-term care consultation
63.13assessment has been completed.
63.14    (d) "Minnesota health care programs" means the medical assistance program under
63.15chapter 256B and the alternative care program under section 256B.0913.
63.16    (e) "Lead agencies" means counties administering or tribes and health plans under
63.17contract with the commissioner to administer long-term care consultation assessment and
63.18support planning services.

63.19    Sec. 19. Minnesota Statutes 2012, section 256B.0911, subdivision 3a, is amended to
63.20read:
63.21    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
63.22services planning, or other assistance intended to support community-based living,
63.23including persons who need assessment in order to determine waiver or alternative care
63.24program eligibility, must be visited by a long-term care consultation team within 20
63.25calendar days after the date on which an assessment was requested or recommended.
63.26Upon statewide implementation of subdivisions 2b, 2c, and 5, this requirement also
63.27applies to an assessment of a person requesting personal care assistance services and
63.28private duty nursing. The commissioner shall provide at least a 90-day notice to lead
63.29agencies prior to the effective date of this requirement. Face-to-face assessments must be
63.30conducted according to paragraphs (b) to (i).
63.31    (b) The lead agency may utilize a team of either the social worker or public health
63.32nurse, or both. Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall
63.33use certified assessors to conduct the assessment. The consultation team members must
63.34confer regarding the most appropriate care for each individual screened or assessed. For
64.1a person with complex health care needs, a public health or registered nurse from the
64.2team must be consulted.
64.3    (c) The assessment must be comprehensive and include a person-centered assessment
64.4of the health, psychological, functional, environmental, and social needs of referred
64.5individuals and provide information necessary to develop a community support plan that
64.6meets the consumers needs, using an assessment form provided by the commissioner.
64.7    (d) The assessment must be conducted in a face-to-face interview with the person
64.8being assessed and the person's legal representative, and other individuals as requested by
64.9the person, who can provide information on the needs, strengths, and preferences of the
64.10person necessary to develop a community support plan that ensures the person's health and
64.11safety, but who is not a provider of service or has any financial interest in the provision
64.12of services. For persons who are to be assessed for elderly waiver customized living
64.13services under section 256B.0915, with the permission of the person being assessed or
64.14the person's designated or legal representative, the client's current or proposed provider
64.15of services may submit a copy of the provider's nursing assessment or written report
64.16outlining its recommendations regarding the client's care needs. The person conducting
64.17the assessment will notify the provider of the date by which this information is to be
64.18submitted. This information shall be provided to the person conducting the assessment
64.19prior to the assessment.
64.20    (e) If the person chooses to use community-based services, the person or the person's
64.21legal representative must be provided with a written community support plan within 40
64.22calendar days of the assessment visit, regardless of whether the individual is eligible for
64.23Minnesota health care programs. The written community support plan must include:
64.24(1) a summary of assessed needs as defined in paragraphs (c) and (d);
64.25(2) the individual's options and choices to meet identified needs, including all
64.26available options for case management services and providers;
64.27(3) identification of health and safety risks and how those risks will be addressed,
64.28including personal risk management strategies;
64.29(4) referral information; and
64.30(5) informal caregiver supports, if applicable.
64.31For a person determined eligible for state plan home care under subdivision 1a,
64.32paragraph (b), clause (1), the person or person's representative must also receive a copy of
64.33the home care service plan developed by the certified assessor.
64.34(f) A person may request assistance in identifying community supports without
64.35participating in a complete assessment. Upon a request for assistance identifying
64.36community support, the person must be transferred or referred to long-term care options
65.1counseling services available under sections 256.975, subdivision 7, and 256.01,
65.2subdivision 24, for telephone assistance and follow up.
65.3    (g) The person has the right to make the final decision between institutional
65.4placement and community placement after the recommendations have been provided,
65.5except as provided in section 256.975, subdivision 4a, paragraph (c) 7a, paragraph (d).
65.6    (h) The lead agency must give the person receiving assessment or support planning,
65.7or the person's legal representative, materials, and forms supplied by the commissioner
65.8containing the following information:
65.9    (1) written recommendations for community-based services and consumer-directed
65.10options;
65.11(2) documentation that the most cost-effective alternatives available were offered to
65.12the individual. For purposes of this clause, "cost-effective" means community services and
65.13living arrangements that cost the same as or less than institutional care. For an individual
65.14found to meet eligibility criteria for home and community-based service programs under
65.15section 256B.0915 or 256B.49, "cost-effectiveness" has the meaning found in the federally
65.16approved waiver plan for each program;
65.17(3) the need for and purpose of preadmission screening conducted by long-term
65.18care options counselors according to section 256.975, subdivisions 7a to 7c, and section
65.19256.01, subdivision 24, if the person selects nursing facility placement. If the individual
65.20selects nursing facility placement, the lead agency shall forward information needed to
65.21complete the level of care determinations and screening for developmental disability and
65.22mental illness collected during the assessment to the long-term care options counselor
65.23using forms provided by the commissioner;
65.24    (4) the role of long-term care consultation assessment and support planning in
65.25eligibility determination for waiver and alternative care programs, and state plan home
65.26care, case management, and other services as defined in subdivision 1a, paragraphs (a),
65.27clause (7), and (b);
65.28    (5) information about Minnesota health care programs;
65.29    (6) the person's freedom to accept or reject the recommendations of the team;
65.30    (7) the person's right to confidentiality under the Minnesota Government Data
65.31Practices Act, chapter 13;
65.32    (8) the certified assessor's decision regarding the person's need for institutional level
65.33of care as determined under criteria established in section 256B.0911, subdivision 4a,
65.34paragraph (d) 4e, and the certified assessor's decision regarding eligibility for all services
65.35and programs as defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
66.1    (9) the person's right to appeal the certified assessor's decision regarding eligibility
66.2for all services and programs as defined in subdivision 1a, paragraphs (a), clause (7), and
66.3(b), and incorporating the decision regarding the need for institutional level of care or the
66.4lead agency's final decisions regarding public programs eligibility according to section
66.5256.045, subdivision 3 .
66.6    (i) Face-to-face assessment completed as part of eligibility determination for
66.7the alternative care, elderly waiver, community alternatives for disabled individuals,
66.8community alternative care, and brain injury waiver programs under sections 256B.0913,
66.9256B.0915 , and 256B.49 is valid to establish service eligibility for no more than 60
66.10calendar days after the date of assessment.
66.11(j) The effective eligibility start date for programs in paragraph (i) can never be
66.12prior to the date of assessment. If an assessment was completed more than 60 days
66.13before the effective waiver or alternative care program eligibility start date, assessment
66.14and support plan information must be updated in a face-to-face visit and documented in
66.15the department's Medicaid Management Information System (MMIS). Notwithstanding
66.16retroactive medical assistance coverage of state plan services, the effective date of
66.17eligibility for programs included in paragraph (i) cannot be prior to the date the most
66.18recent updated assessment is completed.

66.19    Sec. 20. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to
66.20read:
66.21    Subd. 4d. Preadmission screening of individuals under 65 60 years of age. (a)
66.22It is the policy of the state of Minnesota to ensure that individuals with disabilities or
66.23chronic illness are served in the most integrated setting appropriate to their needs and have
66.24the necessary information to make informed choices about home and community-based
66.25service options.
66.26    (b) Individuals under 65 60 years of age who are admitted to a Medicaid-certified
66.27 nursing facility from a hospital must be screened prior to admission as outlined in
66.28subdivisions 4a through 4c according to the requirements outlined in section 256.975,
66.29subdivisions 7a to 7c. This shall be provided by the Disability Linkage Line as required
66.30under section 256.01, subdivision 24.
66.31    (c) Individuals under 65 years of age who are admitted to nursing facilities with
66.32only a telephone screening must receive a face-to-face assessment from the long-term
66.33care consultation team member of the county in which the facility is located or from the
66.34recipient's county case manager within 40 calendar days of admission.
67.1    (d) Individuals under 65 years of age who are admitted to a nursing facility
67.2without preadmission screening according to the exemption described in subdivision 4b,
67.3paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
67.4a face-to-face assessment within 40 days of admission.
67.5    (e) (d) At the face-to-face assessment, the long-term care consultation team member
67.6or county case manager must perform the activities required under subdivision 3b.
67.7    (f) (e) For individuals under 21 years of age, a screening interview which
67.8recommends nursing facility admission must be face-to-face and approved by the
67.9commissioner before the individual is admitted to the nursing facility.
67.10    (g) (f) In the event that an individual under 65 60 years of age is admitted to a
67.11nursing facility on an emergency basis, the county Disability Linkage Line must be
67.12notified of the admission on the next working day, and a face-to-face assessment as
67.13described in paragraph (c) must be conducted within 40 calendar days of admission.
67.14    (h) (g) At the face-to-face assessment, the long-term care consultation team member
67.15or the case manager must present information about home and community-based options,
67.16including consumer-directed options, so the individual can make informed choices. If the
67.17individual chooses home and community-based services, the long-term care consultation
67.18team member or case manager must complete a written relocation plan within 20 working
67.19days of the visit. The plan shall describe the services needed to move out of the facility
67.20and a time line for the move which is designed to ensure a smooth transition to the
67.21individual's home and community.
67.22    (i) (h) An individual under 65 years of age residing in a nursing facility shall receive
67.23a face-to-face assessment at least every 12 months to review the person's service choices
67.24and available alternatives unless the individual indicates, in writing, that annual visits are
67.25not desired. In this case, the individual must receive a face-to-face assessment at least
67.26once every 36 months for the same purposes.
67.27    (j) (i) Notwithstanding the provisions of subdivision 6, the commissioner may pay
67.28county agencies directly for face-to-face assessments for individuals under 65 years of age
67.29who are being considered for placement or residing in a nursing facility.
67.30(j) Funding for preadmission screening shall be provided to the Disability Linkage
67.31Line for the under 60 population by the Department of Human Services to cover screener
67.32salaries and expenses to provide the services described in subdivisions 7a to 7c. The
67.33Disability Linkage Line shall employ, or contract with other agencies to employ, within
67.34the limits of available funding, sufficient personnel to provide preadmission screening and
67.35level of care determination services and shall seek to maximize federal funding for the
67.36service as provided under section 256.01, subdivision 2, paragraph (dd).
68.1EFFECTIVE DATE.This section is effective October 1, 2013.

68.2    Sec. 21. Minnesota Statutes 2012, section 256B.0911, is amended by adding a
68.3subdivision to read:
68.4    Subd. 4e. Determination of institutional level of care. The determination of the
68.5need for nursing facility, hospital, and intermediate care facility levels of care must be
68.6made according to criteria developed by the commissioner, and in section 256B.092,
68.7using forms developed by the commissioner. Effective January 1, 2014, for individuals
68.8age 21 and older, the determination of need for nursing facility level of care shall be
68.9based on criteria in section 144.0724, subdivision 11. For individuals under age 21, the
68.10determination of the need for nursing facility level of care must be made according to
68.11criteria developed by the commissioner until criteria in section 144.0724, subdivision 11,
68.12becomes effective on or after October 1, 2019.

68.13    Sec. 22. Minnesota Statutes 2012, section 256B.0911, subdivision 7, is amended to read:
68.14    Subd. 7. Reimbursement for certified nursing facilities. (a) Medical assistance
68.15reimbursement for nursing facilities shall be authorized for a medical assistance recipient
68.16only if a preadmission screening has been conducted prior to admission or the county has
68.17authorized an exemption. Medical assistance reimbursement for nursing facilities shall
68.18not be provided for any recipient who the local screener has determined does not meet the
68.19level of care criteria for nursing facility placement in section 144.0724, subdivision 11, or,
68.20if indicated, has not had a level II OBRA evaluation as required under the federal Omnibus
68.21Budget Reconciliation Act of 1987 completed unless an admission for a recipient with
68.22mental illness is approved by the local mental health authority or an admission for a
68.23recipient with developmental disability is approved by the state developmental disability
68.24authority.
68.25    (b) The nursing facility must not bill a person who is not a medical assistance
68.26recipient for resident days that preceded the date of completion of screening activities
68.27as required under section 256.975, subdivisions 4a, 4b, and 4c 7a to 7c. The nursing
68.28facility must include unreimbursed resident days in the nursing facility resident day totals
68.29reported to the commissioner.

68.30    Sec. 23. Minnesota Statutes 2012, section 256B.0913, subdivision 4, is amended to read:
68.31    Subd. 4. Eligibility for funding for services for nonmedical assistance recipients.
68.32    (a) Funding for services under the alternative care program is available to persons who
68.33meet the following criteria:
69.1    (1) the person has been determined by a community assessment under section
69.2256B.0911 to be a person who would require the level of care provided in a nursing
69.3facility, as determined under section 256B.0911, subdivision 4a, paragraph (d) 4e, but for
69.4the provision of services under the alternative care program;
69.5    (2) the person is age 65 or older;
69.6    (3) the person would be eligible for medical assistance within 135 days of admission
69.7to a nursing facility;
69.8    (4) the person is not ineligible for the payment of long-term care services by the
69.9medical assistance program due to an asset transfer penalty under section 256B.0595 or
69.10equity interest in the home exceeding $500,000 as stated in section 256B.056;
69.11    (5) the person needs long-term care services that are not funded through other
69.12state or federal funding, or other health insurance or other third-party insurance such as
69.13long-term care insurance;
69.14    (6) except for individuals described in clause (7), the monthly cost of the alternative
69.15care services funded by the program for this person does not exceed 75 percent of the
69.16monthly limit described under section 256B.0915, subdivision 3a. This monthly limit
69.17does not prohibit the alternative care client from payment for additional services, but in no
69.18case may the cost of additional services purchased under this section exceed the difference
69.19between the client's monthly service limit defined under section 256B.0915, subdivision
69.203 , and the alternative care program monthly service limit defined in this paragraph. If
69.21care-related supplies and equipment or environmental modifications and adaptations are or
69.22will be purchased for an alternative care services recipient, the costs may be prorated on a
69.23monthly basis for up to 12 consecutive months beginning with the month of purchase.
69.24If the monthly cost of a recipient's other alternative care services exceeds the monthly
69.25limit established in this paragraph, the annual cost of the alternative care services shall be
69.26determined. In this event, the annual cost of alternative care services shall not exceed 12
69.27times the monthly limit described in this paragraph;
69.28    (7) for individuals assigned a case mix classification A as described under section
69.29256B.0915, subdivision 3a , paragraph (a), with (i) no dependencies in activities of daily
69.30living, or (ii) up to two dependencies in bathing, dressing, grooming, walking, and eating
69.31when the dependency score in eating is three or greater as determined by an assessment
69.32performed under section 256B.0911, the monthly cost of alternative care services funded
69.33by the program cannot exceed $593 per month for all new participants enrolled in
69.34the program on or after July 1, 2011. This monthly limit shall be applied to all other
69.35participants who meet this criteria at reassessment. This monthly limit shall be increased
69.36annually as described in section 256B.0915, subdivision 3a, paragraph (a). This monthly
70.1limit does not prohibit the alternative care client from payment for additional services, but
70.2in no case may the cost of additional services purchased exceed the difference between the
70.3client's monthly service limit defined in this clause and the limit described in clause (6)
70.4for case mix classification A; and
70.5(8) the person is making timely payments of the assessed monthly fee.
70.6A person is ineligible if payment of the fee is over 60 days past due, unless the person
70.7agrees to:
70.8    (i) the appointment of a representative payee;
70.9    (ii) automatic payment from a financial account;
70.10    (iii) the establishment of greater family involvement in the financial management of
70.11payments; or
70.12    (iv) another method acceptable to the lead agency to ensure prompt fee payments.
70.13    The lead agency may extend the client's eligibility as necessary while making
70.14arrangements to facilitate payment of past-due amounts and future premium payments.
70.15Following disenrollment due to nonpayment of a monthly fee, eligibility shall not be
70.16reinstated for a period of 30 days.
70.17    (b) Alternative care funding under this subdivision is not available for a person who
70.18is a medical assistance recipient or who would be eligible for medical assistance without a
70.19spenddown or waiver obligation. A person whose initial application for medical assistance
70.20and the elderly waiver program is being processed may be served under the alternative care
70.21program for a period up to 60 days. If the individual is found to be eligible for medical
70.22assistance, medical assistance must be billed for services payable under the federally
70.23approved elderly waiver plan and delivered from the date the individual was found eligible
70.24for the federally approved elderly waiver plan. Notwithstanding this provision, alternative
70.25care funds may not be used to pay for any service the cost of which: (i) is payable by
70.26medical assistance; (ii) is used by a recipient to meet a waiver obligation; or (iii) is used to
70.27pay a medical assistance income spenddown for a person who is eligible to participate in the
70.28federally approved elderly waiver program under the special income standard provision.
70.29    (c) Alternative care funding is not available for a person who resides in a licensed
70.30nursing home, certified boarding care home, hospital, or intermediate care facility, except
70.31for case management services which are provided in support of the discharge planning
70.32process for a nursing home resident or certified boarding care home resident to assist with
70.33a relocation process to a community-based setting.
70.34    (d) Alternative care funding is not available for a person whose income is greater
70.35than the maintenance needs allowance under section 256B.0915, subdivision 1d, but equal
70.36to or less than 120 percent of the federal poverty guideline effective July 1 in the fiscal
71.1year for which alternative care eligibility is determined, who would be eligible for the
71.2elderly waiver with a waiver obligation.

71.3    Sec. 24. Minnesota Statutes 2012, section 256B.0913, is amended by adding a
71.4subdivision to read:
71.5    Subd. 17. Essential community supports grants. (a) Notwithstanding subdivisions
71.61 to 14, the purpose of the essential community supports grant program is to provide
71.7targeted services to persons age 65 and older who need essential community support, but
71.8whose needs do not meet the level of care required for nursing facility placement under
71.9section 144.0724, subdivision 11.
71.10(b) Essential community supports grants are available not to exceed $400 per person
71.11per month. Essential community supports service grants may be used as authorized within
71.12an authorization period not to exceed 12 months. Grants must be available to a person who:
71.13(1) is age 65 or older;
71.14(2) is not eligible for medical assistance;
71.15(3) would otherwise be financially eligible for the alternative care program under
71.16subdivision 4;
71.17(4) has received a community assessment under section 256B.0911, subdivision 3a
71.18or 3b, and does not require the level of care provided in a nursing facility;
71.19(5) has a community support plan; and
71.20(6) has been determined by a community assessment under section 256B.0911,
71.21subdivision 3a or 3b, to be a person who would require provision of at least one of the
71.22following services, as defined in the approved elderly waiver plan, in order to maintain
71.23their community residence:
71.24(i) caregiver support;
71.25(ii) homemaker support;
71.26(iii) chores; or
71.27(iv) a personal emergency response device or system.
71.28(c) The person receiving any of the essential community supports in this subdivision
71.29must also receive service coordination, not to exceed $600 in a 12-month authorization
71.30period, as part of their community support plan.
71.31(d) A person who has been determined to be eligible for an essential community
71.32supports grant must be reassessed at least annually and continue to meet the criteria in
71.33paragraph (b) to remain eligible for an essential community supports grant.
71.34(e) The commissioner is authorized to use federal matching funds for essential
71.35community supports as necessary and to meet demand for essential community supports
72.1grants as outlined in paragraphs (f) and (g), and that amount of federal funds is
72.2appropriated to the commissioner for this purpose.
72.3(f) Upon federal approval and following a reasonable implementation period
72.4determined by the commissioner, essential community supports are available to an
72.5individual who:
72.6(1) is receiving nursing facility services or home and community-based long-term
72.7services and supports under section 256B.0915 or 256B.49 on the effective date of
72.8implementation of the revised nursing facility level of care under section 144.0724,
72.9subdivision 11;
72.10(2) meets one of the following criteria:
72.11(i) due to the implementation of the revised nursing facility level of care, loses
72.12eligibility for continuing medical assistance payment of nursing facility services at the
72.13first reassessment under section 144.0724, subdivision 11, paragraph (b), that occurs on or
72.14after the effective date of the revised nursing facility level of care criteria under section
72.15144.0724, subdivision 11; or
72.16(ii) due to the implementation of the revised nursing facility level of care, loses
72.17eligibility for continuing medical assistance payment of home and community-based
72.18long-term services and supports under section 256B.0915 or 256B.49 at the first
72.19reassessment required under those sections that occurs on or after the effective date of
72.20implementation of the revised nursing facility level of care under section 144.0724,
72.21subdivision 11;
72.22(3) is not eligible for personal care attendant services; and
72.23(4) has an assessed need for one or more of the supportive services offered under
72.24essential community supports.
72.25Individuals eligible under this paragraph includes individuals who continue to be
72.26eligible for medical assistance state plan benefits and those who are not or are no longer
72.27financially eligible for medical assistance.
72.28(g) Upon federal approval and following a reasonable implementation period
72.29determined by the commissioner, the services available through essential community
72.30supports include the services and grants provided in paragraphs (b) and (c), home-delivered
72.31meals, and community living assistance as defined by the commissioner. These services
72.32are available to all eligible recipients including those outlined in paragraphs (b) and (f).
72.33Recipients are eligible if they have a need for any of these services and meet all other
72.34eligibility criteria.

73.1    Sec. 25. Minnesota Statutes 2012, section 256B.0915, subdivision 3a, is amended to
73.2read:
73.3    Subd. 3a. Elderly waiver cost limits. (a) The monthly limit for the cost of
73.4waivered services to an individual elderly waiver client except for individuals described in
73.5paragraph paragraphs (b) and (d) shall be the weighted average monthly nursing facility
73.6rate of the case mix resident class to which the elderly waiver client would be assigned
73.7under Minnesota Rules, parts 9549.0050 to 9549.0059, less the recipient's maintenance
73.8needs allowance as described in subdivision 1d, paragraph (a), until the first day of the
73.9state fiscal year in which the resident assessment system as described in section 256B.438
73.10for nursing home rate determination is implemented. Effective on the first day of the state
73.11fiscal year in which the resident assessment system as described in section 256B.438 for
73.12nursing home rate determination is implemented and the first day of each subsequent state
73.13fiscal year, the monthly limit for the cost of waivered services to an individual elderly
73.14waiver client shall be the rate of the case mix resident class to which the waiver client
73.15would be assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, in effect on
73.16the last day of the previous state fiscal year, adjusted by any legislatively adopted home
73.17and community-based services percentage rate adjustment.
73.18    (b) The monthly limit for the cost of waivered services to an individual elderly
73.19waiver client assigned to a case mix classification A under paragraph (a) with:
73.20(1) no dependencies in activities of daily living; or
73.21(2) up to two dependencies in bathing, dressing, grooming, walking, and eating
73.22when the dependency score in eating is three or greater as determined by an assessment
73.23performed under section 256B.0911
73.24shall be $1,750 per month effective on July 1, 2011, for all new participants enrolled in
73.25the program on or after July 1, 2011. This monthly limit shall be applied to all other
73.26participants who meet this criteria at reassessment. This monthly limit shall be increased
73.27annually as described in paragraph (a).
73.28(c) If extended medical supplies and equipment or environmental modifications are
73.29or will be purchased for an elderly waiver client, the costs may be prorated for up to
73.3012 consecutive months beginning with the month of purchase. If the monthly cost of a
73.31recipient's waivered services exceeds the monthly limit established in paragraph (a) or
73.32(b), the annual cost of all waivered services shall be determined. In this event, the annual
73.33cost of all waivered services shall not exceed 12 times the monthly limit of waivered
73.34services as described in paragraph (a) or (b).
73.35(d) Effective July 1, 2013, the monthly cost limit of waiver services, including
73.36any necessary home care services described in section 256B.0651, subdivision 2, for
74.1individuals who meet the criteria as ventilator-dependent given in section 256B.0651,
74.2subdivision 1, paragraph (g), shall be the average of the monthly medical assistance
74.3amount established for home care services as described in section 256B.0652, subdivision
74.47, and the annual average contracted amount established by the commissioner for nursing
74.5facility services for ventilator-dependent individuals. This monthly limit shall be increased
74.6annually as described in paragraph (a).

74.7    Sec. 26. Minnesota Statutes 2012, section 256B.0915, is amended by adding a
74.8subdivision to read:
74.9    Subd. 3j. Individual community living support. Upon federal approval, there
74.10is established a new service called individual community living support (ICLS) that is
74.11available on the elderly waiver. ICLS providers may not be the landlord of recipients, nor
74.12have any interest in the recipient's housing. ICLS must be delivered in a single-family
74.13home or apartment where the service recipient or their family owns or rents, as
74.14demonstrated by a lease agreement, and maintains control over the individual unit. Case
74.15managers or care coordinators must develop individual ICLS plans in consultation with
74.16the client using a tool developed by the commissioner. The commissioner shall establish
74.17payment rates and mechanisms to align payments with the type and amount of service
74.18provided, assure statewide uniformity for payment rates, and assure cost-effectiveness.
74.19Licensing standards for ICLS shall be reviewed jointly by the Departments of Health and
74.20Human Services to avoid conflict with provider regulatory standards pursuant to section
74.21144A.43 and chapter 245D.

74.22    Sec. 27. Minnesota Statutes 2012, section 256B.0915, subdivision 5, is amended to read:
74.23    Subd. 5. Assessments and reassessments for waiver clients. (a) Each client
74.24shall receive an initial assessment of strengths, informal supports, and need for services
74.25in accordance with section 256B.0911, subdivisions 3, 3a, and 3b. A reassessment of a
74.26client served under the elderly waiver must be conducted at least every 12 months and at
74.27other times when the case manager determines that there has been significant change in
74.28the client's functioning. This may include instances where the client is discharged from
74.29the hospital. There must be a determination that the client requires nursing facility level
74.30of care as defined in section 256B.0911, subdivision 4a, paragraph (d) 4e, at initial and
74.31subsequent assessments to initiate and maintain participation in the waiver program.
74.32(b) Regardless of other assessments identified in section 144.0724, subdivision
74.334, as appropriate to determine nursing facility level of care for purposes of medical
74.34assistance payment for nursing facility services, only face-to-face assessments conducted
75.1according to section 256B.0911, subdivisions 3a and 3b, that result in a nursing facility
75.2level of care determination will be accepted for purposes of initial and ongoing access to
75.3waiver service payment.

75.4    Sec. 28. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
75.5subdivision to read:
75.6    Subd. 1a. Home and community-based services for older adults. (a) The purpose
75.7of projects selected by the commissioner of human services under this section is to
75.8make strategic changes in the long-term services and supports system for older adults
75.9including statewide capacity for local service development and technical assistance, and
75.10statewide availability of home and community-based services for older adult services,
75.11caregiver support and respite care services, and other supports in the state of Minnesota.
75.12These projects are intended to create incentives for new and expanded home and
75.13community-based services in Minnesota in order to:
75.14(1) reach older adults early in the progression of their need for long-term services
75.15and supports, providing them with low-cost, high-impact services that will prevent or
75.16delay the use of more costly services;
75.17(2) support older adults to live in the most integrated, least restrictive community
75.18setting;
75.19(3) support the informal caregivers of older adults;
75.20(4) develop and implement strategies to integrate long-term services and supports
75.21with health care services, in order to improve the quality of care and enhance the quality
75.22of life of older adults and their informal caregivers;
75.23(5) ensure cost-effective use of financial and human resources;
75.24(6) build community-based approaches and community commitment to delivering
75.25long-term services and supports for older adults in their own homes;
75.26(7) achieve a broad awareness and use of lower-cost in-home services as an
75.27alternative to nursing homes and other residential services;
75.28(8) strengthen and develop additional home and community-based services and
75.29alternatives to nursing homes and other residential services; and
75.30(9) strengthen programs that use volunteers.
75.31(b) The services provided by these projects are available to older adults who are
75.32eligible for medical assistance and the elderly waiver under section 256B.0915, the
75.33alternative care program under section 256B.0913, or essential community supports grant
75.34under subdivision 14, paragraph (b), and to persons who have their own funds to pay for
75.35services.

76.1    Sec. 29. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
76.2subdivision to read:
76.3    Subd. 1b. Definitions. (a) For purposes of this section, the following terms have
76.4the meanings given.
76.5(b) "Community" means a town; township; city; or targeted neighborhood within a
76.6city; or a consortium of towns, townships, cities, or specific neighborhoods within a city.
76.7(c) "Core home and community-based services provider" means a Faith in Action,
76.8Living at Home Block Nurse, Congregational Nurse, or similar community-based
76.9program governed by a board, the majority of whose members reside within the program's
76.10service area, that organizes and uses volunteers and paid staff to deliver nonmedical
76.11services intended to assist older adults to identify and manage risks and to maintain their
76.12community living and integration in the community.
76.13(d) "Eldercare development partnership" means a team of representatives of county
76.14social service and public health agencies, the area agency on aging, local nursing home
76.15providers, local home care providers, and other appropriate home and community-based
76.16providers in the area agency's planning and service area.
76.17(e) "Long-term services and supports" means any service available under the
76.18elderly waiver program or alternative care grant programs; nursing facility services;
76.19transportation services; caregiver support and respite care services; and other home and
76.20community-based services identified as necessary either to maintain lifestyle choices for
76.21older adults or to support them to remain in their own home.
76.22(f) "Older adult" refers to an individual who is 65 years of age or older.

76.23    Sec. 30. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
76.24subdivision to read:
76.25    Subd. 1c. Eldercare development partnerships. The commissioner of human
76.26services shall select and contract with eldercare development partnerships sufficient to
76.27provide statewide availability of service development and technical assistance using a
76.28request for proposals process. Eldercare development partnerships shall:
76.29(1) develop a local long-term services and supports strategy consistent with state
76.30goals and objectives;
76.31(2) identify and use existing local skills, knowledge and relationships, and build
76.32on these assets;
76.33(3) coordinate planning for funds to provide services to older adults, including funds
76.34received under Title III of the Older Americans Act, Title XX of the Social Security Act,
76.35and the Local Public Health Act;
77.1(4) target service development and technical assistance where nursing facility
77.2closures have occurred or are occurring or in areas where service needs have been
77.3identified through activities under section 144A.351;
77.4(5) provide sufficient staff for development and technical support in its designated
77.5area; and
77.6(6) designate a single public or nonprofit member of the eldercare development
77.7partnerships to apply grant funding and manage the project.

77.8    Sec. 31. Minnesota Statutes 2012, section 256B.0917, subdivision 6, is amended to read:
77.9    Subd. 6. Caregiver support and respite care projects. (a) The commissioner
77.10shall establish up to 36 projects to expand the respite care network in the state and to
77.11support caregivers in their responsibilities for care. The purpose of each project shall
77.12be to availability of caregiver support and respite care services for family and other
77.13caregivers. The commissioner shall use a request for proposals to select nonprofit entities
77.14to administer the projects. Projects shall:
77.15(1) establish a local coordinated network of volunteer and paid respite workers;
77.16(2) coordinate assignment of respite workers care services to clients and care
77.17receivers and assure the health and safety of the client; and caregivers of older adults;
77.18(3) provide training for caregivers and ensure that support groups are available
77.19in the community.
77.20(3) assure the health and safety of the older adults;
77.21(4) identify at-risk caregivers;
77.22(5) provide information, education, and training for caregivers in the designated
77.23community; and
77.24(6) demonstrate the need in the proposed service area particularly where nursing
77.25facility closures have occurred or are occurring or areas with service needs identified
77.26by section 144A.351. Preference must be given for projects that reach underserved
77.27populations.
77.28(b) The caregiver support and respite care funds shall be available to the four to six
77.29local long-term care strategy projects designated in subdivisions 1 to 5.
77.30(c) The commissioner shall publish a notice in the State Register to solicit proposals
77.31from public or private nonprofit agencies for the projects not included in the four to six
77.32local long-term care strategy projects defined in subdivision 2. A county agency may,
77.33alone or in combination with other county agencies, apply for caregiver support and
77.34respite care project funds. A public or nonprofit agency within a designated SAIL project
77.35area may apply for project funds if the agency has a letter of agreement with the county
78.1or counties in which services will be developed, stating the intention of the county or
78.2counties to coordinate their activities with the agency requesting a grant.
78.3(d) The commissioner shall select grantees based on the following criteria (b)
78.4Projects must clearly describe:
78.5(1) the ability of the proposal to demonstrate need in the area served, as evidenced
78.6by a community needs assessment or other demographic data;
78.7(2) the ability of the proposal to clearly describe how the project (1) how they will
78.8achieve the their purpose defined in paragraph (b);
78.9(3) the ability of the proposal to reach underserved populations;
78.10(4) the ability of the proposal to demonstrate community commitment to the project,
78.11as evidenced by letters of support and cooperation as well as formation of a community
78.12task force;
78.13(5) the ability of the proposal to clearly describe (2) the process for recruiting,
78.14training, and retraining volunteers; and
78.15(6) the inclusion in the proposal of the (3) their plan to promote the project in the
78.16designated community, including outreach to persons needing the services.
78.17(e) (c) Funds for all projects under this subdivision may be used to:
78.18(1) hire a coordinator to develop a coordinated network of volunteer and paid respite
78.19care services and assign workers to clients;
78.20(2) recruit and train volunteer providers;
78.21(3) train provide information, training, and education to caregivers;
78.22(4) ensure the development of support groups for caregivers;
78.23(5) (4) advertise the availability of the caregiver support and respite care project; and
78.24(6) (5) purchase equipment to maintain a system of assigning workers to clients.
78.25(f) (d) Project funds may not be used to supplant existing funding sources.

78.26    Sec. 32. Minnesota Statutes 2012, section 256B.0917, is amended by adding a
78.27subdivision to read:
78.28    Subd. 7a. Core home and community-based services. The commissioner shall
78.29select and contract with core home and community-based services providers for projects
78.30to provide services and supports to older adults both with and without family and other
78.31informal caregivers using a request for proposals process. Projects must:
78.32(1) have a credible, public, or private nonprofit sponsor providing ongoing financial
78.33support;
78.34(2) have a specific, clearly defined geographic service area;
79.1(3) use a practice framework designed to identify high-risk older adults and help them
79.2take action to better manage their chronic conditions and maintain their community living;
79.3(4) have a team approach to coordination and care, ensuring that the older adult
79.4participants, their families, and the formal and informal providers are all part of planning
79.5and providing services;
79.6(5) provide information, support services, homemaking services, counseling, and
79.7training for the older adults and family caregivers;
79.8(6) encourage service area or neighborhood residents and local organizations to
79.9collaborate in meeting the needs of older adults in their geographic service areas;
79.10(7) recruit, train, and direct the use of volunteers to provide informal services and
79.11other appropriate support to older adults and their caregivers; and
79.12(8) provide coordination and management of formal and informal services to older
79.13adults and their families using less expensive alternatives.

79.14    Sec. 33. Minnesota Statutes 2012, section 256B.0917, subdivision 13, is amended to
79.15read:
79.16    Subd. 13. Community service grants. The commissioner shall award contracts
79.17for grants to public and private nonprofit agencies to establish services that strengthen
79.18a community's ability to provide a system of home and community-based services
79.19for elderly persons. The commissioner shall use a request for proposal process. The
79.20commissioner shall give preference when awarding grants under this section to areas
79.21where nursing facility closures have occurred or are occurring or to areas with service
79.22needs identified under section 144A.351. The commissioner shall consider grants for:
79.23(1) caregiver support and respite care projects under subdivision 6;
79.24(2) the living-at-home/block nurse grant under subdivisions 7 to 10; and
79.25(3) services identified as needed for community transition.

79.26    Sec. 34. Minnesota Statutes 2012, section 256B.092, is amended by adding a
79.27subdivision to read:
79.28    Subd. 14. Reduce avoidable behavioral crisis emergency room, psychiatric
79.29inpatient hospitalizations, and commitments to institutions. (a) Persons receiving
79.30home and community-based services authorized under this section who have had two
79.31or more admissions within a calendar year to an emergency room, psychiatric unit,
79.32or institution must receive consultation from a mental health professional as defined in
79.33section 245.462, subdivision 18, or a behavioral professional as defined in the home and
80.1community-based services state plan within 30 days of discharge. The mental health
80.2professional or behavioral professional must:
80.3(1) conduct a functional assessment of the crisis incident as defined in section
80.4245D.02, subdivision 11, which led to the hospitalization with the goal of developing
80.5proactive strategies as well as necessary reactive strategies to reduce the likelihood of
80.6future avoidable hospitalizations due to a behavioral crisis;
80.7(2) use the results of the functional assessment to amend the coordinated service and
80.8support plan set forth in section 245D.02, subdivision 4b, to address the potential need
80.9for additional staff training, increased staffing, access to crisis mobility services, mental
80.10health services, use of technology, and crisis stabilization services in section 256B.0624,
80.11subdivision 7; and
80.12(3) identify the need for additional consultation, testing, and mental health crisis
80.13intervention team services as defined in section 245D.02, subdivision 20, psychotropic
80.14medication use and monitoring under section 245D.051, as well as the frequency and
80.15duration of ongoing consultation.
80.16(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
80.17the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

80.18    Sec. 35. Minnesota Statutes 2012, section 256B.439, subdivision 1, is amended to read:
80.19    Subdivision 1. Development and implementation of quality profiles. (a) The
80.20commissioner of human services, in cooperation with the commissioner of health,
80.21shall develop and implement a quality profile system profiles for nursing facilities and,
80.22beginning not later than July 1, 2004 2014, other providers of long-term care services,
80.23except when the quality profile system would duplicate requirements under section
80.24256B.5011 , 256B.5012, or 256B.5013. The system quality profiles must be developed
80.25and implemented to the extent possible without the collection of significant amounts of
80.26new data. To the extent possible, the system using existing data sets maintained by the
80.27commissioners of health and human services to the extent possible. The profiles must
80.28incorporate or be coordinated with information on quality maintained by area agencies on
80.29aging, long-term care trade associations, the ombudsman offices, counties, tribes, health
80.30plans, and other entities and the long-term care database maintained under section 256.975,
80.31subdivision 7. The system profiles must be designed to provide information on quality to:
80.32(1) consumers and their families to facilitate informed choices of service providers;
80.33(2) providers to enable them to measure the results of their quality improvement
80.34efforts and compare quality achievements with other service providers; and
81.1(3) public and private purchasers of long-term care services to enable them to
81.2purchase high-quality care.
81.3(b) The system profiles must be developed in consultation with the long-term care
81.4task force, area agencies on aging, and representatives of consumers, providers, and labor
81.5unions. Within the limits of available appropriations, the commissioners may employ
81.6consultants to assist with this project.

81.7    Sec. 36. Minnesota Statutes 2012, section 256B.439, subdivision 2, is amended to read:
81.8    Subd. 2. Quality measurement tools. The commissioners shall identify and apply
81.9existing quality measurement tools to:
81.10(1) emphasize quality of care and its relationship to quality of life; and
81.11(2) address the needs of various users of long-term care services, including, but not
81.12limited to, short-stay residents, persons with behavioral problems, persons with dementia,
81.13and persons who are members of minority groups.
81.14    The tools must be identified and applied, to the extent possible, without requiring
81.15providers to supply information beyond current state and federal requirements.

81.16    Sec. 37. Minnesota Statutes 2012, section 256B.439, subdivision 3, is amended to read:
81.17    Subd. 3. Consumer surveys of nursing facilities residents. Following
81.18identification of the quality measurement tool, the commissioners shall conduct surveys
81.19of long-term care service consumers of nursing facilities to develop quality profiles
81.20of providers. To the extent possible, surveys must be conducted face-to-face by state
81.21employees or contractors. At the discretion of the commissioners, surveys may be
81.22conducted by telephone or by provider staff. Surveys must be conducted periodically to
81.23update quality profiles of individual service nursing facilities providers.

81.24    Sec. 38. Minnesota Statutes 2012, section 256B.439, is amended by adding a
81.25subdivision to read:
81.26    Subd. 3a. Home and community-based services report card in cooperation with
81.27the commissioner of health. The profiles developed for home and community-based
81.28services providers under this section shall be incorporated into a report card and
81.29maintained by the Minnesota Board on Aging pursuant to section 256.975, subdivision
81.307, paragraph (b), clause (2), as data becomes available. The commissioner, in
81.31cooperation with the commissioner of health, shall use consumer choice, quality of life,
81.32care approaches, and cost or flexible purchasing categories to organize the consumer
81.33information in the profiles. The final categories used shall include consumer input and
82.1survey data to the extent that is available through the state agencies. The commissioner
82.2shall develop and disseminate the qualify profiles for a limited number of provider types
82.3initially, and develop quality profiles for additional provider types as measurement tools
82.4are developed and data becomes available. This includes providers of services to older
82.5adults and people with disabilities, regardless of payor source.

82.6    Sec. 39. Minnesota Statutes 2012, section 256B.439, subdivision 4, is amended to read:
82.7    Subd. 4. Dissemination of quality profiles. By July 1, 2003 2014, the
82.8commissioners shall implement a system public awareness effort to disseminate the quality
82.9profiles developed from consumer surveys using the quality measurement tool. Profiles
82.10may be disseminated to through the Senior LinkAge Line and Disability Linkage Line and
82.11to consumers, providers, and purchasers of long-term care services through all feasible
82.12printed and electronic outlets. The commissioners may conduct a public awareness
82.13campaign to inform potential users regarding profile contents and potential uses.

82.14    Sec. 40. Minnesota Statutes 2012, section 256B.49, subdivision 12, is amended to read:
82.15    Subd. 12. Informed choice. Persons who are determined likely to require the level
82.16of care provided in a nursing facility as determined under section 256B.0911, subdivision
82.174e, or a hospital shall be informed of the home and community-based support alternatives
82.18to the provision of inpatient hospital services or nursing facility services. Each person
82.19must be given the choice of either institutional or home and community-based services
82.20using the provisions described in section 256B.77, subdivision 2, paragraph (p).

82.21    Sec. 41. Minnesota Statutes 2012, section 256B.49, subdivision 14, is amended to read:
82.22    Subd. 14. Assessment and reassessment. (a) Assessments and reassessments
82.23shall be conducted by certified assessors according to section 256B.0911, subdivision 2b.
82.24With the permission of the recipient or the recipient's designated legal representative,
82.25the recipient's current provider of services may submit a written report outlining their
82.26recommendations regarding the recipient's care needs prepared by a direct service
82.27employee with at least 20 hours of service to that client. The person conducting the
82.28assessment or reassessment must notify the provider of the date by which this information
82.29is to be submitted. This information shall be provided to the person conducting the
82.30assessment and the person or the person's legal representative and must be considered
82.31prior to the finalization of the assessment or reassessment.
82.32(b) There must be a determination that the client requires a hospital level of care or a
82.33nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
83.1(d) 4e, at initial and subsequent assessments to initiate and maintain participation in the
83.2waiver program.
83.3(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
83.4appropriate to determine nursing facility level of care for purposes of medical assistance
83.5payment for nursing facility services, only face-to-face assessments conducted according
83.6to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
83.7determination or a nursing facility level of care determination must be accepted for
83.8purposes of initial and ongoing access to waiver services payment.
83.9(d) Recipients who are found eligible for home and community-based services under
83.10this section before their 65th birthday may remain eligible for these services after their
83.1165th birthday if they continue to meet all other eligibility factors.
83.12(e) The commissioner shall develop criteria to identify recipients whose level of
83.13functioning is reasonably expected to improve and reassess these recipients to establish
83.14a baseline assessment. Recipients who meet these criteria must have a comprehensive
83.15transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
83.16reassessed every six months until there has been no significant change in the recipient's
83.17functioning for at least 12 months. After there has been no significant change in the
83.18recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
83.19informal support systems, and need for services shall be conducted at least every 12
83.20months and at other times when there has been a significant change in the recipient's
83.21functioning. Counties, case managers, and service providers are responsible for
83.22conducting these reassessments and shall complete the reassessments out of existing funds.

83.23    Sec. 42. Minnesota Statutes 2012, section 256B.49, is amended by adding a
83.24subdivision to read:
83.25    Subd. 25. Reduce avoidable behavioral crisis emergency room, psychiatric
83.26inpatient hospitalizations, and commitments to institutions. (a) Persons receiving
83.27home and community-based services authorized under this section who have two or more
83.28admissions within a calendar year to an emergency room, psychiatric unit, or institution
83.29must receive consultation from a mental health professional as defined in section 245.462,
83.30subdivision 18, or a behavioral professional as defined in the home and community-based
83.31services state plan within 30 days of discharge. The mental health professional or
83.32behavioral professional must:
83.33(1) conduct a functional assessment of the crisis incident as defined in section
83.34245D.02, subdivision 11, which led to the hospitalization with the goal of developing
84.1proactive strategies as well as necessary reactive strategies to reduce the likelihood of
84.2future avoidable hospitalizations due to a behavioral crisis;
84.3(2) use the results of the functional assessment to amend the coordinated service and
84.4support plan in section 245D.02, subdivision 4b, to address the potential need for additional
84.5staff training, increased staffing, access to crisis mobility services, mental health services,
84.6use of technology, and crisis stabilization services in section 256B.0624, subdivision 7; and
84.7(3) identify the need for additional consultation, testing, mental health crisis
84.8intervention team services as defined in section 245D.02, subdivision 20, psychotropic
84.9medication use and monitoring under section 245D.051, as well as the frequency and
84.10duration of ongoing consultation.
84.11(b) For the purposes of this subdivision, "institution" includes, but is not limited to,
84.12the Anoka-Metro Regional Treatment Center and the Minnesota Security Hospital.

84.13    Sec. 43. [256B.85] COMMUNITY FIRST SERVICES AND SUPPORTS.
84.14    Subdivision 1. Basis and scope. (a) Upon federal approval, the commissioner
84.15shall establish a medical assistance state plan option for the provision of home and
84.16community-based personal assistance service and supports called "community first
84.17services and supports (CFSS)."
84.18(b) CFSS is a participant-controlled method of selecting and providing services
84.19and supports that allows the participant maximum control of the services and supports.
84.20Participants may choose the degree to which they direct and manage their supports by
84.21choosing to have a significant and meaningful role in the management of services and
84.22supports including by directly employing support workers with the necessary supports
84.23to perform that function.
84.24(c) CFSS is available statewide to eligible individuals to assist with accomplishing
84.25activities of daily living (ADLs), instrumental activities of daily living (IADLs), and
84.26health-related procedures and tasks through hands-on assistance to complete the task or
84.27supervision and cueing to complete the task; and to assist with acquiring, maintaining, and
84.28enhancing the skills necessary to accomplish ADLs, IADLs, and health-related procedures
84.29and tasks. CFSS allows payment for certain supports and goods such as environmental
84.30modifications and technology that are intended to replace or decrease the need for human
84.31assistance.
84.32(d) Upon federal approval, CFSS will replace the personal care assistance program
84.33under sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
84.34    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
84.35this subdivision have the meanings given.
85.1(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
85.2dressing, bathing, mobility, positioning, and transferring.
85.3(c) "Agency-provider model" means a method of CFSS under which a qualified
85.4agency provides services and supports through the agency's own employees and policies.
85.5The agency must allow the participant to have a significant role in the selection and
85.6dismissal of support workers of their choice for the delivery of their specific services
85.7and supports.
85.8(d) "Behavior" means a category to determine the home care rating and is based on the
85.9criteria in section 256B.0659. "Level I behavior" means physical aggression towards self,
85.10others, or destruction of property that requires the immediate response of another person.
85.11(e) "Complex health-related needs" means a category to determine the home care
85.12rating and is based on the criteria in section 256B.0659.
85.13(f) "Community first services and supports" or "CFSS" means the assistance and
85.14supports program under this section needed for accomplishing activities of daily living,
85.15instrumental activities of daily living, and health-related tasks through hands-on assistance
85.16to complete the task or supervision and cueing to complete the task, or the purchase of
85.17goods as defined in subdivision 7, paragraph (a), clause (2), that replace the need for
85.18human assistance.
85.19(g) "Community first services and supports service delivery plan" or "service delivery
85.20plan" means a written summary of the services and supports, that is based on the community
85.21support plan identified in section 256B.0911 and coordinated services and support plan
85.22and budget identified in section 256B.0915, subdivision 6, if applicable, that is determined
85.23by the participant to meet the assessed needs, using a person-centered planning process.
85.24(h) "Critical activities of daily living" means transferring, mobility, eating, and
85.25toileting.
85.26(i) "Dependency" in activities of daily living means a person requires assistance to
85.27begin and complete one or more of the activities of daily living.
85.28(j) "Financial management services contractor or vendor" means a qualified
85.29organization having a written contract with the department to provide services necessary
85.30to use the flexible spending model under subdivision 13, that include but are not limited
85.31to: participant education and technical assistance; CFSS service delivery planning and
85.32budgeting; billing, making payments, and monitoring of spending; and assisting the
85.33participant in fulfilling employer-related requirements in accordance with Section 3504 of
85.34the IRS code and the IRS Revenue Procedure 70-6.
85.35(k) "Flexible spending model" means a service delivery method of CFSS that uses
85.36an individualized CFSS service delivery plan and service budget and assistance from the
86.1financial management services contractor to facilitate participant employment of support
86.2workers and the acquisition of supports and goods.
86.3(l) "Health-related procedures and tasks" means procedures and tasks related to
86.4the specific needs of an individual that can be delegated or assigned by a state-licensed
86.5healthcare or behavioral health professional and performed by a support worker.
86.6(m) "Instrumental activities of daily living" means activities related to living
86.7independently in the community, including but not limited to: meal planning, preparation,
86.8and cooking; shopping for food, clothing, or other essential items; laundry; housecleaning;
86.9assistance with medications; managing money; communicating needs, preferences, and
86.10activities; arranging supports; and assistance with traveling around and participating
86.11in the community.
86.12(n) "Legal representative" means parent of a minor, a court-appointed guardian, or
86.13another representative with legal authority to make decisions about services and supports
86.14for the participant. Other representatives with legal authority to make decisions include
86.15but are not limited to a health care agent or an attorney-in-fact authorized through a health
86.16care directive or power of attorney.
86.17(o) "Medication assistance" means providing verbal or visual reminders to take
86.18regularly scheduled medication and includes any of the following supports:
86.19(1) under the direction of the participant or the participant's representative, bringing
86.20medications to the participant including medications given through a nebulizer, opening a
86.21container of previously set up medications, emptying the container into the participant's
86.22hand, opening and giving the medication in the original container to the participant, or
86.23bringing to the participant liquids or food to accompany the medication;
86.24(2) organizing medications as directed by the participant or the participant's
86.25representative; and
86.26(3) providing verbal or visual reminders to perform regularly scheduled medications.
86.27(p) "Participant's representative" means a parent, family member, advocate, or
86.28other adult authorized by the participant to serve as a representative in connection with
86.29the provision of CFSS. This authorization must be in writing or by another method
86.30that clearly indicates the participant's free choice. The participant's representative must
86.31have no financial interest in the provision of any services included in the participant's
86.32service delivery plan and must be capable of providing the support necessary to assist
86.33the participant in the use of CFSS. If through the assessment process described in
86.34subdivision 5 a participant is determined to be in need of a participant's representative, one
86.35must be selected. If the participant is unable to assist in the selection of a participant's
86.36representative, the legal representative shall appoint one. Two persons may be designated
87.1as a participant's representative for reasons such as divided households and court-ordered
87.2custodies. Duties of a participant's representatives may include:
87.3(1) being available while care is provided in a method agreed upon by the participant
87.4or the participant's legal representative and documented in the participant's CFSS service
87.5delivery plan;
87.6(2) monitoring CFSS services to ensure the participant's CFSS service delivery
87.7plan is being followed; and
87.8(3) reviewing and signing CFSS time sheets after services are provided to provide
87.9verification of the CFSS services.
87.10(q) "Person-centered planning process" means a process that is driven by the
87.11participant for discovering and planning services and supports that ensures the participant
87.12makes informed choices and decisions. The person-centered planning process must:
87.13(1) include people chosen by the participant;
87.14(2) provide necessary information and support to ensure that the participant directs
87.15the process to the maximum extent possible, and is enabled to make informed choices
87.16and decisions;
87.17(3) be timely and occur at time and locations of convenience to the participant;
87.18(4) reflect cultural considerations of the participant;
87.19(5) include strategies for solving conflict or disagreement within the process,
87.20including clear conflict-of-interest guidelines for all planning;
87.21(6) offers choices to the participant regarding the services and supports they receive
87.22and from whom;
87.23(7) include a method for the participant to request updates to the plan; and
87.24(8) record the alternative home and community-based settings that were considered
87.25by the participant.
87.26(r) "Shared services" means the provision of CFSS services by the same CFSS
87.27support worker to two or three participants who voluntarily enter into an agreement to
87.28receive services at the same time and in the same setting by the same provider.
87.29(s) "Support specialist" means a professional with the skills and ability to assist the
87.30participant using either the agency provider model under subdivision 11 or the flexible
87.31spending model under subdivision 13, in services including, but not limited to assistance
87.32regarding:
87.33(1) the development, implementation, and evaluation of the CFSS service delivery
87.34plan under subdivision 6;
88.1(2) recruitment, training, or supervision, including supervision of health-related
88.2tasks or behavioral supports appropriately delegated by a health care professional, and
88.3evaluation of support workers; and
88.4(3) facilitating the use of informal and community supports, goods, or resources.
88.5(t) "Support worker" means an employee of the agency provider or of the participant
88.6who has direct contact with the participant and provides services as specified within the
88.7participant's service delivery plan.
88.8(u) "Wages and benefits" means the hourly wages and salaries, the employer's
88.9share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
88.10compensation, mileage reimbursement, health and dental insurance, life insurance,
88.11disability insurance, long-term care insurance, uniform allowance, contributions to
88.12employee retirement accounts, or other forms of employee compensation and benefits.
88.13    Subd. 3. Eligibility. (a) CFSS is available to a person who meets one of the
88.14following:
88.15(1) is a recipient of medical assistance as determined under section 256B.055,
88.16256B.056, or 256B.057, subdivisions 5 and 9;
88.17(2) is a recipient of the alternative care program under section 256B.0913;
88.18(3) is a waiver recipient as defined under section 256B.0915, 256B.092, 256B.093,
88.19or 256B.49; or
88.20(4) has medical services identified in a participant's individualized education
88.21program and is eligible for services as determined in section 256B.0625, subdivision 26.
88.22(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
88.23meet all of the following:
88.24(1) require assistance and be determined dependent in one activity of daily living or
88.25Level I behavior based on assessment under section 256B.0911;
88.26(2) is not a recipient under the family support grant under section 252.32;
88.27(3) lives in the person's own apartment or home including a family foster care setting
88.28licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a
88.29noncertified boarding care or boarding and lodging establishments under chapter 157;
88.30unless transitioning into the community from an institution; and
88.31(4) has not been excluded or disenrolled from the flexible spending model.
88.32(c) The commissioner shall disenroll or exclude participants from the flexible
88.33spending model and transfer them to the agency-provider model under the following
88.34circumstances that include but are not limited to:
88.35(1) when a participant has been restricted by the Minnesota restricted recipient
88.36program, the participant may be excluded for a specified time period;
89.1(2) when a participant exits the flexible spending service delivery model during the
89.2participant's service plan year. Upon transfer, the participant shall not access the flexible
89.3spending model for the remainder of that service plan year; or
89.4(3) when the department determines that the participant or participant's representative
89.5or legal representative cannot manage participant responsibilities under the service
89.6delivery model. The commissioner must develop policies for determining if a participant
89.7is unable to manage responsibilities under a service model.
89.8(d) A participant may appeal in writing to the department to contest the department's
89.9decision under paragraph (c), clause (3), to remove or exclude the participant from the
89.10flexible spending model.
89.11    Subd. 4. Eligibility for other services. Selection of CFSS by a participant must not
89.12restrict access to other medically necessary care and services furnished under the state
89.13plan medical assistance benefit or other services available through alternative care.
89.14    Subd. 5. Assessment requirements. (a) The assessment of functional need must:
89.15(1) be conducted by a certified assessor according to the criteria established in
89.16section 256B.0911;
89.17(2) be conducted face-to-face, initially and at least annually thereafter, or when there
89.18is a significant change in the participant's condition or a change in the need for services
89.19and supports; and
89.20(3) be completed using the format established by the commissioner.
89.21(b) A participant who is residing in a facility may be assessed and choose CFSS for
89.22the purpose of using CFSS to return to the community as described in subdivisions 3
89.23and 7, paragraph (a), clause (5).
89.24(c) The results of the assessment and any recommendations and authorizations for
89.25CFSS must be determined and communicated in writing by the lead agency's certified
89.26assessor as defined in section 256B.0911 to the participant and the agency-provider or
89.27financial management services provider chosen by the participant within 40 calendar days
89.28and must include the participant's right to appeal under section 256.045.
89.29    Subd. 6. Community first services and support service delivery plan. (a) The
89.30CFSS service delivery plan must be developed, implemented, and evaluated through a
89.31person-centered planning process by the participant, or the participant's representative
89.32or legal representative who may be assisted by a support specialist. The CFSS service
89.33delivery plan must reflect the services and supports that are important to the participant
89.34and for the participant to meet the needs assessed by the certified assessor and identified
89.35in the community support plan under section 256B.0911 or the coordinated services and
89.36support plan identified in section 256B.0915, subdivision 6, if applicable. The CFSS
90.1service delivery plan must be reviewed by the participant and the agency-provider or
90.2financial management services contractor at least annually upon reassessment, or when
90.3there is a significant change in the participant's condition, or a change in the need for
90.4services and supports.
90.5(b) The commissioner shall establish the format and criteria for the CFSS service
90.6delivery plan.
90.7(c) The CFSS service delivery plan must be person-centered and:
90.8(1) specify the agency-provider or financial management services contractor selected
90.9by the participant;
90.10(2) reflect the setting in which the participant resides that is chosen by the participant;
90.11(3) reflect the participant's strengths and preferences;
90.12(4) include the means to address the clinical and support needs as identified through
90.13an assessment of functional needs;
90.14(5) include individually identified goals and desired outcomes;
90.15(6) reflect the services and supports, paid and unpaid, that will assist the participant
90.16to achieve identified goals, and the providers of those services and supports, including
90.17natural supports;
90.18(7) identify the amount and frequency of face-to-face supports and amount and
90.19frequency of remote supports and technology that will be used;
90.20(8) identify risk factors and measures in place to minimize them, including
90.21individualized backup plans;
90.22(9) be understandable to the participant and the individuals providing support;
90.23(10) identify the individual or entity responsible for monitoring the plan;
90.24(11) be finalized and agreed to in writing by the participant and signed by all
90.25individuals and providers responsible for its implementation;
90.26(12) be distributed to the participant and other people involved in the plan; and
90.27(13) prevent the provision of unnecessary or inappropriate care.
90.28(d) The total units of agency-provider services or the budget allocation amount for
90.29the flexible spending model include both annual totals and a monthly average amount
90.30that cover the number of months of the service authorization. The amount used each
90.31month may vary, but additional funds must not be provided above the annual service
90.32authorization amount unless a change in condition is assessed and authorized by the
90.33certified assessor and documented in the community support plan, coordinated services
90.34and supports plan, and service delivery plan.
90.35    Subd. 7. Community first services and supports; covered services. Services
90.36and supports covered under CFSS include:
91.1(1) assistance to accomplish activities of daily living (ADLs), instrumental activities
91.2of daily living (IADLs), and health-related procedures and tasks through hands-on
91.3assistance to complete the task or supervision and cueing to complete the task;
91.4(2) assistance to acquire, maintain, or enhance the skills necessary for the participant
91.5to accomplish activities of daily living, instrumental activities of daily living, or
91.6health-related tasks;
91.7(3) expenditures for items, services, supports, environmental modifications, or
91.8goods, including assistive technology. These expenditures must:
91.9(i) relate to a need identified in a participant's CFSS service delivery plan;
91.10(ii) increase independence or substitute for human assistance to the extent that
91.11expenditures would otherwise be made for human assistance for the participant's assessed
91.12needs; and
91.13(iii) fit within the annual limit of the participant's approved service allocation
91.14or budget;
91.15(4) observation and redirection for episodes where there is a need for redirection
91.16due to participant behaviors or intervention needed due to a participant's symptoms. An
91.17assessment of behaviors must meet the criteria in this clause. A recipient qualifies as
91.18having a need for assistance due to behaviors if the recipient's behavior requires assistance
91.19at least four times per week and shows one or more of the following behaviors:
91.20(i) physical aggression towards self or others, or destruction of property that requires
91.21the immediate response of another person;
91.22(ii) increased vulnerability due to cognitive deficits or socially inappropriate
91.23behavior; or
91.24(iii) increased need for assistance for recipients who are verbally aggressive or
91.25resistive to care so that time needed to perform activities of daily living is increased;
91.26(5) back-up systems or mechanisms, such as the use of pagers or other electronic
91.27devices, to ensure continuity of the participant's services and supports;
91.28(6) transition costs, including:
91.29(i) deposits for rent and utilities;
91.30(ii) first month's rent and utilities;
91.31(iii) bedding;
91.32(iv) basic kitchen supplies;
91.33(v) other necessities, to the extent that these necessities are not otherwise covered
91.34under any other funding that the participant is eligible to receive; and
91.35(vi) other required necessities for an individual to make the transition from a nursing
91.36facility, institution for mental diseases, or intermediate care facility for persons with
92.1developmental disabilities to a community-based home setting where the participant
92.2resides; and
92.3(7) services by a support specialist defined under subdivision 2 that are chosen
92.4by the participant.
92.5    Subd. 8. Determination of CFSS service methodology. (a) All community first
92.6services and supports must be authorized by the commissioner or the commissioner's
92.7designee before services begin except for the assessments established in section
92.8256B.0911. The authorization for CFSS must be completed within 30 days after receiving
92.9a complete request.
92.10(b) The amount of CFSS authorized must be based on the recipient's home
92.11care rating. The home care rating shall be determined by the commissioner or the
92.12commissioner's designee based on information submitted to the commissioner identifying
92.13the following for a recipient:
92.14(1) the total number of dependencies of activities of daily living as defined in
92.15subdivision 2;
92.16(2) the presence of complex health-related needs as defined in subdivision 2; and
92.17(3) the presence of Level I behavior as defined in subdivision 2.
92.18(c) For purposes meeting the criteria in paragraph (b), the methodology to determine
92.19the total minutes for CFSS for each home care rating is based on the median paid units
92.20per day for each home care rating from fiscal year 2007 data for the PCA program. Each
92.21home care rating has a base number of minutes assigned. Additional minutes are added
92.22through the assessment and identification of the following:
92.23(1) 30 additional minutes per day for a dependency in each critical activity of daily
92.24living as defined in subdivision 2;
92.25(2) 30 additional minutes per day for each complex health-related function as
92.26defined in subdivision 2; and
92.27(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2.
92.28    Subd. 9. Noncovered services. (a) Services or supports that are not eligible for
92.29payment under this section include those that:
92.30(1) are not authorized by the certified assessor or included in the written service
92.31delivery plan;
92.32(2) are provided prior to the authorization of services and the approval of the written
92.33CFSS service delivery plan;
92.34(3) are duplicative of other paid services in the written service delivery plan;
93.1(4) supplant natural unpaid supports that are provided voluntarily to the participant
93.2and are selected by the participant in lieu of a support worker and appropriately meeting
93.3the participant's needs;
93.4(5) are not effective means to meet the participant's needs; and
93.5(6) are available through other funding sources, including, but not limited to, funding
93.6through Title IV-E of the Social Security Act.
93.7(b) Additional services, goods, or supports that are not covered include:
93.8(1) those that are not for the direct benefit of the participant;
93.9(2) any fees incurred by the participant, such as Minnesota health care programs fees
93.10and co-pays, legal fees, or costs related to advocate agencies;
93.11(3) insurance, except for insurance costs related to employee coverage;
93.12(4) room and board costs for the participant with the exception of allowable
93.13transition costs in subdivision 7, clause (6);
93.14(5) services, supports, or goods that are not related to the assessed needs;
93.15(6) special education and related services provided under the Individuals with
93.16Disabilities Education Act and vocational rehabilitation services provided under the
93.17Rehabilitation Act of 1973;
93.18(7) assistive technology devices and assistive technology services other than those
93.19for back-up systems or mechanisms to ensure continuity of service and supports listed in
93.20subdivision 7;
93.21(8) medical supplies and equipment;
93.22(9) environmental modifications, except as specified in subdivision 7;
93.23(10) expenses for travel, lodging, or meals related to training the participant, the
93.24participant's representative, legal representative, or paid or unpaid caregivers that exceed
93.25$500 in a 12-month period;
93.26(11) experimental treatments;
93.27(12) any service or good covered by other medical assistance state plan services,
93.28including prescription and over-the-counter medications, compounds, and solutions and
93.29related fees, including premiums and co-payments;
93.30(13) membership dues or costs, except when the service is necessary and appropriate
93.31to treat a physical condition or to improve or maintain the participant's physical condition.
93.32The condition must be identified in the participant's CFSS plan and monitored by a
93.33physician enrolled in a Minnesota health care program;
93.34(14) vacation expenses other than the cost of direct services;
93.35(15) vehicle maintenance or modifications not related to the disability, health
93.36condition, or physical need; and
94.1(16) tickets and related costs to attend sporting or other recreational or entertainment
94.2events.
94.3    Subd. 10. Provider qualifications and general requirements. (a)
94.4Agency-providers delivering services under the agency-provider model under subdivision
94.511 or financial management service (FMS) contractors under subdivision 13 shall:
94.6(1) enroll as a medical assistance Minnesota health care programs provider and meet
94.7all applicable provider standards;
94.8(2) comply with medical assistance provider enrollment requirements;
94.9(3) demonstrate compliance with law and policies of CFSS as determined by the
94.10commissioner;
94.11(4) comply with background study requirements under chapter 245C;
94.12(5) verify and maintain records of all services and expenditures by the participant,
94.13including hours worked by support workers and support specialists;
94.14(6) not engage in any agency-initiated direct contact or marketing in person, by
94.15telephone, or other electronic means to potential participants, guardians, family member
94.16or participants' representatives;
94.17(7) pay support workers and support specialists based upon actual hours of services
94.18provided;
94.19(8) withhold and pay all applicable federal and state payroll taxes;
94.20(9) make arrangements and pay unemployment insurance, taxes, workers'
94.21compensation, liability insurance, and other benefits, if any;
94.22(10) enter into a written agreement with the participant, participant's representative,
94.23or legal representative that assigns roles and responsibilities to be performed before
94.24services, supports, or goods are provided using a format established by the commissioner;
94.25(11) report suspected neglect and abuse to the common entry point according to
94.26sections 256B.0651 and 626.557; and
94.27(12) provide the participant with a copy of the service-related rights under
94.28subdivision 19 at the start of services and supports.
94.29(b) The commissioner shall develop policies and procedures designed to ensure
94.30program integrity and fiscal accountability for goods and services provided in this section.
94.31    Subd. 11. Agency-provider model. (a) The agency-provider model is limited to
94.32the services provided by support workers and support specialists who are employed by
94.33an agency-provider that is licensed according to chapter 245A or meets other criteria
94.34established by the commissioner, including required training.
95.1(b) The agency-provider shall allow the participant to retain the ability to have a
95.2significant role in the selection and dismissal of the support workers for the delivery of the
95.3services and supports specified in the service delivery plan.
95.4(c) A participant may use authorized units of CFSS services as needed within
95.5a service authorization that is not greater than 12 months. Using authorized units
95.6agency-provider services or the budget allocation amount for the flexible spending model
95.7flexibly does not increase the total amount of services and supports authorized for a
95.8participant or included in the participant's service delivery plan.
95.9(d) A participant may share CFSS services. Two or three CFSS participants may
95.10share services at the same time provided by the same support worker.
95.11(e) The agency-provider must use a minimum of 72.5 percent of the revenue
95.12generated by the medical assistance payment for CFSS for support worker wages and
95.13benefits. The agency-provider must document how this requirement is being met. The
95.14revenue generated by the support specialist and the reasonable costs associated with the
95.15support specialist must not be used in making this calculation.
95.16(f) The agency-provider model must be used by individuals who have been restricted
95.17by the Minnesota restricted recipient program.
95.18    Subd. 12. Requirements for initial enrollment of CFSS provider agencies. (a)
95.19All CFSS provider agencies must provide, at the time of enrollment as a CFSS provider
95.20agency in a format determined by the commissioner, information and documentation that
95.21includes, but is not limited to, the following:
95.22(1) the CFSS provider agency's current contact information including address,
95.23telephone number, and e-mail address;
95.24(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
95.25provider's payments from Medicaid in the previous year, whichever is less;
95.26(3) proof of fidelity bond coverage in the amount of $20,000;
95.27(4) proof of workers' compensation insurance coverage;
95.28(5) proof of liability insurance;
95.29(6) a description of the CFSS provider agency's organization identifying the names
95.30or all owners, managing employees, staff, board of directors, and the affiliations of the
95.31directors, owners, or staff to other service providers;
95.32(7) a copy of the CFSS provider agency's written policies and procedures including:
95.33hiring of employees; training requirements; service delivery; and employee and consumer
95.34safety including process for notification and resolution of consumer grievances,
95.35identification and prevention of communicable diseases, and employee misconduct;
96.1(8) copies of all other forms the CFSS provider agency uses in the course of daily
96.2business including, but not limited to:
96.3(i) a copy of the CFSS provider agency's time sheet if the time sheet varies from
96.4the standard time sheet for CFSS services approved by the commissioner, and a letter
96.5requesting approval of the CFSS provider agency's nonstandard time sheet;
96.6(ii) the CFSS provider agency's template for the CFSS care plan; and
96.7(iii) the CFSS provider agency's template for the written agreement in subdivision
96.821 for recipients using the CFSS choice option, if applicable;
96.9(9) a list of all training and classes that the CFSS provider agency requires of its
96.10staff providing CFSS services;
96.11(10) documentation that the CFSS provider agency and staff have successfully
96.12completed all the training required by this section;
96.13(11) documentation of the agency's marketing practices;
96.14(12) disclosure of ownership, leasing, or management of all residential properties
96.15that is used or could be used for providing home care services;
96.16(13) documentation that the agency will use the following percentages of revenue
96.17generated from the medical assistance rate paid for CFSS services for employee personal
96.18care assistant wages and benefits: 72.5 percent of revenue from CFSS providers. The
96.19revenue generated by the support specialist and the reasonable costs associated with the
96.20support specialist shall not be used in making this calculation; and
96.21(14) documentation that the agency does not burden recipients' free exercise of their
96.22right to choose service providers by requiring personal care assistants to sign an agreement
96.23not to work with any particular CFSS recipient or for another CFSS provider agency after
96.24leaving the agency and that the agency is not taking action on any such agreements or
96.25requirements regardless of the date signed.
96.26(b) CFSS provider agencies shall provide the information specified in paragraph
96.27(a) to the commissioner.
96.28(c) All CFSS provider agencies shall require all employees in management and
96.29supervisory positions and owners of the agency who are active in the day-to-day
96.30management and operations of the agency to complete mandatory training as determined
96.31by the commissioner. Employees in management and supervisory positions and owners
96.32who are active in the day-to-day operations of an agency who have completed the required
96.33training as an employee with a CFSS provider agency do not need to repeat the required
96.34training if they are hired by another agency, if they have completed the training within
96.35the past three years. CFSS provider agency billing staff shall complete training about
96.36CFSS program financial management. Any new owners or employees in management
97.1and supervisory positions involved in the day-to-day operations are required to complete
97.2mandatory training as a requisite of working for the agency. CFSS provider agencies
97.3certified for participation in Medicare as home health agencies are exempt from the
97.4training required in this subdivision.
97.5    Subd. 13. Flexible spending model. (a) Under the flexible spending model
97.6participants can exercise more responsibility and control over the services and supports
97.7described and budgeted within the CFSS service delivery plan. Under this model:
97.8(1) participants directly employ support workers;
97.9(2) participants may use a budget allocation to obtain supports and goods as defined
97.10in subdivision 7; and
97.11(3) from the financial management services (FMS) contractor the participant may
97.12choose a range of support assistance services relating to:
97.13(i) planning, budgeting, and management of services and support;
97.14(ii) the participant's employment, training, supervision, and evaluation of workers;
97.15(iii) acquisition and payment for supports and goods; and
97.16(iv) evaluation of individual service outcomes as needed for the scope of the
97.17participant's degree of control and responsibility.
97.18(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
97.19may authorize a legal representative or participant's representative to do so on their behalf.
97.20(c) The FMS contractor shall not provide CFSS services and supports under the
97.21agency-provider service model. The FMS contractor shall provide service functions as
97.22determined by the commissioner that include but are not limited to:
97.23(1) information and consultation about CFSS;
97.24(2) assistance with the development of the service delivery plan and flexible
97.25spending model as requested by the participant;
97.26(3) billing and making payments for flexible spending model expenditures;
97.27(4) assisting participants in fulfilling employer-related requirements according to
97.28Internal Revenue Code Procedure 70-6, section 3504, Agency Employer Tax Liability,
97.29regulation 137036-08, which includes assistance with filing and paying payroll taxes, and
97.30obtaining worker compensation coverage;
97.31(5) data recording and reporting of participant spending; and
97.32(6) other duties established in the contract with the department.
97.33(d) A participant who requests to purchase goods and supports along with support
97.34worker services under the agency-provider model must use flexible spending model
97.35with a service delivery plan that specifies the amount of services to be authorized to the
97.36agency-provider and the expenditures to be paid by the FMS contractor.
98.1(e) The FMS contractor shall:
98.2(1) not limit or restrict the participant's choice of service or support providers or
98.3service delivery models as authorized by the commissioner;
98.4(2) provide the participant and the targeted case manager, if applicable, with a
98.5monthly written summary of the spending for services and supports that were billed
98.6against the spending budget;
98.7(3) be knowledgeable of state and federal employment regulations under the Fair
98.8Labor Standards Act of 1938, and comply with the requirements under the Internal
98.9Revenue Service Revenue Code Procedure 70-6, Section 35-4, Agency Employer Tax
98.10Liability for vendor or fiscal employer agent, and any requirements necessary to process
98.11employer and employee deductions, provide appropriate and timely submission of
98.12employer tax liabilities, and maintain documentation to support medical assistance claims;
98.13(4) have current and adequate liability insurance and bonding and sufficient cash
98.14flow as determined by the commission and have on staff or under contract a certified
98.15public accountant or an individual with a baccalaureate degree in accounting;
98.16(5) assume fiscal accountability for state funds designated for the program; and
98.17(6) maintain documentation of receipts, invoices, and bills to track all services and
98.18supports expenditures for any goods purchased and maintain time records of support
98.19workers. The documentation and time records must be maintained for a minimum of
98.20five years from the claim date and be available for audit or review upon request by the
98.21commissioner. Claims submitted by the FMS contractor to the commissioner for payment
98.22must correspond with services, amounts, and time periods as authorized in the participant's
98.23spending budget and service plan.
98.24(f) The commissioner of human services shall:
98.25(1) establish rates and payment methodology for the FMS contractor;
98.26(2) identify a process to ensure quality and performance standards for the FMS
98.27contractor and ensure statewide access to FMS contractors; and
98.28(3) establish a uniform protocol for delivering and administering CFSS services
98.29to be used by eligible FMS contractors.
98.30(g) Participants who are disenrolled from the model shall be transferred to the
98.31agency-provider model.
98.32    Subd. 14. Participant's responsibilities under flexible spending model. (a) A
98.33participant using the flexible spending model must use a FMS contractor or vendor that is
98.34under contract with the department. Upon a determination of eligibility and completion of
98.35the assessment and community support plan, the participant shall choose a FMS contractor
98.36from a list of eligible vendors maintained by the department.
99.1(b) When the participant, participant's representative, or legal representative chooses
99.2to be the employer of the support worker, they are responsible for recruiting, interviewing,
99.3hiring, training, scheduling, supervising, and discharging direct support workers.
99.4(c) In addition to the employer responsibilities in paragraph (b), the participant,
99.5participant's representative, or legal representative is responsible for:
99.6(1) tracking the services provided and all expenditures for goods or other supports;
99.7(2) preparing and submitting time sheets, signed by both the participant and support
99.8worker, to the FMS contractor on a regular basis and in a timely manner according to
99.9the FMS contractor's procedures;
99.10(3) notifying the FMS contractor within ten days of any changes in circumstances
99.11affecting the CFSS service plan or in the participant's place of residence including, but
99.12not limited to, any hospitalization of the participant or change in the participant's address,
99.13telephone number, or employment;
99.14(4) notifying the FMS contractor of any changes in the employment status of each
99.15participant support worker; and
99.16(5) reporting any problems resulting from the quality of services rendered by the
99.17support worker to the FMS contractor. If the participant is unable to resolve any problems
99.18resulting from the quality of service rendered by the support worker with the assistance of
99.19the FMS contractor, the participant shall report the situation to the department.
99.20    Subd. 15. Documentation of support services provided. (a) Support services
99.21provided to a participant by a support worker employed by either an agency-provider
99.22or the participant acting as the employer must be documented daily by each support
99.23worker, on a time sheet form approved by the commissioner. All documentation may be
99.24Web-based, electronic, or paper documentation. The completed form must be submitted
99.25on a monthly basis to the provider or the participant and the FMS contractor selected by
99.26the participant to provide assistance with meeting the participant's employer obligations
99.27and kept in the recipient's health record.
99.28(b) The activity documentation must correspond to the written service delivery plan
99.29and be reviewed by the agency provider or the participant and the FMS contractor when
99.30the participant is acting as the employer of the support worker.
99.31(c) The time sheet must be on a form approved by the commissioner documenting
99.32time the support worker provides services in the home. The following criteria must be
99.33included in the time sheet:
99.34(1) full name of the support worker and individual provider number;
99.35(2) provider name and telephone numbers, if an agency-provider is responsible for
99.36delivery services under the written service plan;
100.1(3) full name of the participant;
100.2(4) consecutive dates, including month, day, and year, and arrival and departure
100.3times with a.m. or p.m. notations;
100.4(5) signatures of the participant or the participant's representative;
100.5(6) personal signature of the support worker;
100.6(7) any shared care provided, if applicable;
100.7(8) a statement that it is a federal crime to provide false information on CFSS
100.8billings for medical assistance payments; and
100.9(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
100.10    Subd. 16. Support workers requirements. (a) Support workers shall:
100.11(1) enroll with the department as a support worker after a background study under
100.12chapter 245C has been completed and the support worker has received a notice from the
100.13commissioner that:
100.14(i) the support worker is not disqualified under section 245C.14; or
100.15(ii) is disqualified, but the support worker has received a set-aside of the
100.16disqualification under section 245C.22;
100.17(2) have the ability to effectively communicate with the participant or the
100.18participant's representative;
100.19(3) have the skills and ability to provide the services and supports according to the
100.20person's CFSS service delivery plan and respond appropriately to the participant's needs;
100.21(4) not be a participant of CFSS;
100.22(5) complete the basic standardized training as determined by the commissioner
100.23before completing enrollment. The training must be available in languages other than
100.24English and to those who need accommodations due to disabilities. Support worker
100.25training must include successful completion of the following training components: basic
100.26first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
100.27and responsibilities of support workers including information about basic body mechanics,
100.28emergency preparedness, orientation to positive behavioral practices, orientation to
100.29responding to a mental health crisis, fraud issues, time cards and documentation, and an
100.30overview of person-centered planning and self-direction. Upon completion of the training
100.31components, the support worker must pass the certification test to provide assistance
100.32to participants;
100.33(6) complete training and orientation on the participant's individual needs; and
100.34(7) maintain the privacy and confidentiality of the participant, and not independently
100.35determine the medication dose or time for medications for the participant.
101.1(b) The commissioner may deny or terminate a support worker's provider enrollment
101.2and provider number if the support worker:
101.3(1) lacks the skills, knowledge, or ability to adequately or safely perform the
101.4required work;
101.5(2) fails to provide the authorized services required by the participant employer;
101.6(3) has been intoxicated by alcohol or drugs while providing authorized services to
101.7the participant or while in the participant's home;
101.8(4) has manufactured or distributed drugs while providing authorized services to the
101.9participant or while in the participant's home; or
101.10(5) has been excluded as a provider by the commissioner of human services, or the
101.11United States Department of Health and Human Services, Office of Inspector General,
101.12from participation in Medicaid, Medicare, or any other federal health care program.
101.13(c) A support worker may appeal in writing to the commissioner to contest the
101.14decision to terminate the support worker's provider enrollment and provider number.
101.15    Subd. 17. Support specialist requirements and payments. The commissioner
101.16shall develop qualifications, scope of functions, and payment rates and service limits for a
101.17support specialist that may provide additional or specialized assistance necessary to plan,
101.18implement, arrange, augment, or evaluate services and supports.
101.19    Subd. 18. Service unit and budget allocation requirements. (a) For the
101.20agency-provider model, services will be authorized in units of service. The total service
101.21unit amount must be established based upon the assessed need for CFSS services, and
101.22must not exceed the maximum number of units available as determined by section
101.23256B.0652, subdivision 6. The unit rate established by the commissioner is used with
101.24assessed units to determine the maximum available CFSS allocation.
101.25(b) For the flexible spending model, services and supports are authorized under
101.26a budget limit.
101.27(c) The maximum available CFSS participant budget allocation shall be established
101.28by multiplying the number of units authorized under subdivision 8 by the payment rate
101.29established by the commissioner.
101.30    Subd. 19. Support system. (a) The commissioner shall provide information,
101.31consultation, training, and assistance to ensure the participant is able to manage the
101.32services and supports and budgets, if applicable. This support shall include individual
101.33consultation on how to select and employ workers, manage responsibilities under CFSS,
101.34and evaluate personal outcomes.
101.35(b) The commissioner shall provide assistance with the development of risk
101.36management agreements.
102.1    Subd. 20. Service-related rights. Participants must be provided with adequate
102.2information, counseling, training, and assistance, as needed, to ensure that the participant
102.3is able to choose and manage services, models, and budgets. This support shall include
102.4information regarding: (1) person-centered planning; (2) the range and scope of individual
102.5choices; (3) the process for changing plans, services and budgets; (4) the grievance
102.6process; (5) individual rights; (6) identifying and assessing appropriate services; (7) risks
102.7and responsibilities; and (8) risk management. A participant who appeals a reduction in
102.8previously authorized CFSS services may continue previously authorized services pending
102.9an appeal under section 256.045. The commissioner must ensure that the participant
102.10has a copy of the most recent service delivery plan that contains a detailed explanation
102.11of which areas of covered CFSS are reduced, and provide notice of the amount of the
102.12budget reduction, and the reasons for the reduction in the participant's notice of denial,
102.13termination, or reduction.
102.14    Subd. 21. Development and Implementation Council. The commissioner
102.15shall establish a Development and Implementation Council of which the majority of
102.16members are individuals with disabilities, elderly individuals, and their representatives.
102.17The commissioner shall consult and collaborate with the council when developing and
102.18implementing this section.
102.19    Subd. 22. Quality assurance and risk management system. (a) The commissioner
102.20shall establish quality assurance and risk management measures for use in developing and
102.21implementing CFSS including those that (1) recognize the roles and responsibilities of those
102.22involved in obtaining CFSS, and (2) ensure the appropriateness of such plans and budgets
102.23based upon a recipient's resources and capabilities. Risk management measures must
102.24include background studies, and backup and emergency plans, including disaster planning.
102.25(b) The commissioner shall provide ongoing technical assistance and resource and
102.26educational materials for CFSS participants.
102.27(c) Performance assessment measures, such as a participant's satisfaction with the
102.28services and supports, and ongoing monitoring of health and well-being shall be identified
102.29in consultation with the council established in subdivision 21.
102.30    Subd. 23. Commissioner's access. When the commissioner is investigating a
102.31possible overpayment of Medicaid funds, the commissioner must be given immediate
102.32access without prior notice to the agency provider or FMS contractor's office during
102.33regular business hours and to documentation and records related to services provided and
102.34submission of claims for services provided. Denying the commissioner access to records
102.35is cause for immediate suspension of payment and terminating the agency provider's
102.36enrollment according to section 256B.064 or terminating the FMS contract.
103.1    Subd. 24. CFSS agency-providers; background studies. CFSS agency-providers
103.2enrolled to provide personal care assistance services under the medical assistance program
103.3shall comply with the following:
103.4(1) owners who have a five percent interest or more and all managing employees
103.5are subject to a background study as provided in chapter 245C. This applies to currently
103.6enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
103.7agency-provider. "Managing employee" has the same meaning as Code of Federal
103.8Regulations, title 42, section 455. An organization is barred from enrollment if:
103.9(i) the organization has not initiated background studies on owners managing
103.10employees; or
103.11(ii) the organization has initiated background studies on owners and managing
103.12employees, but the commissioner has sent the organization a notice that an owner or
103.13managing employee of the organization has been disqualified under section 245C.14, and
103.14the owner or managing employee has not received a set-aside of the disqualification
103.15under section 245C.22;
103.16(2) a background study must be initiated and completed for all support specialists; and
103.17(3) a background study must be initiated and completed for all support workers.
103.18EFFECTIVE DATE.This section is effective upon federal approval. The
103.19commissioner of human services shall notify the revisor of statutes when this occurs.

103.20    Sec. 44. Minnesota Statutes 2012, section 256I.05, is amended by adding a subdivision
103.21to read:
103.22    Subd. 1o. Supplementary service rate; exemptions. A county agency shall not
103.23negotiate a supplementary service rate under this section for any individual that has been
103.24determined to be eligible for Housing Stability Services as approved by the Centers
103.25for Medicare and Medicaid Services, and who resides in an establishment voluntarily
103.26registered under section 144D.025, as a supportive housing establishment or participates
103.27in the Minnesota supportive housing demonstration program under section 256I.04,
103.28subdivision 3, paragraph (a), clause (4).

103.29    Sec. 45. Minnesota Statutes 2012, section 626.557, subdivision 4, is amended to read:
103.30    Subd. 4. Reporting. (a) Except as provided in paragraph (b), a mandated reporter
103.31shall immediately make an oral report to the common entry point. The common entry
103.32point may accept electronic reports submitted through a Web-based reporting system
103.33established by the commissioner. Use of a telecommunications device for the deaf or other
103.34similar device shall be considered an oral report. The common entry point may not require
104.1written reports. To the extent possible, the report must be of sufficient content to identify
104.2the vulnerable adult, the caregiver, the nature and extent of the suspected maltreatment,
104.3any evidence of previous maltreatment, the name and address of the reporter, the time,
104.4date, and location of the incident, and any other information that the reporter believes
104.5might be helpful in investigating the suspected maltreatment. A mandated reporter may
104.6disclose not public data, as defined in section 13.02, and medical records under sections
104.7144.291 to 144.298, to the extent necessary to comply with this subdivision.
104.8(b) A boarding care home that is licensed under sections 144.50 to 144.58 and
104.9certified under Title 19 of the Social Security Act, a nursing home that is licensed under
104.10section 144A.02 and certified under Title 18 or Title 19 of the Social Security Act, or a
104.11hospital that is licensed under sections 144.50 to 144.58 and has swing beds certified under
104.12Code of Federal Regulations, title 42, section 482.66, may submit a report electronically
104.13to the common entry point instead of submitting an oral report. The report may be a
104.14duplicate of the initial report the facility submits electronically to the commissioner of
104.15health to comply with the reporting requirements under Code of Federal Regulations, title
104.1642, section 483.13. The commissioner of health may modify these reporting requirements
104.17to include items required under paragraph (a) that are not currently included in the
104.18electronic reporting form.
104.19EFFECTIVE DATE.This section is effective July 1, 2014.

104.20    Sec. 46. Minnesota Statutes 2012, section 626.557, subdivision 9, is amended to read:
104.21    Subd. 9. Common entry point designation. (a) Each county board shall designate
104.22a common entry point for reports of suspected maltreatment. Two or more county boards
104.23may jointly designate a single The commissioner of human services shall establish a
104.24 common entry point effective July 1, 2014. The common entry point is the unit responsible
104.25for receiving the report of suspected maltreatment under this section.
104.26(b) The common entry point must be available 24 hours per day to take calls from
104.27reporters of suspected maltreatment. The common entry point shall use a standard intake
104.28form that includes:
104.29(1) the time and date of the report;
104.30(2) the name, address, and telephone number of the person reporting;
104.31(3) the time, date, and location of the incident;
104.32(4) the names of the persons involved, including but not limited to, perpetrators,
104.33alleged victims, and witnesses;
104.34(5) whether there was a risk of imminent danger to the alleged victim;
104.35(6) a description of the suspected maltreatment;
105.1(7) the disability, if any, of the alleged victim;
105.2(8) the relationship of the alleged perpetrator to the alleged victim;
105.3(9) whether a facility was involved and, if so, which agency licenses the facility;
105.4(10) any action taken by the common entry point;
105.5(11) whether law enforcement has been notified;
105.6(12) whether the reporter wishes to receive notification of the initial and final
105.7reports; and
105.8(13) if the report is from a facility with an internal reporting procedure, the name,
105.9mailing address, and telephone number of the person who initiated the report internally.
105.10(c) The common entry point is not required to complete each item on the form prior
105.11to dispatching the report to the appropriate lead investigative agency.
105.12(d) The common entry point shall immediately report to a law enforcement agency
105.13any incident in which there is reason to believe a crime has been committed.
105.14(e) If a report is initially made to a law enforcement agency or a lead investigative
105.15agency, those agencies shall take the report on the appropriate common entry point intake
105.16forms and immediately forward a copy to the common entry point.
105.17(f) The common entry point staff must receive training on how to screen and
105.18dispatch reports efficiently and in accordance with this section.
105.19(g) The commissioner of human services shall maintain a centralized database
105.20for the collection of common entry point data, lead investigative agency data including
105.21maltreatment report disposition, and appeals data. The common entry point shall
105.22have access to the centralized database and must log the reports into the database and
105.23immediately identify and locate prior reports of abuse, neglect, or exploitation.
105.24(h) When appropriate, the common entry point staff must refer calls that do not
105.25allege the abuse, neglect, or exploitation of a vulnerable adult to other organizations
105.26that might resolve the reporter's concerns.
105.27(i) a common entry point must be operated in a manner that enables the
105.28commissioner of human services to:
105.29(1) track critical steps in the reporting, evaluation, referral, response, disposition,
105.30and investigative process to ensure compliance with all requirements for all reports;
105.31(2) maintain data to facilitate the production of aggregate statistical reports for
105.32monitoring patterns of abuse, neglect, or exploitation;
105.33(3) serve as a resource for the evaluation, management, and planning of preventative
105.34and remedial services for vulnerable adults who have been subject to abuse, neglect,
105.35or exploitation;
106.1(4) set standards, priorities, and policies to maximize the efficiency and effectiveness
106.2of the common entry point; and
106.3(5) track and manage consumer complaints related to the common entry point.
106.4(j) The commissioners of human services and health shall collaborate on the
106.5creation of a system for referring reports to the lead investigative agencies. This system
106.6shall enable the commissioner of human services to track critical steps in the reporting,
106.7evaluation, referral, response, disposition, investigation, notification, determination, and
106.8appeal processes.

106.9    Sec. 47. Minnesota Statutes 2012, section 626.557, subdivision 9e, is amended to read:
106.10    Subd. 9e. Education requirements. (a) The commissioners of health, human
106.11services, and public safety shall cooperate in the development of a joint program for
106.12education of lead investigative agency investigators in the appropriate techniques for
106.13investigation of complaints of maltreatment. This program must be developed by July
106.141, 1996. The program must include but need not be limited to the following areas: (1)
106.15information collection and preservation; (2) analysis of facts; (3) levels of evidence; (4)
106.16conclusions based on evidence; (5) interviewing skills, including specialized training to
106.17interview people with unique needs; (6) report writing; (7) coordination and referral
106.18to other necessary agencies such as law enforcement and judicial agencies; (8) human
106.19relations and cultural diversity; (9) the dynamics of adult abuse and neglect within family
106.20systems and the appropriate methods for interviewing relatives in the course of the
106.21assessment or investigation; (10) the protective social services that are available to protect
106.22alleged victims from further abuse, neglect, or financial exploitation; (11) the methods by
106.23which lead investigative agency investigators and law enforcement workers cooperate in
106.24conducting assessments and investigations in order to avoid duplication of efforts; and
106.25(12) data practices laws and procedures, including provisions for sharing data.
106.26(b) The commissioner of human services shall conduct an outreach campaign to
106.27promote the common entry point for reporting vulnerable adult maltreatment. This
106.28campaign shall use the Internet and other means of communication.
106.29(b) (c) The commissioners of health, human services, and public safety shall offer at
106.30least annual education to others on the requirements of this section, on how this section is
106.31implemented, and investigation techniques.
106.32(c) (d) The commissioner of human services, in coordination with the commissioner
106.33of public safety shall provide training for the common entry point staff as required in this
106.34subdivision and the program courses described in this subdivision, at least four times
106.35per year. At a minimum, the training shall be held twice annually in the seven-county
107.1metropolitan area and twice annually outside the seven-county metropolitan area. The
107.2commissioners shall give priority in the program areas cited in paragraph (a) to persons
107.3currently performing assessments and investigations pursuant to this section.
107.4(d) (e) The commissioner of public safety shall notify in writing law enforcement
107.5personnel of any new requirements under this section. The commissioner of public
107.6safety shall conduct regional training for law enforcement personnel regarding their
107.7responsibility under this section.
107.8(e) (f) Each lead investigative agency investigator must complete the education
107.9program specified by this subdivision within the first 12 months of work as a lead
107.10investigative agency investigator.
107.11A lead investigative agency investigator employed when these requirements take
107.12effect must complete the program within the first year after training is available or as soon
107.13as training is available.
107.14All lead investigative agency investigators having responsibility for investigation
107.15duties under this section must receive a minimum of eight hours of continuing education
107.16or in-service training each year specific to their duties under this section.

107.17    Sec. 48. REPEALER.
107.18(a) Minnesota Statutes 2012, sections 245A.655; and 256B.0917, subdivisions 1, 2,
107.193, 4, 5, 7, 8, 9, 10, 11, 12, and 14, are repealed.
107.20(b) Minnesota Statutes 2012, section 256B.0911, subdivisions 4a, 4b, and 4c, are
107.21repealed effective October 1, 2013.

107.22    Sec. 49. EFFECTIVE DATE; CONTINGENT SYSTEMS MODERNIZATION
107.23APPROPRIATION.
107.24    Subdivision 1. Definitions. (a) For the purposes of this section, the terms in this
107.25subdivision have the meanings given.
107.26(b) Unless otherwise indicated, "commissioner" means the commissioner of human
107.27services.
107.28(c) "Contingent systems modernization appropriation" refers to the appropriation in
107.29article 15, section 2.
107.30(d) "Department" means the Department of Human Services.
107.31(e) "Plan" means the plan that outlines how the provisions in this article, and the
107.32contingent appropriation for systems modernization, are implemented once federal action
107.33on Reform 2020 has occurred.
108.1(f) Unless otherwise indicated, "Reform 2020" means the commissioner's request
108.2for any necessary federal approval of provisions in this article that modify or provide
108.3new medical assistance services, or that otherwise modify the federal role in the state's
108.4long-term care system.
108.5    Subd. 2. Intent; effective dates generally. (a) Because the changes contained in
108.6this article generate savings that are contingent on federal approval of Reform 2020,
108.7the legislature has also made an appropriation for systems modernization contingent on
108.8federal approval of Reform 2020. The purpose of this section is to outline how this article
108.9and the contingent systems modernization appropriation in article 15 are implemented if
108.10Reform 2020 is fully, partially, or incrementally approved or denied.
108.11(b) In order for sections 1 to 48 of this article to be effective, the commissioner must
108.12follow the provisions of subdivisions 3 and 4, as applicable, notwithstanding any other
108.13effective dates for those sections.
108.14    Subd. 3. Federal approval. (a) The implementation of this article is contingent
108.15on federal approval.
108.16(b) Upon full or partial approval of the waiver application, the commissioner shall
108.17develop a plan for implementing the provisions in this article that received federal
108.18approval as well as any that do not require federal approval. The plan must:
108.19(1) include fiscal estimates for the 2014-2015 and 2016-2017 biennia;
108.20(2) include the contingent systems modernization appropriation, which cannot
108.21exceed $16,992,000 for the biennium ending June 30, 2015; and
108.22(3) include spending estimates that, with federal administrative reimbursement, do
108.23not exceed the department's net general fund appropriations for the 2014-2015 biennium.
108.24(c) Upon approval by the commissioner of management and budget, the department
108.25may implement the plan.
108.26(d) The commissioner may follow this plan and implement parts of Reform 2020
108.27consistent with federal law if federal approval is denied, received incrementally, or
108.28significantly delayed.
108.29(e) The commissioner must notify the chairs and ranking minority members of the
108.30legislative committees with jurisdiction over health and human services funding of the
108.31plan. The plan must be made publicly available online.
108.32    Subd. 4. Disbursement; implementation. The commissioner of management and
108.33budget shall disburse the appropriations in article 15, section 2, to the commissioner to
108.34allow for implementation of the approved plan and make necessary adjustments in the
108.35accounting system to reflect any modified funding levels. Notwithstanding Minnesota
108.36Statutes, section 16A.11, subdivision 3, paragraph (b), these fiscal estimates must be
109.1considered in establishing the appropriation base for the biennium ending June 30, 2017.
109.2The commissioner of management and budget shall reflect the modified funding levels in
109.3the first fund balance following the approval of the plan.


109.7    Section 1. Minnesota Statutes 2012, section 256B.4912, subdivision 2, is amended to
109.8read:
109.9    Subd. 2. Payment methodologies. (a) The commissioner shall establish, as defined
109.10under section 256B.4913, statewide payment methodologies that meet federal waiver
109.11requirements for home and community-based waiver services for individuals with
109.12disabilities. The payment methodologies must abide by the principles of transparency
109.13and equitability across the state. The methodologies must involve a uniform process of
109.14structuring rates for each service and must promote quality and participant choice.
109.15    (b) As of January 1, 2012, counties shall not implement changes to established
109.16processes for rate-setting methodologies for individuals using components of or data
109.17from research rates.

109.18    Sec. 2. Minnesota Statutes 2012, section 256B.4912, subdivision 3, is amended to read:
109.19    Subd. 3. Payment requirements. The payment methodologies established under
109.20this section shall accommodate:
109.21(1) supervision costs;
109.22(2) staffing patterns staff compensation;
109.23(3) staffing and supervisory patterns;
109.24(3) (4) program-related expenses;
109.25(4) (5) general and administrative expenses; and
109.26(5) (6) consideration of recipient intensity.

109.27    Sec. 3. Minnesota Statutes 2012, section 256B.4913, is amended to read:
109.28256B.4913 PAYMENT METHODOLOGY DEVELOPMENT.
109.29    Subdivision 1. Research period and rates. (a) For the purposes of this
109.30section, "research rate" means a proposed payment rate for the provision of home
109.31and community-based waivered services to meet federal requirements and assess the
109.32implications of changing resources on the provision of services and "research period"
109.33means the time period during which the research rate is being assessed by the commissioner.
110.1    (b) The commissioner shall determine and publish initial frameworks and values to
110.2generate research rates for individuals receiving home and community-based services.
110.3    (c) The initial values issued by the commissioner shall ensure projected spending
110.4for home and community-based services for each service area is equivalent to projected
110.5spending under current law in the most recent expenditure forecast.
110.6    (d) The initial values issued shall be based on the most updated information and cost
110.7data available on supervision, employee-related costs, client programming and supports,
110.8programming planning supports, transportation, administrative overhead, and utilization
110.9costs. These service areas are:
110.10    (1) residential services, defined as corporate foster care, family foster care, residential
110.11care, supported living services, customized living, and 24-hour customized living;
110.12    (2) day program services, defined as adult day care, day training and habilitation,
110.13prevocational services, structured day services, and transportation;
110.14    (3) unit-based services with programming, defined as in-home family support,
110.15independent living services, supported living services, supported employment, behavior
110.16programming, and housing access coordination; and
110.17    (4) unit-based services without programming, defined as respite, personal support,
110.18and night supervision.
110.19    (e) The commissioner shall make available the underlying assessment information,
110.20without any identifying information, and the statistical modeling used to generate the
110.21initial research rate and calculate budget neutrality.
110.22    Subd. 1a. Application. The payment methodologies in this section apply to home
110.23and community-based services waivers under sections 256B.092 and 256B.49. This
110.24section does not change existing waiver policies and procedures.
110.25    Subd. 1b. Definitions. (a) For purposes of this section, the following terms have the
110.26meanings given them, unless the context clearly indicates otherwise.
110.27(b) "Commissioner" means the commissioner of human services.
110.28(c) "Component value" means underlying factors that are part of the cost of providing
110.29services that are built into the waiver rates methodology to calculate service rates.
110.30(d) "Customized living tool" means a methodology for setting service rates which
110.31delineates and documents the amount of each component service included in a recipient's
110.32customized living service plan.
110.33(e) "Disability Waiver Rates System" means a statewide system which establishes
110.34rates that are based on uniform processes and captures the individualized nature of waiver
110.35services and recipient needs.
111.1(f) "Median" means the amount that divides distribution into two equal groups, half
111.2above the median and half below the median.
111.3(g) "Payment" or "rate" means reimbursement to an eligible provider for services
111.4provided to a qualified individual based on an approved service authorization.
111.5(h) "Rates management system" means a Web-based software application that uses
111.6a framework and component values, as determined by the commissioner, to establish
111.7service rates.
111.8(i) "Recipient" means a person receiving home and community-based services
111.9funded under any of the disability waivers.
111.10    Subd. 1c. Applicable services. Applicable services are those authorized under the
111.11state's home and community-based services waivers under sections 256B.092 and 256B.49,
111.12including as defined in the federally approved home and community-based services plan:
111.13(1) 24-hour customized living;
111.14(2) adult day care;
111.15(3) adult day care bath;
111.16(4) behavioral programming;
111.17(5) companion services;
111.18(6) customized living;
111.19(7) day training and habilitation;
111.20(8) housing access coordination;
111.21(9) independent living skills;
111.22(10) in-home family support;
111.23(11) night supervision;
111.24(12) personal support;
111.25(13) prevocational services;
111.26(14) residential care services;
111.27(15) residential support services;
111.28(16) respite services;
111.29(17) structured day services;
111.30(18) supported employment services;
111.31(19) supported living services;
111.32(20) transportation services; and
111.33(21) other services as approved by the federal government in the state home and
111.34community-based services plan.
112.1    Subd. 2. Framework values. (a) The commissioner shall propose legislation with
112.2the specific payment methodology frameworks, process for calculation, and specific
112.3values to populate the frameworks by February 15, 2013.
112.4    (b) The commissioner shall provide underlying data and information used to
112.5formulate the final frameworks and values to the existing stakeholder workgroup by
112.6January 15, 2013.
112.7    (c) The commissioner shall provide recommendations for the final frameworks
112.8and values, and the basis for the recommendations, to the legislative committees with
112.9jurisdiction over health and human services finance by February 15, 2013.
112.10    (d) The commissioner shall review the following topics during the research period
112.11and propose, as necessary, recommendations to address the following research questions:
112.12    (1) underlying differences in the cost to provide services throughout the state;
112.13    (2) a data-driven process for determining labor costs and customizations for staffing
112.14classifications included in each rate framework based on the services performed;
112.15    (3) the allocation of resources previously established under section 256B.501,
112.16subdivision 4b;
112.17    (4) further definition and development of unit-based services;
112.18    (5) the impact of splitting the allocation of resources for unit-based services for those
112.19with programming aspects and those without;
112.20    (6) linking assessment criteria to future assessment processes for determination
112.21of customizations;
112.22    (7) recognition of cost differences in the use of monitoring technology where it is
112.23appropriate to substitute for supervision;
112.24    (8) implications for day services of reimbursement based on a unit rate and a daily
112.25rate;
112.26    (9) a definition of shared and individual staffing for unit-based services;
112.27    (10) the underlying costs of providing transportation associated with day services; and
112.28    (11) an exception process for individuals with exceptional needs that cannot be met
112.29under the initial research rate, and an alternative payment structure for those individuals.
112.30    (e) The commissioner shall develop a comprehensive plan based on information
112.31gathered during the research period that uses statistically reliable and valid assessment
112.32data to refine payment methodologies.
112.33    (f) The commissioner shall make recommendations and provide underlying data and
112.34information used to formulate these research recommendations to the existing stakeholder
112.35workgroup by January 15, 2013.
113.1    Subd. 3. Data collection. (a) The commissioner shall conduct any necessary
113.2research and gather additional data for the further development and refinement of payment
113.3methodology components. These include but are not limited to:
113.4    (1) levels of service utilization and patterns of use;
113.5    (2) staffing patterns for each service;
113.6    (3) profiles of individual service needs; and
113.7    (4) cost factors involved in providing transportation services.
113.8    (b) The commissioner shall provide this information to the existing stakeholder
113.9workgroup by January 15, 2013.
113.10    Subd. 4. Rate stabilization adjustment. Beginning January 1, 2014, the
113.11commissioner shall adjust individual rates determined by the new payment methodology
113.12so that the new rate varies no more than one percent per year from the rate effective
113.13on December 31 of the prior calendar year. This adjustment is made annually and is
113.14effective for three calendar years from the date of implementation. This subdivision
113.15expires January 1, 2017.
113.16    Subd. 4a. Rate stabilization adjustment. (a) The commissioner of human services
113.17shall adjust individual reimbursement rates by no more than 1.0 percent per year effective
113.18January 1, 2014. Rates must be adjusted using the new payment methodology so that the
113.19new unit rate varies no more than 1.0 percent per year from the rate effective December
113.201 of the prior calendar year. This adjustment is made annually for three calendar years
113.21from the date of implementation.
113.22(b) Rate stabilization adjustment applies to services that are authorized in a
113.23recipient's service plan prior to January 1, 2014.
113.24(c) Exemptions shall be made only when there is a significant change in the
113.25recipient's assessed needs which results in a service authorization change. Exemption
113.26adjustments shall be limited to the difference in the authorized framework rate specific to
113.27change in assessed need. Exemptions shall be managed within lead agencies' budgets per
113.28existing allocation procedures which govern county waiver budget allocation.
113.29(d) This subdivision expires January 1, 2017.
113.30    Subd. 5. Stakeholder consultation. The commissioner shall continue consultation
113.31on regular intervals, with the existing stakeholder group established as part of the
113.32rate-setting methodology process and others to gather input, concerns, and data, and
113.33exchange ideas for to assist in the legislative proposals for full implementation of the new
113.34rate payment system and to make pertinent information available to the public through
113.35the department's Web site.
114.1    Subd. 6. Implementation. (a) The commissioner may shall implement changes
114.2no sooner than on January 1, 2014, to payment rates for individuals receiving home and
114.3community-based waivered services after the enactment of legislation that establishes
114.4specific payment methodology frameworks, processes for rate calculations, and specific
114.5values to populate the payment methodology frameworks disability waiver rates system.
114.6(b) Rates shall be determined using component values as provided under this
114.7section. Lead agencies, in consultation with provider agencies, shall enter person-specific
114.8information into a rate management system developed by the commissioner. The rate
114.9management system must calculate rates that lead agencies must use as the basis for
114.10authorizing services on behalf of disability waiver recipients subject to the requirements
114.11of subdivision 4.
114.12(c) On January 1, 2014, all new service authorizations must use the disability waiver
114.13rates system. Beginning January 1, 2014, all renewing individual service plans must use the
114.14disability waiver rates system as reassessment and reauthorization occurs. By December
114.1531, 2014, data for all recipients must be entered into the disability waiver rates system.
114.16(d) Beginning January 1, 2014, through implementation, the commissioner shall
114.17make adjustments to lead agency waiver budgets per the federally approved home and
114.18community-based services waiver plans for people with disabilities as authorized under
114.19sections 256B.092 and 256B.49.
114.20    Subd. 7. Uniform payment methodology. The commissioner shall determine
114.21a uniform methodology to meet the individualized service plan for recipients with
114.22disabilities as funded under the waiver plan for home and community-based services
114.23under sections 256B.092 and 256B.49. The commissioner shall use the component values,
114.24with consideration of recipient needs, to determine the service payment rate under this
114.25section. The payment methodology for customized living, 24-hour customized living, and
114.26residential care services shall be the customized living tool. Revisions to the customized
114.27living tool shall be made to reflect services and activities unique to disability-related
114.28recipient needs.
114.29    Subd. 8. Payments for residential services. (a) Payments for residential support
114.30services as defined in sections 256B.092, subdivision 11, and 256B.49, subdivision 22,
114.31must be calculated as follows:
114.32(1) Determine the number of units of service to meet a recipient's needs.
114.33(2) Personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
114.34national and Minnesota-specific rates or rates derived by the commissioner as provided in
114.35paragraph (c). This is defined as the direct care rate.
115.1(3) For a recipient requiring customization for deaf and hard-of-hearing language
115.2accessibility under subdivision 15, add the customization rate provided in subdivision 15
115.3to the result of clause (2). This is defined as the customized direct care rate.
115.4(4) Multiply the number of residential services direct staff hours by the appropriate
115.5staff wage in paragraph (c) or the customized direct care rate.
115.6(5) Multiply the number of direct staff hours by the product of the supervision
115.7span of control ratio in paragraph (d), clause (1), and the supervision wage in paragraph
115.8(c), clause (5).
115.9(6) Combine the results of clauses (4) and (5), and multiply the result by one plus
115.10the employee vacation, sick, and training allowance ratio in paragraph (d), clause (2).
115.11This is defined as the direct staffing cost.
115.12(7) For employee-related expenses, multiply the direct staffing cost by one plus the
115.13employee-related cost ratio in paragraph (d), clause (3).
115.14(8) For client programming and supports, the commissioner shall add $2,179 per
115.15year adjusted to an hourly rate.
115.16(9) For transportation, if provided, the commissioner shall add $1,680, or $3,000 if
115.17customized for adapted transport per year adjusted to an hourly rate.
115.18(b) The total rate shall be calculated using the following steps:
115.19(1) Subtotal paragraph (a), clauses (7) to (9).
115.20(2) Sum the standard general and administrative rate, the program-related expense
115.21ratio, and the absence and utilization ratio.
115.22(3) Divide the result of clause (1) by one minus the result of clause (2). This is
115.23the total payment amount.
115.24(c)(1) The base wage index is established to determine staffing costs associated with
115.25providing services to individuals receiving home and community-based services. For
115.26purposes of developing and calculating the proposed base wage, Minnesota-specific wages
115.27taken from job descriptions and standard occupational classification (SOC) codes from
115.28the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
115.29Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
115.30clauses (2) to (5).
115.31(2) The base wage index for residential direct basic care services is:
115.32(i) 50 percent of the median wage for personal and home health aide (SOC code
115.3339-9021);
115.34(ii) 30 percent of the median wage for nursing aide (SOC code 31-1012); and
115.35(iii) 20 percent of the median wage for social and human services aide (SOC code
115.3621-1093).
116.1(3) The base wage index for residential direct care intensive services is:
116.2(i) 20 percent of the median wage for home health aide (SOC code 31-1011);
116.3(ii) 20 percent of the median wage for personal and home health aide (SOC code
116.439-9021);
116.5(iii) 20 percent of the median wage for nursing aide (SOC code 31-1012);
116.6(iv) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
116.7and
116.8(v) 20 percent of the median wage for social and human services aide (SOC code
116.921-1093).
116.10(4) When residential direct care basic services are provided during normal sleeping
116.11hours, the basic wage is $7.66 per hour, except in a family foster care setting the wage is
116.12$2.80 per hour.
116.13(5) For supervisory staff, the basic wage is $17.43 per hour.
116.14(d) Component values for residential support services, excluding family foster
116.15care, are:
116.16(1) supervisory span of control ratio: 11 percent;
116.17(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
116.18(3) employee-related cost ratio: 23.6 percent;
116.19(4) general administrative support ratio: 13.25 percent;
116.20(5) program-related expense ratio: 1.3 percent; and
116.21(6) absence and utilization factor ratio: 3.9 percent.
116.22(e) Component values for family foster care are:
116.23(1) supervisory span of control ratio: 11 percent;
116.24(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
116.25(3) employee-related cost ratio: 23.6 percent;
116.26(4) general administrative support ratio: 3.3 percent; and
116.27(5) program-related expense ratio: 1.3 percent.
116.28(f) The commissioner shall revise the wage rates in the manner provided in
116.29subdivision 12.
116.30    Subd. 9. Payments for day programs. (a) Payments for services with day
116.31programs, including adult day care, day treatment and habilitation, prevocational services,
116.32and structured day services must be calculated as follows:
116.33(1) Determine the number of units of service to meet a recipient's needs.
116.34(2) Personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
116.35Minnesota-specific rates or rates derived by the commissioner as provided in paragraph (b).
117.1(3) For a recipient requiring customization for deaf and hard-of-hearing language
117.2accessibility under subdivision 15, add the customization rate provided in subdivision 15
117.3to the result of clause (2). This is defined as the customized direct care rate.
117.4(4) Multiply the number of day program direct staff hours by the appropriate staff
117.5wage in paragraph (b) or the customized direct care rate.
117.6(5) Multiply the number of day direct staff hours by the product of the supervision
117.7span of control ratio in paragraph (c), clause (1), and the supervision wage in paragraph
117.8(b), clause (3).
117.9(6) Combine the results of clauses (4) and (5), and multiply the result by one plus
117.10the employee vacation, sick, and training allowance ratio in paragraph (c), clause (2).
117.11This is defined as the direct staffing rate.
117.12(7) For program plan support, multiply the result of clause (6) by one plus the
117.13program plan support ratio in paragraph (c), clause (4).
117.14(8) For employee-related expenses, multiply the result of clause (7) by one plus the
117.15employee-related cost ratio in paragraph (c), clause (3).
117.16(9) For client programming and supports, multiply the result of clause (8) by one
117.17plus the client programming and support ratio in paragraph (c), clause (5).
117.18(10) For program facility costs, add $8.30 per week with consideration of staffing
117.19ratios to meet individual needs.
117.20(11) For adult day bath services, add $7.01 per 15 minute unit.
117.21(12) This is the subtotal rate.
117.22(13) Sum the standard general and administrative rate, the program-related expense
117.23ratio, and the absence and utilization factor ratio.
117.24(14) Divide the result of clause (12) by one minus the result of clause (13). This is
117.25the total payment amount.
117.26(15) For transportation provided as part of day training and habilitation, add a base
117.27of $2.52 plus:
117.28(i) $2.50 for a trip between zero to ten miles without a lift or $7.05 with a lift;
117.29(ii) $7.75 for a trip between 11 and 20 miles without a lift or $22.16 with a lift;
117.30(iii) $17.75 for a trip between 21 and 50 miles without a lift and $50.76 with a lift;
117.31(iv) $25.50 for a trip of 51 miles or more without a lift and $72.93 with a lift; and
117.32(v) divide by six for a shared trip.
117.33(b)(1) The base wage index is established to determine staffing costs associated with
117.34providing services to individuals receiving home and community-based services. For
117.35purposes of developing and calculating the proposed base wage, Minnesota-specific wages
117.36taken from job descriptions and standard occupational classification (SOC) codes from
118.1the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
118.2Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
118.3clauses (2) and (3).
118.4(2) The base wage index for direct services is:
118.5(i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
118.6(ii) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
118.7and
118.8(iii) 60 percent of the median wage for social and human services aide (SOC code
118.921-1093).
118.10(3) For supervisory staff, the base wage index is $17.43 per hour.
118.11(c) Component values for day services for all services are:
118.12(1) supervisory span of control ratio: 11 percent;
118.13(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
118.14(3) employee-related cost ratio: 23.6 percent;
118.15(4) program plan support ratio: 5.6 percent;
118.16(5) client programming and support ratio: 10 percent;
118.17(6) general administrative support ratio: 13.25 percent;
118.18(7) program-related expense ratio: 1.8 percent; and
118.19(8) absence and utilization factor ratio: 3.9 percent.
118.20(d) The commissioner shall revise the wage rates in the manner provided in
118.21subdivision 12.
118.22    Subd. 10. Payments for unit-based with program services. (a) Payments for
118.23unit-based with program services, including behavior programming, housing access
118.24coordination, in-home family support, independent living skills training, hourly supported
118.25living services, and supported employment provided to an individual outside of any day or
118.26residential service plan must be calculated as follows, unless the services are authorized
118.27separately under subdivisions 8 and 9:
118.28(1) Determine the number of units of service to meet a recipient's needs.
118.29(2) Personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
118.30Minnesota-specific rates or rates derived by the commissioner as provided in paragraph (b).
118.31(3) For a recipient requiring customization for deaf and hard-of-hearing language
118.32accessibility under subdivision 15, add the customization rate provided in subdivision 15
118.33to the result of clause (2). This is defined as the customized direct care rate.
118.34(4) Multiply the number of direct staff hours by the appropriate staff wage in
118.35paragraph (b) or the customized direct care rate.
119.1(5) Multiply the number of direct staff hours by the product of the supervision
119.2span of control ratio in paragraph (c), clause (1), and the supervision wage in paragraph
119.3(b), clause (10).
119.4(6) Combine the results of clauses (4) and (5), and multiply the result by one plus
119.5the employee vacation, sick, and training allowance ratio in paragraph (c), clause (2).
119.6This is defined as the direct staffing rate.
119.7(7) For program plan support, multiply the result of clause (6) by one plus the
119.8program plan supports ratio in paragraph (c), clause (4).
119.9(8) For employee-related expenses, multiply the result of clause (7) by one plus the
119.10employee-related cost ratio in paragraph (c), clause (3).
119.11(9) For client programming and supports, multiply the result of clause (8) by one
119.12plus the client programming and supports ratio in paragraph (c), clause (5).
119.13(10) This is the subtotal rate.
119.14(11) Sum the standard general and administrative rate, the program-related expense
119.15ratio, and the absence and utilization factor ratio.
119.16(12) Divide the result of clause (10) by one minus the result of clause (11). This is
119.17the total payment amount.
119.18(b)(1) The base wage index is established to determine staffing costs associated with
119.19providing services to individuals receiving home and community-based services. For
119.20purposes of developing and calculating the proposed base wage, Minnesota-specific wages
119.21taken from job descriptions and standard occupational classification (SOC) codes from
119.22the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
119.23Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
119.24clauses (2) to (10).
119.25(2) The base wage index for a behavior program analyst is 100 percent of the median
119.26wage for mental health counselor (SOC code 21-1014).
119.27(3) The base wage index for a behavior program professional is 100 percent of the
119.28median wage for clinical counseling and school psychologist (SOC code 19-3031).
119.29(4) The base wage index for a behavior program specialist is 100 percent of the
119.30median wage for psychiatric technician (SOC code 29-2053).
119.31(5) The base wage index for hourly supportive living services is:
119.32(i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
119.33(ii) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
119.34and
119.35(iii) 60 percent of the median wage for social and human services aide (SOC code
119.3621-1093).
120.1(6) The base wage index for housing access coordinator services is:
120.2(i) 50 percent of the median wage for community and social services specialist
120.3(SOC code 21-1099); and
120.4(ii) 50 percent of the median wage for social and human services aide (SOC code
120.521-1093).
120.6(7) The base wage index for in-home family support services is:
120.7(i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
120.8(ii) 30 percent of the median wage for community social service specialist (SOC
120.9code 21-1099);
120.10(iii) 40 percent of the median wage for social and human services aide (SOC code
120.1121-1093); and
120.12(iv) ten percent of the median wage for psychiatric technician (SOC code 29-2053).
120.13(8) The base wage index for independent living skills is:
120.14(i) 40 percent of the median wage for community social service specialist (SOC
120.15code 21-1099);
120.16(ii) 50 percent of the median wage for social and human services aide (SOC code
120.1721-1093); and
120.18(iii) ten percent of the median wage for psychiatric technician (SOC code 29-2053).
120.19(9) The base wage index for supported employment services is:
120.20(i) 20 percent of the median wage for nursing aide (SOC code 31-1012);
120.21(ii) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
120.22and
120.23(iii) 60 percent of the median wage for social and human services aide (SOC code
120.2421-1093).
120.25(10) For a supervisor, the base wage index is $17.43 per hour with the exception of the
120.26supervision of behavior analysts and behavior specialists which shall be $30.75 per hour.
120.27(c) Component values for unit-based with program services are:
120.28(1) supervisory span of control ratio: 11 percent;
120.29(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
120.30(3) employee-related cost ratio: 23.6 percent;
120.31(4) program plan supports ratio: 3.1 percent;
120.32(5) client programming and supports ratio: 8.6 percent;
120.33(6) general administrative support ratio: 13.25 percent;
120.34(7) program-related expense ratio: 6.1 percent; and
120.35(8) absence and utilization factor ratio: 3.9 percent.
121.1(d) The commissioner shall revise the wage rates in the manner provided in
121.2subdivision 12.
121.3    Subd. 11. Payments for unit-based without program services. (a) Payments
121.4for unit-based without program services including night supervision, personal support,
121.5respite, and companion care provided to an individual outside of any day or residential
121.6service plan must be calculated as follows unless the services are authorized separately
121.7under subdivisions 8 and 9:
121.8(1) For all services except respite, determine the number of units of service to meet
121.9a recipient's needs.
121.10(2) Personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
121.11Minnesota-specific rate or rates derived by the commissioner as provided in paragraph (b).
121.12(3) For a recipient requiring customization for deaf and hard-of-hearing language
121.13accessibility under subdivision 15, add the customization rate provided in subdivision 15
121.14to the result of clause (2). This is defined as the customized direct care rate.
121.15(4) Multiply the number of direct staff hours by the appropriate staff wage in
121.16paragraph (b) or the customized direct care rate.
121.17(5) Multiply the number of direct staff hours by the product of the supervision
121.18span of control ratio in paragraph (c), clause (1), and the supervision wage in paragraph
121.19(b), clause (6).
121.20(6) Combine the results of clauses (4) and (5) and multiply the result by one plus
121.21the employee vacation, sick, and training allowance ratio in paragraph (c), clause (2).
121.22This is defined as the direct staffing rate.
121.23(7) For program plan support, multiply the result of clause (6) by one plus the
121.24program plan support ratio in paragraph (c), clause (4).
121.25(8) For employee-related expenses, multiply the result of clause (7) by one plus the
121.26employee-related cost ratio in paragraph (c), clause (3).
121.27(9) For client programming and supports, multiply the result of clause (8) by one
121.28plus the client programming and support ratio in paragraph (c), clause (5).
121.29(10) This is the subtotal rate.
121.30(11) Sum the standard general and administrative rate, the program-related expense
121.31ratio, and the absence and utilization factor ratio.
121.32(12) Divide the result of clause (10) by one minus the result of clause (11). This is
121.33the total payment amount.
121.34(13) For respite services, determine the number of daily units of service to meet an
121.35individual's needs.
122.1(14) Personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
122.2Minnesota-specific rate or rates derived by the commissioner as provided in paragraph (b).
122.3(15) For a recipient requiring deaf and hard-of-hearing customization under
122.4subdivision 15, add the customization rate provided in subdivision 15 to the result of
122.5clause (14). This is defined as the customized direct care rate.
122.6(16) Multiply the number of direct staff hours by the appropriate staff wage in
122.7paragraph (b).
122.8(17) Multiply the number of direct staff hours by the product of the supervisory
122.9span of control ratio in paragraph (d), clause (1), and the supervision wage in paragraph
122.10(b), clause (6).
122.11(18) Combine the results of clauses (16) and (17) and multiply the result by one plus
122.12the employee vacation, sick, and training allowance ratio in paragraph (d), clause (2).
122.13This is defined as the direct staffing rate.
122.14(19) For employee-related expenses, multiply the result of clause (18) by one plus
122.15the employee-related cost ratio in paragraph (d), clause (3).
122.16(20) This is the subtotal rate.
122.17(21) Sum the standard general and administrative rate, the program-related expense
122.18ratio, and the absence and utilization factor ratio.
122.19(22) Divide the result of clause (20) by one minus the result of clause (21). This is
122.20the total payment amount.
122.21(b)(1) The base wage index is established to determine staffing costs associated
122.22with providing services to recipients receiving home and community-based services. For
122.23purposes of developing and calculating the proposed base wage, Minnesota-specific wages
122.24taken from job descriptions and standard occupational classification (SOC) codes from
122.25the Bureau of Labor Statistics, as defined in the most recent edition of the Occupational
122.26Outlook Handbook, shall be used. The base wage index shall be calculated as provided in
122.27clauses (2) to (6):
122.28(2) The base wage index for adult companion staff is:
122.29(i) 50 percent of the median wage for personal and home care aide (SOC code
122.3039-9021); and
122.31(ii) 50 percent of the median wage for nursing aides, orderlies, and attendants (SOC
122.32code 31-1012).
122.33(3) The base wage index for night supervision staff is:
122.34(i) 20 percent of the median wage for home health aide (SOC code 31-1011);
122.35(ii) 20 percent of the median wage for personal and home health aide (SOC code
122.3639-9021);
123.1(iii) 20 percent of the median wage for nursing aide (SOC code 31-1012);
123.2(iv) 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
123.3and
123.4(v) 20 percent of the median wage for social and human services aide (SOC code
123.521-1093).
123.6(4) The base wage index for respite staff is:
123.7(i) 50 percent of the median wage for personal and home care aide (SOC code
123.839-9021); and
123.9(ii) 50 percent of the median wage for nursing aides, orderlies, and attendants (SOC
123.10code 31-1012).
123.11(5) The base wage index for personal support staff is:
123.12(i) 50 percent of the median wage for personal and home care aide (SOC code
123.1339-9021); and
123.14(ii) 50 percent of the median wage for nursing aides, orderlies, and attendants (SOC
123.15code 31-1012).
123.16(6) The base wage index for supervisory staff is $17.43 per hour.
123.17(c) Component values for unit-based services without programming except respite
123.18are:
123.19(1) supervisory span of control ratio: 11 percent;
123.20(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
123.21(3) employee-related cost ratio: 23.6 percent;
123.22(4) program plan support ratio: 3.1 percent;
123.23(5) client programming and support ratio: 8.6 percent;
123.24(6) general administrative support ratio: 13.25 percent;
123.25(7) program-related expense ratio: 6.1 percent; and
123.26(8) absence and utilization factor ratio: 3.9 percent.
123.27(d) Component values for unit-based services without programming for respite are:
123.28(1) supervisory span of control ratio: 11 percent;
123.29(2) employee vacation, sick, and training allowance ratio: 8.71 percent;
123.30(3) employee-related cost ratio: 23.6 percent;
123.31(4) general administrative support ratio: 13.25 percent;
123.32(5) program-related expense ratio: 6.1 percent; and
123.33(6) absence and utilization factor ratio: 3.9 percent.
123.34(e) The commissioner shall revise the wage rates in the manner provider in
123.35subdivision 12.
124.1    Subd. 12. Updating or changing payment values. (a) The commissioner shall
124.2develop and implement uniform procedures to refine terms and update or adjust values
124.3used to calculate payment rates in this section. For calendar year 2014, the commissioner
124.4shall use the values, terms, and procedures provided in this section.
124.5(b) The commissioner shall work with stakeholders to assess efficacy of values
124.6and payment rates. The commissioner shall report back to the legislature with proposed
124.7changes for component values and recommendations for revisions on the schedule
124.8provided in paragraphs (c) and (d).
124.9(c) The commissioner shall work with stakeholders to continue refining a
124.10subset of component values, which are to be referred to as interim values, and report
124.11recommendations to the legislature by February 15, 2014. Interim component values are:
124.12transportation rates for day training and habilitation; transportation for adult day, structured
124.13day, and prevocational services; geographic difference factor; day program facility rate;
124.14services where monitoring technology replaces staff time; shared services for independent
124.15living skills training; and supported employment and billing for indirect services.
124.16(d) The commissioner shall report and make recommendations to the legislature on:
124.17February 15, 2015, February 15, 2017, February 15, 2019, and February 15, 2021. After
124.182021, reports shall be provided on a four-year cycle.
124.19(e) The commissioner shall provide a public notice via list serve in October of each
124.20year beginning October 1, 2014. The notice shall contain information detailing legislatively
124.21approved changes in: calculation values including derived wage rates and related employee
124.22and administrative factors; services utilization; county and tribal allocation changes
124.23and; information on adjustments to be made to calculation values and timing of those
124.24adjustment. Information in this notice shall be effective January 1 of the following year.
124.25    Subd. 13. Payment implementation. Upon implementation of the payment
124.26methodologies under this section, those payment rates supersede rates established in county
124.27contracts for recipients receiving waiver services under sections 256B.092 and 256B.49.
124.28    Subd. 14. Transportation. The commissioner shall require that the purchase
124.29of transportation services be cost-effective and be limited to market rates where the
124.30transportation mode is generally available and accessible.
124.31    Subd. 15. Customization of rates for individuals. For persons determined to have
124.32higher needs based on being deaf or hard-of-hearing, the direct care costs must be increased
124.33by an adjustment factor prior to calculating the price under subdivisions 8 to 11. The
124.34customization rate with respect to deaf or hard-of-hearing persons shall be $2.70 per hour
124.35for waiver recipients who meet the respective criteria as determined by the commissioner.
125.1    Subd. 16. Exceptions. (a) In a format prescribed by the commissioner, lead
125.2agencies must identify individuals with exceptional needs that cannot be met under the
125.3disability waiver rate system. The commissioner shall use that information to evaluate
125.4and, if necessary, approve an alternative payment rate for those individuals.
125.5(b) Lead agencies must submit exceptions requests to the state. Requests must
125.6include information specifying: the extraordinary needs of the individual that are not
125.7accounted for in payment methodology; the effort and costs required to meet those needs;
125.8and recommendations from the lead agency regarding the request. Requests must be
125.9reviewed and determinations made by the state. Approved exceptions must be managed
125.10within the lead agencies' budgets.
125.11    Subd. 17. Budget neutrality adjustment. (a) The commissioner shall calculate the
125.12total spending for all home and community-based waiver services under the payments as
125.13defined in subdivisions 8 to 11, and total forecasted spending under current law for the
125.14fiscal year beginning July 1, 2013. If total forecasted spending under subdivisions 8
125.15to 11 is projected to be higher than under current law, the commissioner shall adjust
125.16the rate by the percentage needed to adjust spending in each category to the same level
125.17as projected under current law.
125.18(b) The commissioner shall make any legislatively authorized changes to provider
125.19rates that are beyond subdivision 12 in this subdivision.


125.22    Section 1. Minnesota Statutes 2012, section 245.4661, subdivision 5, is amended to read:
125.23    Subd. 5. Planning for pilot projects. (a) Each local plan for a pilot project, with
125.24the exception of the placement of a Minnesota specialty treatment facility as defined in
125.25paragraph (c), must be developed under the direction of the county board, or multiple
125.26county boards acting jointly, as the local mental health authority. The planning process
125.27for each pilot shall include, but not be limited to, mental health consumers, families,
125.28advocates, local mental health advisory councils, local and state providers, representatives
125.29of state and local public employee bargaining units, and the department of human services.
125.30As part of the planning process, the county board or boards shall designate a managing
125.31entity responsible for receipt of funds and management of the pilot project.
125.32(b) For Minnesota specialty treatment facilities, the commissioner shall issue a
125.33request for proposal for regions in which a need has been identified for services.
126.1(c) For purposes of this section, Minnesota specialty treatment facility is defined as
126.2an intensive rehabilitative mental health service under section 256B.0622, subdivision 2,
126.3paragraph (b).

126.4    Sec. 2. Minnesota Statutes 2012, section 245.4661, subdivision 6, is amended to read:
126.5    Subd. 6. Duties of commissioner. (a) For purposes of the pilot projects, the
126.6commissioner shall facilitate integration of funds or other resources as needed and
126.7requested by each project. These resources may include:
126.8(1) residential services funds administered under Minnesota Rules, parts 9535.2000
126.9to 9535.3000, in an amount to be determined by mutual agreement between the project's
126.10managing entity and the commissioner of human services after an examination of the
126.11county's historical utilization of facilities located both within and outside of the county
126.12and licensed under Minnesota Rules, parts 9520.0500 to 9520.0690;
126.13(2) community support services funds administered under Minnesota Rules, parts
126.149535.1700 to 9535.1760;
126.15(3) other mental health special project funds;
126.16(4) medical assistance, general assistance medical care, MinnesotaCare and group
126.17residential housing if requested by the project's managing entity, and if the commissioner
126.18determines this would be consistent with the state's overall health care reform efforts; and
126.19(5) regional treatment center resources consistent with section 246.0136, subdivision
126.201 .; and
126.21(6) funds transferred from section 246.18, subdivision 8, for grants to providers to
126.22participate in mental health specialty treatment services, awarded to providers through
126.23a request for proposal process.
126.24(b) The commissioner shall consider the following criteria in awarding start-up and
126.25implementation grants for the pilot projects:
126.26(1) the ability of the proposed projects to accomplish the objectives described in
126.27subdivision 2;
126.28(2) the size of the target population to be served; and
126.29(3) geographical distribution.
126.30(c) The commissioner shall review overall status of the projects initiatives at least
126.31every two years and recommend any legislative changes needed by January 15 of each
126.32odd-numbered year.
126.33(d) The commissioner may waive administrative rule requirements which are
126.34incompatible with the implementation of the pilot project.
127.1(e) The commissioner may exempt the participating counties from fiscal sanctions
127.2for noncompliance with requirements in laws and rules which are incompatible with the
127.3implementation of the pilot project.
127.4(f) The commissioner may award grants to an entity designated by a county board or
127.5group of county boards to pay for start-up and implementation costs of the pilot project.

127.6    Sec. 3. Minnesota Statutes 2012, section 245.4682, subdivision 2, is amended to read:
127.7    Subd. 2. General provisions. (a) In the design and implementation of reforms to
127.8the mental health system, the commissioner shall:
127.9    (1) consult with consumers, families, counties, tribes, advocates, providers, and
127.10other stakeholders;
127.11    (2) bring to the legislature, and the State Advisory Council on Mental Health, by
127.12January 15, 2008, recommendations for legislation to update the role of counties and to
127.13clarify the case management roles, functions, and decision-making authority of health
127.14plans and counties, and to clarify county retention of the responsibility for the delivery of
127.15social services as required under subdivision 3, paragraph (a);
127.16    (3) withhold implementation of any recommended changes in case management
127.17roles, functions, and decision-making authority until after the release of the report due
127.18January 15, 2008;
127.19    (4) ensure continuity of care for persons affected by these reforms including
127.20ensuring client choice of provider by requiring broad provider networks and developing
127.21mechanisms to facilitate a smooth transition of service responsibilities;
127.22    (5) provide accountability for the efficient and effective use of public and private
127.23resources in achieving positive outcomes for consumers;
127.24    (6) ensure client access to applicable protections and appeals; and
127.25    (7) make budget transfers necessary to implement the reallocation of services and
127.26client responsibilities between counties and health care programs that do not increase the
127.27state and county costs and efficiently allocate state funds.
127.28    (b) When making transfers under paragraph (a) necessary to implement movement
127.29of responsibility for clients and services between counties and health care programs,
127.30the commissioner, in consultation with counties, shall ensure that any transfer of state
127.31grants to health care programs, including the value of case management transfer grants
127.32under section 256B.0625, subdivision 20, does not exceed the value of the services being
127.33transferred for the latest 12-month period for which data is available. The commissioner
127.34may make quarterly adjustments based on the availability of additional data during the
127.35first four quarters after the transfers first occur. If case management transfer grants under
128.1section 256B.0625, subdivision 20, are repealed and the value, based on the last year prior
128.2to repeal, exceeds the value of the services being transferred, the difference becomes an
128.3ongoing part of each county's adult and children's mental health grants under sections
128.4245.4661 , 245.4889, and 256E.12.
128.5    (c) This appropriation is not authorized to be expended after December 31, 2010,
128.6unless approved by the legislature.

128.7    Sec. 4. Minnesota Statutes 2012, section 246.18, subdivision 8, is amended to read:
128.8    Subd. 8. State-operated services account. (a) The state-operated services account is
128.9established in the special revenue fund. Revenue generated by new state-operated services
128.10listed under this section established after July 1, 2010, that are not enterprise activities must
128.11be deposited into the state-operated services account, unless otherwise specified in law:
128.12(1) intensive residential treatment services;
128.13(2) foster care services; and
128.14(3) psychiatric extensive recovery treatment services.
128.15(b) Funds deposited in the state-operated services account are available to the
128.16commissioner of human services for the purposes of:
128.17(1) providing services needed to transition individuals from institutional settings
128.18within state-operated services to the community when those services have no other
128.19adequate funding source;
128.20(2) grants to providers participating in mental health specialty treatment services
128.21under section 245.4661; and
128.22(3) to fund the operation of the Intensive Residential Treatment Service program in
128.23Willmar.

128.24    Sec. 5. Minnesota Statutes 2012, section 246.18, is amended by adding a subdivision
128.25to read:
128.26    Subd. 9. Transfers. The commissioner may transfer state mental health grant funds
128.27to the account in subdivision 8 for noncovered allowable costs of a provider certified and
128.28licensed under section 256B.0622, and operating under section 246.014.

128.29    Sec. 6. [254B.14] CHEMICAL HEALTH NAVIGATION PROGRAM.
128.30    Subdivision 1. Establishment; purpose. (a) There is established a state-county
128.31chemical health navigation program. The Department of Human Services and interested
128.32counties shall work in partnership to augment the current chemical health service delivery
129.1system to promote better outcomes for eligible individuals and greater accountability and
129.2productivity in the delivery of state and county funded chemical dependency services.
129.3(b) The navigation program shall allow flexibility for eligible individuals to
129.4timely access needed services as well as to align systems and services to offer the most
129.5appropriate level of chemical health services to eligible individuals.
129.6(c) Chemical health navigation programs must maintain eligibility requirements for
129.7the consolidated chemical dependency treatment fund, continue to meet the requirements
129.8of Minnesota Rules, parts 9530.6405 to 9530.6505 and 9530.6600 to 9530.6655, and must
129.9not put current and future federal funding of chemical health services at risk.
129.10    Subd. 2. Program implementation. (a) Each county's participation in the chemical
129.11health navigation program is voluntary.
129.12(b) The commissioner and each county participating in the chemical health
129.13navigation program shall enter into an agreement governing the operation of the county's
129.14navigation program. Each county shall implement its program within 60 days of the final
129.15agreement with the commissioner.
129.16    Subd. 3. Notice of program discontinuation. Each county's participation in the
129.17chemical health navigation program may be discontinued for any reason by the county or
129.18the commissioner after 30 days' written notice to the other party. Any unspent funds held
129.19for the exiting county's pro rata share in the special revenue fund under the authority in
129.20subdivision 5, paragraph (d), shall be transferred to the consolidated chemical dependency
129.21treatment fund following discontinuation of the program.
129.22    Subd. 4. Eligibility for navigator program. To be considered for participation in
129.23a navigator program, an individual must:
129.24(1) be a resident of a county with an approved navigator program;
129.25(2) be eligible for chemical dependency fund services;
129.26(3) be a voluntary participant in the navigator program;
129.27(4) have at least one severity rating of two or above in dimensions four, five, or six
129.28in a comprehensive assessment under Minnesota Rules, part 9530.6422; and
129.29(5) have had at least two treatment episodes in the past two years, not limited
129.30to episodes reimbursed by the consolidated chemical dependency treatment funds. An
129.31admission to an emergency room, a detoxification program, or a hospital may be substituted
129.32for a treatment episode if it resulted from the individual's substance use disorder.
129.33    Subd. 5. Duties of commissioner. (a) Notwithstanding any other provisions in this
129.34chapter, the commissioner may authorize chemical health navigator programs to use
129.35chemical dependency treatment funds to pay for nontreatment services:
130.1(1) in addition to those authorized under section 254B.03, subdivision 2, paragraph
130.2(a); and
130.3(2) by vendors in addition to those authorized under section 254B.05 when not
130.4providing chemical dependency treatment services.
130.5(b) Participating counties may contract with providers to provide nontreatment
130.6services pursuant to section 256B.69, subdivision 6, paragraph (c).
130.7(c) For the purposes of this section, "nontreatment services" include community-based
130.8navigator services, peer support, family engagement and support, housing support and rent
130.9subsidy for up to 90 days, supported employment, and independent living skills.
130.10(d) State expenditures for chemical dependency services and nontreatment
130.11services provided through the navigator programs must not be greater than the chemical
130.12dependency treatment fund expected share of forecasted expenditures in the absence of
130.13the navigator programs. The commissioner may restructure the schedule of payments
130.14between the state and participating counties under the local agency share and division of
130.15cost provisions under section 254B.03, subdivisions 3 and 4, as necessary to facilitate
130.16the operation of the navigation programs.
130.17(e) To the extent that state fiscal year expenditures within a county's navigator
130.18program are less than the expected share of forecasted expenditures in the absence of the
130.19navigator program, the commissioner shall deposit the unexpended funds in a separate
130.20account within the consolidated chemical dependency treatment fund, and make these
130.21funds available for expenditure by the county for the following year. To the extent that
130.22treatment and nontreatment services expenditures within a county's navigator program
130.23exceed the amount expected in the absence of the navigator program, the county shall be
130.24responsible for the portion of costs for nontreatment services expended in excess of the
130.25otherwise expected share of forecasted expenditures.
130.26(f) The commissioner may waive administrative rule requirements that are
130.27incompatible with the implementation of navigator programs, except that any chemical
130.28dependency treatment funded under this section must continue to be provided by a
130.29licensed treatment provider.
130.30(g) The commissioner shall not approve or enter into any agreement related to
130.31navigator programs authorized under this section that puts current or future federal
130.32funding at risk.
130.33(h) The commissioner shall provide participating counties with transactional data,
130.34reports, provider data, and other data generated by county activity to assess and measure
130.35outcomes. This information must be transmitted to participating counties at least once
130.36every six months.
131.1    Subd. 6. Duties of county board. The county board, or other county entity that is
131.2approved to administer a navigator program, shall:
131.3(1) administer the program in a manner consistent with this section;
131.4(2) ensure that no one is denied chemical dependency treatment services for which
131.5they would otherwise be eligible under section 254A.03, subdivision 3; and
131.6(3) provide the commissioner with timely and pertinent information as negotiated in
131.7the agreement governing operation of the county's navigator program.
131.8    Subd. 7. Managed care. (a) An individual who is eligible for the navigator program
131.9under subdivision 4 is excluded from mandatory enrollment in managed care.
131.10(b) The commissioner shall seek any federal waivers and approvals necessary to
131.11allow managed care organizations to use capitated funds received from the commissioner
131.12to access nontreatment services defined in subdivision 5.
131.13    Subd. 8. Report. The commissioner, in partnership with participating counties,
131.14shall provide an annual report on the achievement of navigator program outcomes to the
131.15legislative committees with jurisdiction over chemical health. The report shall address
131.16qualitative and quantitative outcomes.
131.17EFFECTIVE DATE.This section is effective the day following final enactment.

131.18    Sec. 7. [256.478] HOME AND COMMUNITY-BASED SERVICES
131.19TRANSITIONS GRANTS.
131.20(a) The commissioner shall make available home and community-based services
131.21transition grants to serve individuals who do not meet eligibility criteria for the medical
131.22assistance program under section 256B.056 or 256B.057, but who otherwise meet the
131.23criteria under section 256B.092, subdivision 13, or 256B.49, subdivision 24.
131.24(b) For the purposes of this section, the commissioner has the authority to transfer
131.25funds between the medical assistance account and the home and community-based
131.26services transitions grants account.

131.27    Sec. 8. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
131.28subdivision to read:
131.29    Subd. 61. Family psychoeducation services. Effective July 1, 2013, or upon
131.30federal approval, whichever is later, medical assistance covers family psychoeducation
131.31services provided to a child up to age 21 with a diagnosed mental health condition when
131.32identified in the child's individual treatment plan and provided by a licensed mental health
131.33professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a
131.34clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who
132.1has determined it medically necessary to involve family members in the child's care. For
132.2the purposes of this subdivision, "family psychoeducation services" means information
132.3or demonstration provided to an individual or family as part of an individual, family,
132.4multifamily group, or peer group session to explain, educate, and support the child and
132.5family in understanding a child's symptoms of mental illness, the impact on the child's
132.6development, and needed components of treatment and skill development so that the
132.7individual, family, or group can help the child to prevent relapse, prevent the acquisition
132.8of comorbid disorders, and to achieve optimal mental health and long-term resilience.

132.9    Sec. 9. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
132.10subdivision to read:
132.11    Subd. 62. Mental health clinical care consultation. Effective July 1, 2013, or upon
132.12federal approval, whichever is later, medical assistance covers clinical care consultation
132.13for a person up to age 21 who is diagnosed with a complex mental health condition or a
132.14mental health condition that co-occurs with other complex and chronic conditions, when
132.15described in the person's individual treatment plan and provided by a licensed mental
132.16health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A. For
132.17the purposes of this subdivision, "clinical care consultation" means communication from a
132.18treating mental health professional to other providers not under the clinical supervision of
132.19the treating mental health professional who are working with the same client to inform,
132.20inquire, and instruct regarding the client's symptoms; strategies for effective engagement,
132.21care, and intervention needs; and treatment expectations across service settings; and to
132.22direct and coordinate clinical service components provided to the client and family.

132.23    Sec. 10. Minnesota Statutes 2012, section 256B.092, is amended by adding a
132.24subdivision to read:
132.25    Subd. 13. Waiver allocations for transition populations. (a) The commissioner
132.26shall make available additional waiver allocations and additional necessary resources
132.27to assure timely discharges from the Anoka Metro Regional Treatment Center and the
132.28Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
132.29(1) are otherwise eligible for the developmental disabilities waiver under this section;
132.30(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
132.31the Minnesota Security Hospital;
132.32(3) whose discharge would be significantly delayed without the available waiver
132.33allocation; and
132.34(4) who have met treatment objectives and no longer meet hospital level of care.
133.1(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
133.2requirements of the federal approved waiver plan.
133.3(c) Any corporate foster care home developed under this subdivision must be
133.4considered an exception under section 245A.03, subdivision 7, paragraph (a).

133.5    Sec. 11. Minnesota Statutes 2012, section 256B.0946, is amended to read:
133.6256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.
133.7    Subdivision 1. Required covered service components. (a) Effective July 1, 2006,
133.8 upon enactment and subject to federal approval, medical assistance covers medically
133.9necessary intensive treatment services described under paragraph (b) that are provided
133.10by a provider entity eligible under subdivision 3 to a client eligible under subdivision 2
133.11who is placed in a treatment foster home licensed under Minnesota Rules, parts 2960.3000
133.12to 2960.3340.
133.13(b) Intensive treatment services to children with severe emotional disturbance mental
133.14illness residing in treatment foster care family settings must meet the relevant standards
133.15for mental health services under sections 245.487 to 245.4889. In addition, that comprise
133.16 specific required service components provided in clauses (1) to (5), are reimbursed by
133.17medical assistance must when they meet the following standards:
133.18(1) case management service component must meet the standards in Minnesota
133.19Rules, parts 9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10;
133.20(1) psychotherapy provided by a mental health professional as defined in Minnesota
133.21Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota
133.22Rules, part 9505.0371, subpart 5, item C;
133.23(2) psychotherapy, crisis assistance, and skills training components must meet the
133.24 provided according to standards for children's therapeutic services and supports in section
133.25256B.0943 ; and
133.26(3) individual family, and group psychoeducation services under supervision of,
133.27defined in subdivision 1a, paragraph (q), provided by a mental health professional. or a
133.28clinical trainee;
133.29(4) clinical care consultation, as defined in subdivision 1a, and provided by a mental
133.30health professional or a clinical trainee; and
133.31(5) service delivery payment requirements as provided under subdivision 4.
133.32    Subd. 1a. Definitions. For the purposes of this section, the following terms have
133.33the meanings given them.
133.34(a) "Clinical care consultation" means communication from a treating clinician to
133.35other providers working with the same client to inform, inquire, and instruct regarding
134.1the client's symptoms, strategies for effective engagement, care and intervention needs,
134.2and treatment expectations across service settings, including but not limited to the client's
134.3school, social services, day care, probation, home, primary care, medication prescribers,
134.4disabilities services, and other mental health providers and to direct and coordinate clinical
134.5service components provided to the client and family.
134.6(b) "Clinical supervision" means the documented time a clinical supervisor and
134.7supervisee spend together to discuss the supervisee's work, to review individual client
134.8cases, and for the supervisee's professional development. It includes the documented
134.9oversight and supervision responsibility for planning, implementation, and evaluation of
134.10services for a client's mental health treatment.
134.11(c) "Clinical supervisor" means the mental health professional who is responsible
134.12for clinical supervision.
134.13(d) "Clinical trainee" has the meaning given in Minnesota Rules, part 9505.0371,
134.14subpart 5, item C;
134.15(e) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a,
134.16including the development of a plan that addresses prevention and intervention strategies
134.17to be used in a potential crisis, but does not include actual crisis intervention.
134.18(f) "Culturally appropriate" means providing mental health services in a manner that
134.19incorporates the child's cultural influences, as defined in Minnesota Rules, part 9505.0370,
134.20subpart 9, into interventions as a way to maximize resiliency factors and utilize cultural
134.21strengths and resources to promote overall wellness.
134.22(g) "Culture" means the distinct ways of living and understanding the world that
134.23are used by a group of people and are transmitted from one generation to another or
134.24adopted by an individual.
134.25(h) "Diagnostic assessment" has the meaning given in Minnesota Rules, part
134.269505.0370, subpart 11.
134.27(i) "Family" means a person who is identified by the client or the client's parent or
134.28guardian as being important to the client's mental health treatment. Family may include,
134.29but is not limited to, parents, foster parents, children, spouse, committed partners, former
134.30spouses, persons related by blood or adoption, persons who are a part of the client's
134.31permanency plan, or persons who are presently residing together as a family unit.
134.32(j) "Foster care" has the meaning given in section 260C.007, subdivision 18.
134.33(k) "Foster family setting" means the foster home in which the license holder resides.
134.34(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part
134.359505.0370, subpart 15.
135.1(m) "Mental health practitioner" has the meaning given in Minnesota Rules, part
135.29505.0370, subpart 17.
135.3(n) "Mental health professional" has the meaning given in Minnesota Rules, part
135.49505.0370, subpart 18.
135.5(o) "Mental illness" has the meaning given in Minnesota Rules, part 9505.0370,
135.6subpart 20.
135.7(p) "Parent" has the meaning given in section 260C.007, subdivision 25.
135.8(q) "Psychoeducation services" means information or demonstration provided to
135.9an individual, family, or group to explain, educate, and support the individual, family, or
135.10group in understanding a child's symptoms of mental illness, the impact on the child's
135.11development, and needed components of treatment and skill development so that the
135.12individual, family, or group can help the child to prevent relapse, prevent the acquisition
135.13of comorbid disorders, and to achieve optimal mental health and long-term resilience.
135.14(r) "Psychotherapy" has the meaning given in Minnesota Rules, part 9505.0370,
135.15subpart 27.
135.16(s) "Team consultation and treatment planning" means the coordination of treatment
135.17plans and consultation among providers in a group concerning the treatment needs of the
135.18child, including disseminating the child's treatment service schedule to all members of the
135.19service team. Team members must include all mental health professionals working with
135.20the child, a parent, the child unless the team lead or parent deem it clinically inappropriate,
135.21and at least two of the following: an individualized education program case manager;
135.22probation agent; children's mental health case manager; child welfare worker, including
135.23adoption or guardianship worker; primary care provider; foster parent; and any other
135.24member of the child's service team.
135.25    Subd. 2. Determination of client eligibility. A client's eligibility to receive
135.26treatment foster care under this section shall be determined by An eligible recipient is an
135.27individual, from birth through age 20, who is currently placed in a foster home licensed
135.28under Minnesota Rules, parts 2960.3000 to 2960.3340, and has received a diagnostic
135.29assessment, and an evaluation of level of care needed, and development of an individual
135.30treatment plan, as defined in paragraphs (a) to (c) and (b).
135.31(a) The diagnostic assessment must:
135.32(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
135.33conducted by a psychiatrist, licensed psychologist, or licensed independent clinical social
135.34worker that is mental health professional or a clinical trainee;
135.35(2) determine whether or not a child meets the criteria for mental illness, as defined
135.36in Minnesota Rules, part 9505.0370, subpart 20;
136.1(3) document that intensive treatment services are medically necessary within a
136.2foster family setting to ameliorate identified symptoms and functional impairments;
136.3(4) be performed within 180 days prior to before the start of service; and
136.4(2) include current diagnoses on all five axes of the client's current mental health
136.5status;
136.6(3) determine whether or not a child meets the criteria for severe emotional
136.7disturbance in section 245.4871, subdivision 6, or for serious and persistent mental illness
136.8in section 245.462, subdivision 20; and
136.9(4) be completed annually until age 18. For individuals between age 18 and 21,
136.10unless a client's mental health condition has changed markedly since the client's most
136.11recent diagnostic assessment, annual updating is necessary. For the purpose of this section,
136.12"updating" means a written summary, including current diagnoses on all five axes, by a
136.13mental health professional of the client's current mental status and service needs.
136.14(5) be completed as either a standard or extended diagnostic assessment annually to
136.15determine continued eligibility for the service.
136.16(b) The evaluation of level of care must be conducted by the placing county with
136.17an instrument, tribe, or case manager in conjunction with the diagnostic assessment as
136.18described by Minnesota Rules, part 9505.0372, subpart 1, item B, using a validated tool
136.19 approved by the commissioner of human services and not subject to the rulemaking
136.20process, consistent with section 245.4885, subdivision 1, paragraph (d), the result of which
136.21evaluation demonstrates that the child requires intensive intervention without 24-hour
136.22medical monitoring. The commissioner shall update the list of approved level of care
136.23instruments tools annually and publish on the department's Web site.
136.24(c) The individual treatment plan must be:
136.25(1) based on the information in the client's diagnostic assessment;
136.26(2) developed through a child-centered, family driven planning process that identifies
136.27service needs and individualized, planned, and culturally appropriate interventions that
136.28contain specific measurable treatment goals and objectives for the client and treatment
136.29strategies for the client's family and foster family;
136.30(3) reviewed at least once every 90 days and revised; and
136.31(4) signed by the client or, if appropriate, by the client's parent or other person
136.32authorized by statute to consent to mental health services for the client.
136.33    Subd. 3. Eligible mental health services providers. (a) Eligible providers for
136.34intensive children's mental health services in a foster family setting must be certified
136.35by the state and have a service provision contract with a county board or a reservation
137.1tribal council and must be able to demonstrate the ability to provide all of the services
137.2required in this section.
137.3(b) For purposes of this section, a provider agency must have an individual
137.4placement agreement for each recipient and must be a licensed child placing agency, under
137.5Minnesota Rules, parts 9543.0010 to 9543.0150, and either be:
137.6(1) a county county-operated entity certified by the state;
137.7(2) an Indian Health Services facility operated by a tribe or tribal organization under
137.8funding authorized by United States Code, title 25, sections 450f to 450n, or title 3 of the
137.9Indian Self-Determination Act, Public Law 93-638, section 638 (facilities or providers); or
137.10(3) a noncounty entity under contract with a county board.
137.11(c) Certified providers that do not meet the service delivery standards required in
137.12this section shall be subject to a decertification process.
137.13(d) For the purposes of this section, all services delivered to a client must be
137.14provided by a mental health professional or a clinical trainee.
137.15    Subd. 4. Eligible provider responsibilities Service delivery payment
137.16requirements. (a) To be an eligible provider for payment under this section, a provider
137.17must develop and practice written policies and procedures for treatment foster care services
137.18 intensive treatment in foster care, consistent with subdivision 1, paragraph (b), clauses (1),
137.19(2), and (3) and comply with the following requirements in paragraphs (b) to (n).
137.20(b) In delivering services under this section, a treatment foster care provider must
137.21ensure that staff caseload size reasonably enables the provider to play an active role in
137.22service planning, monitoring, delivering, and reviewing for discharge planning to meet
137.23the needs of the client, the client's foster family, and the birth family, as specified in each
137.24client's individual treatment plan.
137.25(b) A qualified clinical supervisor, as defined in and performing in compliance with
137.26Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
137.27provision of services described in this section.
137.28(c) Each client receiving treatment services must receive an extended diagnostic
137.29assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within
137.3030 days of enrollment in this service unless the client has a previous extended diagnostic
137.31assessment that the client, parent, and mental health professional agree still accurately
137.32describes the client's current mental health functioning.
137.33(d) Each previous and current mental health, school, and physical health treatment
137.34provider must be contacted to request documentation of treatment and assessments that the
137.35eligible client has received and this information must be reviewed and incorporated into
137.36the diagnostic assessment and team consultation and treatment planning review process.
138.1(e) Each client receiving treatment must be assessed for a trauma history and
138.2the client's treatment plan must document how the results of the assessment will be
138.3incorporated into treatment.
138.4(f) Each client receiving treatment services must have an individual treatment plan
138.5that is reviewed, evaluated, and signed every 90 days using the team consultation and
138.6treatment planning process, as defined in subdivision 1a, paragraph (s).
138.7(g) Care consultation, as defined in subdivision 1a, paragraph (a), must be provided
138.8in accordance with the client's individual treatment plan.
138.9(h) Each client must have a crisis assistance plan within ten days of initiating
138.10services and must have access to clinical phone support 24 hours per day, seven days per
138.11week, during the course of treatment, and the crisis plan must demonstrate coordination
138.12with the local or regional mobile crisis intervention team.
138.13(i) Services must be delivered and documented at least three days per week, equaling
138.14at least six hours of treatment per week, unless reduced units of service are specified on
138.15the treatment plan as part of transition or on a discharge plan to another service or level of
138.16care. Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
138.17(j) Location of service delivery must be in the client's home, day care setting,
138.18school, or other community-based setting that is specified on the client's individualized
138.19treatment plan.
138.20(k) Treatment must be developmentally and culturally appropriate for the client.
138.21(l) Services must be delivered in continual collaboration and consultation with the
138.22client's medical providers and, in particular, with prescribers of psychotropic medications,
138.23including those prescribed on an off-label basis, and members of the service team must be
138.24aware of the medication regimen and potential side effects.
138.25(m) Parents, siblings, foster parents, and members of the child's permanency plan
138.26must be involved in treatment and service delivery unless otherwise noted in the treatment
138.27plan.
138.28(n) Transition planning for the child must be conducted starting with the first
138.29treatment plan and must be addressed throughout treatment to support the child's
138.30permanency plan and postdischarge mental health service needs.
138.31    Subd. 5. Service authorization. The commissioner will administer authorizations
138.32for services under this section in compliance with section 256B.0625, subdivision 25.
138.33    Subd. 6. Excluded services. (a) Services in clauses (1) to (4) (7) are not covered
138.34under this section and are not eligible for medical assistance payment as components of
138.35intensive treatment in foster care services, but may be billed separately:
139.1(1) treatment foster care services provided in violation of medical assistance policy
139.2in Minnesota Rules, part 9505.0220;
139.3(2) service components of children's therapeutic services and supports
139.4simultaneously provided by more than one treatment foster care provider;
139.5(3) home and community-based waiver services; and
139.6(4) treatment foster care services provided to a child without a level of care
139.7determination according to section 245.4885, subdivision 1.
139.8(1) inpatient psychiatric hospital treatment;
139.9(2) mental health targeted case management;
139.10(3) partial hospitalization;
139.11(4) medication management;
139.12(5) children's mental health day treatment services;
139.13(6) crisis response services under section 256B.0944; and
139.14(7) transportation.
139.15(b) Children receiving intensive treatment in foster care services are not eligible for
139.16medical assistance reimbursement for the following services while receiving intensive
139.17treatment in foster care:
139.18(1) mental health case management services under section 256B.0625, subdivision
139.1920 ; and
139.20(2) (1) psychotherapy and skill skills training components of children's therapeutic
139.21services and supports under section 256B.0625, subdivision 35b.;
139.22(2) mental health behavioral aide services as defined in section 256B.0943,
139.23subdivision 1, paragraph (m);
139.24(3) home and community-based waiver services;
139.25(4) mental health residential treatment; and
139.26(5) room and board costs as defined in section 256I.03, subdivision 6.
139.27    Subd. 7. Medical assistance payment and rate setting. The commissioner shall
139.28establish a single daily per-client encounter rate for intensive treatment in foster care
139.29services. The rate must be constructed to cover only eligible services delivered to an
139.30eligible recipient by an eligible provider, as prescribed in subdivision 1, paragraph (b).

139.31    Sec. 12. Minnesota Statutes 2012, section 256B.49, is amended by adding a
139.32subdivision to read:
139.33    Subd. 24. Waiver allocations for transition populations. (a) The commissioner
139.34shall make available additional waiver allocations and additional necessary resources
140.1to assure timely discharges from the Anoka Metro Regional Treatment Center and the
140.2Minnesota Security Hospital in St. Peter for individuals who meet the following criteria:
140.3(1) are otherwise eligible for the brain injury, community alternatives for disabled
140.4individuals, or community alternative care waivers under this section;
140.5(2) who would otherwise remain at the Anoka Metro Regional Treatment Center or
140.6the Minnesota Security Hospital;
140.7(3) whose discharge would be significantly delayed without the available waiver
140.8allocation; and
140.9(4) who have met treatment objectives and no longer meet hospital level of care.
140.10(b) Additional waiver allocations under this subdivision must meet cost-effectiveness
140.11requirements of the federal approved waiver plan.
140.12(c) Any corporate foster care home developed under this subdivision must be
140.13considered an exception under section 245A.03, subdivision 7, paragraph (a).

140.14    Sec. 13. Minnesota Statutes 2012, section 256B.761, is amended to read:
140.15256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
140.16(a) Effective for services rendered on or after July 1, 2001, payment for medication
140.17management provided to psychiatric patients, outpatient mental health services, day
140.18treatment services, home-based mental health services, and family community support
140.19services shall be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the
140.2050th percentile of 1999 charges.
140.21(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
140.22services provided by an entity that operates: (1) a Medicare-certified comprehensive
140.23outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1,
140.241993, with at least 33 percent of the clients receiving rehabilitation services in the most
140.25recent calendar year who are medical assistance recipients, will be increased by 38 percent,
140.26when those services are provided within the comprehensive outpatient rehabilitation
140.27facility and provided to residents of nursing facilities owned by the entity.
140.28(c) The commissioner shall establish three levels of payment for mental health
140.29diagnostic assessment, based on three levels of complexity. The aggregate payment under
140.30the tiered rates must not exceed the projected aggregate payments for mental health
140.31diagnostic assessment under the previous single rate. The new rate structure is effective
140.32January 1, 2011, or upon federal approval, whichever is later.
140.33(d) In addition to rate increases otherwise provided, the commissioner may
140.34restructure coverage policy and rates to improve access to adult rehabilitative mental
140.35health services under section 256B.0623 and related mental health support services under
141.1section 256B.021, subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and
141.22016, the projected state share of increased costs due to this paragraph is transferred
141.3from adult mental health grants under sections 245.4661 and 256E.12. The transfer for
141.4fiscal year 2016 is a permanent base adjustment for subsequent fiscal years. Payments
141.5made to managed care plans and county-based purchasing plans under sections 256B.69,
141.6256B.692, and 256L.12 shall reflect the rate changes described in this paragraph.


141.9    Section 1. Minnesota Statutes 2012, section 243.166, subdivision 7, is amended to read:
141.10    Subd. 7. Use of data. (a) Except as otherwise provided in subdivision 7a or sections
141.11244.052 and 299C.093, the data provided under this section is private data on individuals
141.12under section 13.02, subdivision 12.
141.13(b) The data may be used only for by law enforcement and corrections agencies for
141.14 law enforcement and corrections purposes.
141.15(c) The commissioner of human services is authorized to have access to the data for:
141.16(1) state-operated services, as defined in section 246.014, are also authorized to
141.17have access to the data for the purposes described in section 246.13, subdivision 2,
141.18paragraph (b); and
141.19(2) purposes of completing background studies under chapter 245C.

141.20    Sec. 2. Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision
141.21to read:
141.22    Subd. 4a. Agency background studies. (a) The commissioner shall develop
141.23and implement an electronic process for the regular transfer of new criminal history
141.24information that is added to the Minnesota court information system. The commissioner's
141.25system must include for review only information that relates to individuals who have been
141.26the subject of a background study under this chapter that remain affiliated with the agency
141.27that initiated the background study. For purposes of this paragraph, an individual remains
141.28affiliated with an agency that initiated the background study until the agency informs the
141.29commissioner that the individual is no longer affiliated. When any individual no longer
141.30affiliated according to this paragraph returns to a position requiring a background study
141.31under this chapter, the agency with whom the individual is again affiliated shall initiate
141.32a new background study regardless of the length of time the individual was no longer
141.33affiliated with the agency.
142.1(b) The commissioner shall develop and implement an online system for agencies that
142.2initiate background studies under this chapter to access and maintain records of background
142.3studies initiated by that agency. The system must show all active background study subjects
142.4affiliated with that agency and the status of each individual's background study. Each
142.5agency that initiates background studies must use this system to notify the commissioner
142.6of discontinued affiliation for purposes of the processes required under paragraph (a).

142.7    Sec. 3. Minnesota Statutes 2012, section 245C.08, subdivision 1, is amended to read:
142.8    Subdivision 1. Background studies conducted by Department of Human
142.9Services. (a) For a background study conducted by the Department of Human Services,
142.10the commissioner shall review:
142.11    (1) information related to names of substantiated perpetrators of maltreatment of
142.12vulnerable adults that has been received by the commissioner as required under section
142.13626.557, subdivision 9c , paragraph (j);
142.14    (2) the commissioner's records relating to the maltreatment of minors in licensed
142.15programs, and from findings of maltreatment of minors as indicated through the social
142.16service information system;
142.17    (3) information from juvenile courts as required in subdivision 4 for individuals
142.18listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
142.19    (4) information from the Bureau of Criminal Apprehension, including information
142.20regarding a background study subject's registration in Minnesota as a predatory offender
142.21under section 243.166;
142.22    (5) except as provided in clause (6), information from the national crime information
142.23system when the commissioner has reasonable cause as defined under section 245C.05,
142.24subdivision 5; and
142.25    (6) for a background study related to a child foster care application for licensure or
142.26adoptions, the commissioner shall also review:
142.27    (i) information from the child abuse and neglect registry for any state in which the
142.28background study subject has resided for the past five years; and
142.29    (ii) information from national crime information databases, when the background
142.30study subject is 18 years of age or older.
142.31    (b) Notwithstanding expungement by a court, the commissioner may consider
142.32information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
142.33received notice of the petition for expungement and the court order for expungement is
142.34directed specifically to the commissioner.
143.1    (c) The commissioner shall also review criminal history information received
143.2according to section 245C.04, subdivision 4a, from the Minnesota court information
143.3system that relates to individuals who have already been studied under this chapter and
143.4who remain affiliated with the agency that initiated the background study.

143.5    Sec. 4. Minnesota Statutes 2012, section 256B.04, subdivision 21, is amended to read:
143.6    Subd. 21. Provider enrollment. (a) If the commissioner or the Centers for
143.7Medicare and Medicaid Services determines that a provider is designated "high-risk," the
143.8commissioner may withhold payment from providers within that category upon initial
143.9enrollment for a 90-day period. The withholding for each provider must begin on the date
143.10of the first submission of a claim.
143.11(b) An enrolled provider that is also licensed by the commissioner under chapter
143.12245A must designate an individual as the entity's compliance officer. The compliance
143.13officer must:
143.14(1) develop policies and procedures to assure adherence to medical assistance laws
143.15and regulations and to prevent inappropriate claims submissions;
143.16(2) train the employees of the provider entity, and any agents or subcontractors of
143.17the provider entity including billers, on the policies and procedures under clause (1);
143.18(3) respond to allegations of improper conduct related to the provision or billing of
143.19medical assistance services, and implement action to remediate any resulting problems;
143.20(4) use evaluation techniques to monitor compliance with medical assistance laws
143.21and regulations;
143.22(5) promptly report to the commissioner any identified violations of medical
143.23assistance laws or regulations; and
143.24    (6) within 60 days of discovery by the provider of a medical assistance
143.25reimbursement overpayment, report the overpayment to the commissioner and make
143.26arrangements with the commissioner for the commissioner's recovery of the overpayment.
143.27The commissioner may require, as a condition of enrollment in medical assistance, that a
143.28provider within a particular industry sector or category establish a compliance program that
143.29contains the core elements established by the Centers for Medicare and Medicaid Services.
143.30(c) The commissioner may revoke the enrollment of an ordering or rendering
143.31provider for a period of not more than one year, if the provider fails to maintain and, upon
143.32request from the commissioner, provide access to documentation relating to written orders
143.33or requests for payment for durable medical equipment, certifications for home health
143.34services, or referrals for other items or services written or ordered by such provider, when
143.35the commissioner has identified a pattern of a lack of documentation. A pattern means a
144.1failure to maintain documentation or provide access to documentation on more than one
144.2occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
144.3provider under the provisions of section 256B.064.
144.4(d) The commissioner shall terminate or deny the enrollment of any individual or
144.5entity if the individual or entity has been terminated from participation in Medicare or
144.6under the Medicaid program or Children's Health Insurance Program of any other state.
144.7(e) As a condition of enrollment in medical assistance, the commissioner shall
144.8require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
144.9and Medicaid Services or the Minnesota Department of Human Services commissioner
144.10 permit the Centers for Medicare and Medicaid Services, its agents, or its designated
144.11contractors and the state agency, its agents, or its designated contractors to conduct
144.12unannounced on-site inspections of any provider location. The commissioner shall publish
144.13in the Minnesota Health Care Program Provider Manual a list of provider types designated
144.14"limited," "moderate," or "high-risk," based on the criteria and standards used to designate
144.15Medicare providers in Code of Federal Regulations, title 42, section 424.518. The list and
144.16criteria are not subject to the requirements of chapter 14. The commissioner's designations
144.17are not subject to administrative appeal.
144.18(f) As a condition of enrollment in medical assistance, the commissioner shall
144.19require that a high-risk provider, or a person with a direct or indirect ownership interest in
144.20the provider of five percent or higher, consent to criminal background checks, including
144.21fingerprinting, when required to do so under state law or by a determination by the
144.22commissioner or the Centers for Medicare and Medicaid Services that a provider is
144.23designated high-risk for fraud, waste, or abuse.
144.24(g) As a condition of enrollment, all durable medical equipment, prosthetics,
144.25orthotics, and supplies (DMEPOS) suppliers operating in Minnesota are required to name
144.26the Department of Human Services, in addition to the Centers for Medicare and Medicaid
144.27Services, as an obligee on all surety performance bonds required pursuant to section
144.284312(a) of the Balanced Budget Act of 1997, Public Law 105-33, amending Social
144.29Security Act, section 1834(a). The performance bond must also allow for recovery of
144.30costs and fees in pursuing a claim on the bond.
144.31(h) The Department of Human Services may require a provider to purchase a
144.32performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
144.33or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
144.34department determines there is significant evidence of or potential for fraud and abuse by
144.35the provider, or (3) the provider or category of providers is designated high-risk pursuant
144.36to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450, or the
145.1department otherwise finds it is in the best interest of the Medicaid program to do so. The
145.2performance bond must be in an amount of $100,000 or ten percent of the provider's
145.3payments from Medicaid during the immediately preceding 12 months, whichever is
145.4greater. The performance bond must name the Department of Human Services as an
145.5obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.
145.6EFFECTIVE DATE.This section is effective the day following final enactment.

145.7    Sec. 5. Minnesota Statutes 2012, section 256B.04, is amended by adding a subdivision
145.8to read:
145.9    Subd. 22. Application fee. (a) The commissioner must collect and retain federally
145.10required nonrefundable application fees to pay for provider screening activities in
145.11accordance with Code of Federal Regulations, title 42, section 455, subpart E. The
145.12enrollment application must be made under the procedures specified by the commissioner,
145.13in the form specified by the commissioner, and accompanied by an application fee
145.14described in paragraph (b), or a request for a hardship exception as described in the
145.15specified procedures. Application fees must be deposited in the provider screening account
145.16in the special revenue fund. Amounts in the provider screening account are appropriated
145.17to the commissioner for costs associated with the provider screening activities required
145.18in Code of Federal Regulations, title 42, section 455, subpart E. The commissioner
145.19shall conduct screening activities as required by Code of Federal Regulations, title 42,
145.20section 455, subpart E, and as otherwise provided by law, to include database checks,
145.21unannounced pre- and postenrollment site visits, fingerprinting, and criminal background
145.22studies. The commissioner must revalidate all providers under this subdivision at least
145.23once every five years.
145.24(b) The application fee under this subdivision is $532 for the calendar year 2013.
145.25For calendar year 2014 and subsequent years, the fee:
145.26(1) is adjusted by the percentage change to the consumer price index for all urban
145.27consumers, United States city average, for the 12-month period ending with June of the
145.28previous year. The resulting fee must be announced in the Federal Register;
145.29(2) is effective from January 1 to December 31 of a calendar year;
145.30(3) is required on the submission of an initial application, an application to establish
145.31a new practice location, an application for re-enrollment when the provider is not enrolled
145.32at the time of application of re-enrollment, or at revalidation when required by federal
145.33regulation; and
145.34(4) must be in the amount in effect for the calendar year during which the application
145.35for enrollment, new practice location, or re-enrollment is being submitted.
146.1(c) The application fee under this subdivision cannot be charged to:
146.2(1) providers who are enrolled in Medicare or who provide documentation of
146.3payment of the fee to, and enrollment with, another state;
146.4(2) providers who are enrolled but are required to submit new applications for
146.5purposes of re-enrollment; or
146.6(3) a provider who enrolls as an individual.
146.7EFFECTIVE DATE.This section is effective the day following final enactment.

146.8    Sec. 6. Minnesota Statutes 2012, section 256B.064, subdivision 1a, is amended to read:
146.9    Subd. 1a. Grounds for sanctions against vendors. The commissioner may
146.10impose sanctions against a vendor of medical care for any of the following: (1) fraud,
146.11theft, or abuse in connection with the provision of medical care to recipients of public
146.12assistance; (2) a pattern of presentment of false or duplicate claims or claims for services
146.13not medically necessary; (3) a pattern of making false statements of material facts for
146.14the purpose of obtaining greater compensation than that to which the vendor is legally
146.15entitled; (4) suspension or termination as a Medicare vendor; (5) refusal to grant the state
146.16agency access during regular business hours to examine all records necessary to disclose
146.17the extent of services provided to program recipients and appropriateness of claims for
146.18payment; (6) failure to repay an overpayment or a fine finally established under this
146.19section; and (7) failure to correct errors in the maintenance of health service or financial
146.20records for which a fine was imposed or after issuance of a warning by the commissioner;
146.21and (8) any reason for which a vendor could be excluded from participation in the
146.22Medicare program under section 1128, 1128A, or 1866(b)(2) of the Social Security Act.
146.23The determination of services not medically necessary may be made by the commissioner
146.24in consultation with a peer advisory task force appointed by the commissioner on the
146.25recommendation of appropriate professional organizations. The task force expires as
146.26provided in section 15.059, subdivision 5.

146.27    Sec. 7. Minnesota Statutes 2012, section 256B.064, subdivision 1b, is amended to read:
146.28    Subd. 1b. Sanctions available. The commissioner may impose the following
146.29sanctions for the conduct described in subdivision 1a: suspension or withholding of
146.30payments to a vendor and suspending or terminating participation in the program, or
146.31imposition of a fine under subdivision 2, paragraph (f). When imposing sanctions under
146.32this section, the commissioner shall consider the nature, chronicity, or severity of the
146.33conduct and the effect of the conduct on the health and safety of persons served by the
147.1vendor. Regardless of imposition of sanctions, the commissioner may make a referral
147.2to the appropriate state licensing board.

147.3    Sec. 8. Minnesota Statutes 2012, section 256B.064, subdivision 2, is amended to read:
147.4    Subd. 2. Imposition of monetary recovery and sanctions. (a) The commissioner
147.5shall determine any monetary amounts to be recovered and sanctions to be imposed upon
147.6a vendor of medical care under this section. Except as provided in paragraphs (b) and
147.7(d), neither a monetary recovery nor a sanction will be imposed by the commissioner
147.8without prior notice and an opportunity for a hearing, according to chapter 14, on the
147.9commissioner's proposed action, provided that the commissioner may suspend or reduce
147.10payment to a vendor of medical care, except a nursing home or convalescent care facility,
147.11after notice and prior to the hearing if in the commissioner's opinion that action is
147.12necessary to protect the public welfare and the interests of the program.
147.13(b) Except when the commissioner finds good cause not to suspend payments under
147.14Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
147.15withhold or reduce payments to a vendor of medical care without providing advance
147.16notice of such withholding or reduction if either of the following occurs:
147.17(1) the vendor is convicted of a crime involving the conduct described in subdivision
147.181a; or
147.19(2) the commissioner determines there is a credible allegation of fraud for which an
147.20investigation is pending under the program. A credible allegation of fraud is an allegation
147.21which has been verified by the state, from any source, including but not limited to:
147.22(i) fraud hotline complaints;
147.23(ii) claims data mining; and
147.24(iii) patterns identified through provider audits, civil false claims cases, and law
147.25enforcement investigations.
147.26Allegations are considered to be credible when they have an indicia of reliability
147.27and the state agency has reviewed all allegations, facts, and evidence carefully and acts
147.28judiciously on a case-by-case basis.
147.29(c) The commissioner must send notice of the withholding or reduction of payments
147.30under paragraph (b) within five days of taking such action unless requested in writing by a
147.31law enforcement agency to temporarily withhold the notice. The notice must:
147.32(1) state that payments are being withheld according to paragraph (b);
147.33(2) set forth the general allegations as to the nature of the withholding action, but
147.34need not disclose any specific information concerning an ongoing investigation;
148.1(3) except in the case of a conviction for conduct described in subdivision 1a, state
148.2that the withholding is for a temporary period and cite the circumstances under which
148.3withholding will be terminated;
148.4(4) identify the types of claims to which the withholding applies; and
148.5(5) inform the vendor of the right to submit written evidence for consideration by
148.6the commissioner.
148.7The withholding or reduction of payments will not continue after the commissioner
148.8determines there is insufficient evidence of fraud by the vendor, or after legal proceedings
148.9relating to the alleged fraud are completed, unless the commissioner has sent notice of
148.10intention to impose monetary recovery or sanctions under paragraph (a).
148.11(d) The commissioner shall suspend or terminate a vendor's participation in the
148.12program without providing advance notice and an opportunity for a hearing when the
148.13suspension or termination is required because of the vendor's exclusion from participation
148.14in Medicare. Within five days of taking such action, the commissioner must send notice of
148.15the suspension or termination. The notice must:
148.16(1) state that suspension or termination is the result of the vendor's exclusion from
148.17Medicare;
148.18(2) identify the effective date of the suspension or termination; and
148.19(3) inform the vendor of the need to be reinstated to Medicare before reapplying
148.20for participation in the program.
148.21(e) Upon receipt of a notice under paragraph (a) that a monetary recovery or
148.22sanction is to be imposed, a vendor may request a contested case, as defined in section
148.2314.02, subdivision 3 , by filing with the commissioner a written request of appeal. The
148.24appeal request must be received by the commissioner no later than 30 days after the date
148.25the notification of monetary recovery or sanction was mailed to the vendor. The appeal
148.26request must specify:
148.27(1) each disputed item, the reason for the dispute, and an estimate of the dollar
148.28amount involved for each disputed item;
148.29(2) the computation that the vendor believes is correct;
148.30(3) the authority in statute or rule upon which the vendor relies for each disputed item;
148.31(4) the name and address of the person or entity with whom contacts may be made
148.32regarding the appeal; and
148.33(5) other information required by the commissioner.
148.34(f) The commissioner may order a vendor to forfeit a fine for failure to fully
148.35document services according to standards in this chapter and Minnesota Rules, chapter
148.369505. Fines may be assessed when the commissioner has no evidence that services were
149.1not provided and services are partially documented in the health service or financial
149.2record, but specific required components of documentation are missing. The fine for
149.3incomplete documentation shall equal 20 percent of the amount paid on the claims for
149.4reimbursement submitted by the vendor, or up to $5,000, whichever is less.
149.5(g) The vendor shall pay the fine assessed on or before the payment date specified. If
149.6the vendor fails to pay the fine, the commissioner may withhold or reduce payments and
149.7recover the amount of the fine. A timely appeal shall stay payment of the fine until the
149.8commissioner issues a final order.

149.9    Sec. 9. Minnesota Statutes 2012, section 256B.0659, subdivision 21, is amended to read:
149.10    Subd. 21. Requirements for initial enrollment of personal care assistance
149.11provider agencies. (a) All personal care assistance provider agencies must provide, at the
149.12time of enrollment as a personal care assistance provider agency in a format determined
149.13by the commissioner, information and documentation that includes, but is not limited to,
149.14the following:
149.15    (1) the personal care assistance provider agency's current contact information
149.16including address, telephone number, and e-mail address;
149.17    (2) proof of surety bond coverage in the amount of $50,000 $100,000 or ten percent
149.18of the provider's payments from Medicaid in the previous year, whichever is less more.
149.19The performance bond must be in a form approved by the commissioner, must be renewed
149.20annually, and must allow for recovery of costs and fees in pursuing a claim on the bond;
149.21    (3) proof of fidelity bond coverage in the amount of $20,000;
149.22    (4) proof of workers' compensation insurance coverage;
149.23    (5) proof of liability insurance;
149.24    (6) a description of the personal care assistance provider agency's organization
149.25identifying the names of all owners, managing employees, staff, board of directors, and
149.26the affiliations of the directors, owners, or staff to other service providers;
149.27    (7) a copy of the personal care assistance provider agency's written policies and
149.28procedures including: hiring of employees; training requirements; service delivery;
149.29and employee and consumer safety including process for notification and resolution
149.30of consumer grievances, identification and prevention of communicable diseases, and
149.31employee misconduct;
149.32    (8) copies of all other forms the personal care assistance provider agency uses in
149.33the course of daily business including, but not limited to:
149.34    (i) a copy of the personal care assistance provider agency's time sheet if the time
149.35sheet varies from the standard time sheet for personal care assistance services approved
150.1by the commissioner, and a letter requesting approval of the personal care assistance
150.2provider agency's nonstandard time sheet;
150.3    (ii) the personal care assistance provider agency's template for the personal care
150.4assistance care plan; and
150.5    (iii) the personal care assistance provider agency's template for the written
150.6agreement in subdivision 20 for recipients using the personal care assistance choice
150.7option, if applicable;
150.8    (9) a list of all training and classes that the personal care assistance provider agency
150.9requires of its staff providing personal care assistance services;
150.10    (10) documentation that the personal care assistance provider agency and staff have
150.11successfully completed all the training required by this section;
150.12    (11) documentation of the agency's marketing practices;
150.13    (12) disclosure of ownership, leasing, or management of all residential properties
150.14that is used or could be used for providing home care services;
150.15    (13) documentation that the agency will use the following percentages of revenue
150.16generated from the medical assistance rate paid for personal care assistance services
150.17for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
150.18personal care assistance choice option and 72.5 percent of revenue from other personal
150.19care assistance providers. The revenue generated by the qualified professional and the
150.20reasonable costs associated with the qualified professional shall not be used in making
150.21this calculation; and
150.22    (14) effective May 15, 2010, documentation that the agency does not burden
150.23recipients' free exercise of their right to choose service providers by requiring personal
150.24care assistants to sign an agreement not to work with any particular personal care
150.25assistance recipient or for another personal care assistance provider agency after leaving
150.26the agency and that the agency is not taking action on any such agreements or requirements
150.27regardless of the date signed.
150.28    (b) Personal care assistance provider agencies shall provide the information specified
150.29in paragraph (a) to the commissioner at the time the personal care assistance provider
150.30agency enrolls as a vendor or upon request from the commissioner. The commissioner
150.31shall collect the information specified in paragraph (a) from all personal care assistance
150.32providers beginning July 1, 2009.
150.33    (c) All personal care assistance provider agencies shall require all employees in
150.34management and supervisory positions and owners of the agency who are active in the
150.35day-to-day management and operations of the agency to complete mandatory training
150.36as determined by the commissioner before enrollment of the agency as a provider.
151.1Employees in management and supervisory positions and owners who are active in
151.2the day-to-day operations of an agency who have completed the required training as
151.3an employee with a personal care assistance provider agency do not need to repeat
151.4the required training if they are hired by another agency, if they have completed the
151.5training within the past three years. By September 1, 2010, the required training must
151.6be available with meaningful access according to title VI of the Civil Rights Act and
151.7federal regulations adopted under that law or any guidance from the United States Health
151.8and Human Services Department. The required training must be available online or by
151.9electronic remote connection. The required training must provide for competency testing.
151.10Personal care assistance provider agency billing staff shall complete training about
151.11personal care assistance program financial management. This training is effective July 1,
151.122009. Any personal care assistance provider agency enrolled before that date shall, if it
151.13has not already, complete the provider training within 18 months of July 1, 2009. Any new
151.14owners or employees in management and supervisory positions involved in the day-to-day
151.15operations are required to complete mandatory training as a requisite of working for the
151.16agency. Personal care assistance provider agencies certified for participation in Medicare
151.17as home health agencies are exempt from the training required in this subdivision. When
151.18available, Medicare-certified home health agency owners, supervisors, or managers must
151.19successfully complete the competency test.
151.20EFFECTIVE DATE.This section is effective the day following final enactment.


151.23    Section 1. Minnesota Statutes 2012, section 256.9657, subdivision 2, is amended to read:
151.24    Subd. 2. Hospital surcharge. (a) Effective October 1, 1992, each Minnesota
151.25hospital except facilities of the federal Indian Health Service and regional treatment
151.26centers shall pay to the medical assistance account a surcharge equal to 1.4 percent of net
151.27patient revenues excluding net Medicare revenues reported by that provider to the health
151.28care cost information system according to the schedule in subdivision 4.
151.29(b) Effective July 1, 1994, the surcharge under paragraph (a) is increased to 1.56
151.30percent.
151.31(c) Effective July 1, 2013, the surcharge under paragraph (b) is increased to 2.63
151.32percent for all nongovernment-owned hospitals.
151.33(d) Notwithstanding the Medicare cost finding and allowable cost principles, the
151.34hospital surcharge is not an allowable cost for purposes of rate setting under sections
151.35256.9685 to 256.9695.
152.1EFFECTIVE DATE.This section is effective July 1, 2013.

152.2    Sec. 2. Minnesota Statutes 2012, section 256.9685, subdivision 2, is amended to read:
152.3    Subd. 2. Federal requirements. (a) If it is determined that a provision of this
152.4section or section 256.9686, 256.969, or 256.9695 conflicts with existing or future
152.5requirements of the United States government with respect to federal financial participation
152.6in medical assistance, the federal requirements prevail. The commissioner may, in the
152.7aggregate, prospectively and retrospectively, reduce payment rates and payments to avoid
152.8reduced federal financial participation resulting from rates and payments determined by
152.9the commissioner that are in excess of the Medicare upper payment limitations.
152.10(b) For rates and payments determined by the commissioner to be in excess of the
152.11Medicare upper payment limits for the nongovernment-owned limit category, rates and
152.12payments shall be reduced to the limits according to clauses (1) to (4):
152.13(1) rates and payments under section 256.969, subdivision 3a, paragraph (j), shall be
152.14reduced proportionately;
152.15(2) if rates and payments remain above the limit, medical education payments under
152.16section 62J.692, subdivision 8, shall be the first reduction for the government-owned
152.17limit category;
152.18(3) if rates and payments remain above the limit, rates and payments not included
152.19under clause (1) shall be reduced in total; and
152.20(4) the state share of payments under clauses (1) and (2) shall be returned to the
152.21hospital.

152.22    Sec. 3. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
152.23    Subd. 3a. Payments. (a) Acute care hospital billings under the medical
152.24assistance program must not be submitted until the recipient is discharged. However,
152.25the commissioner shall establish monthly interim payments for inpatient hospitals that
152.26have individual patient lengths of stay over 30 days regardless of diagnostic category.
152.27Except as provided in section 256.9693, medical assistance reimbursement for treatment
152.28of mental illness shall be reimbursed based on diagnostic classifications. Individual
152.29hospital payments established under this section and sections 256.9685, 256.9686, and
152.30256.9695 , in addition to third-party and recipient liability, for discharges occurring during
152.31the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
152.32inpatient services paid for the same period of time to the hospital. This payment limitation
152.33shall be calculated separately for medical assistance and general assistance medical
152.34care services. The limitation on general assistance medical care shall be effective for
153.1admissions occurring on or after July 1, 1991. Services that have rates established under
153.2subdivision 11 or 12, must be limited separately from other services. After consulting with
153.3the affected hospitals, the commissioner may consider related hospitals one entity and
153.4may merge the payment rates while maintaining separate provider numbers. The operating
153.5and property base rates per admission or per day shall be derived from the best Medicare
153.6and claims data available when rates are established. The commissioner shall determine
153.7the best Medicare and claims data, taking into consideration variables of recency of the
153.8data, audit disposition, settlement status, and the ability to set rates in a timely manner.
153.9The commissioner shall notify hospitals of payment rates by December 1 of the year
153.10preceding the rate year. The rate setting data must reflect the admissions data used to
153.11establish relative values. Base year changes from 1981 to the base year established for the
153.12rate year beginning January 1, 1991, and for subsequent rate years, shall not be limited
153.13to the limits ending June 30, 1987, on the maximum rate of increase under subdivision
153.141. The commissioner may adjust base year cost, relative value, and case mix index data
153.15to exclude the costs of services that have been discontinued by the October 1 of the year
153.16preceding the rate year or that are paid separately from inpatient services. Inpatient stays
153.17that encompass portions of two or more rate years shall have payments established based
153.18on payment rates in effect at the time of admission unless the date of admission preceded
153.19the rate year in effect by six months or more. In this case, operating payment rates for
153.20services rendered during the rate year in effect and established based on the date of
153.21admission shall be adjusted to the rate year in effect by the hospital cost index.
153.22    (b) For fee-for-service admissions occurring on or after July 1, 2002, the total
153.23payment, before third-party liability and spenddown, made to hospitals for inpatient
153.24services is reduced by .5 percent from the current statutory rates.
153.25    (c) In addition to the reduction in paragraph (b), the total payment for fee-for-service
153.26admissions occurring on or after July 1, 2003, made to hospitals for inpatient services
153.27before third-party liability and spenddown, is reduced five percent from the current
153.28statutory rates. Mental health services within diagnosis related groups 424 to 432, and
153.29facilities defined under subdivision 16 are excluded from this paragraph.
153.30    (d) In addition to the reduction in paragraphs (b) and (c), the total payment for
153.31fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for
153.32inpatient services before third-party liability and spenddown, is reduced 6.0 percent
153.33from the current statutory rates. Mental health services within diagnosis related groups
153.34424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
153.35Notwithstanding section 256.9686, subdivision 7, for purposes of this paragraph, medical
153.36assistance does not include general assistance medical care. Payments made to managed
154.1care plans shall be reduced for services provided on or after January 1, 2006, to reflect
154.2this reduction.
154.3    (e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
154.4fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made
154.5to hospitals for inpatient services before third-party liability and spenddown, is reduced
154.63.46 percent from the current statutory rates. Mental health services with diagnosis related
154.7groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
154.8paragraph. Payments made to managed care plans shall be reduced for services provided
154.9on or after January 1, 2009, through June 30, 2009, to reflect this reduction.
154.10    (f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for
154.11fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made
154.12to hospitals for inpatient services before third-party liability and spenddown, is reduced
154.131.9 percent from the current statutory rates. Mental health services with diagnosis related
154.14groups 424 to 432 and facilities defined under subdivision 16 are excluded from this
154.15paragraph. Payments made to managed care plans shall be reduced for services provided
154.16on or after July 1, 2009, through June 30, 2011, to reflect this reduction.
154.17    (g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment
154.18for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for
154.19inpatient services before third-party liability and spenddown, is reduced 1.79 percent
154.20from the current statutory rates. Mental health services with diagnosis related groups
154.21424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.
154.22Payments made to managed care plans shall be reduced for services provided on or after
154.23July 1, 2011, to reflect this reduction.
154.24(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total
154.25payment for fee-for-service admissions occurring on or after July 1, 2009, made to
154.26hospitals for inpatient services before third-party liability and spenddown, is reduced
154.27one percent from the current statutory rates. Facilities defined under subdivision 16 are
154.28excluded from this paragraph. Payments made to managed care plans shall be reduced for
154.29services provided on or after October 1, 2009, to reflect this reduction.
154.30(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total
154.31payment for fee-for-service admissions occurring on or after July 1, 2011, made to
154.32hospitals for inpatient services before third-party liability and spenddown, is reduced
154.331.96 percent from the current statutory rates. Facilities defined under subdivision 16 are
154.34excluded from this paragraph. Payments made to managed care plans shall be reduced for
154.35services provided on or after January 1, 2011, to reflect this reduction.
155.1(j) In order to offset the rateable reductions provided for in this subdivision, the total
155.2payment rate for medical assistance admissions for nongovernment-owned hospitals
155.3occurring on or after July 1, 2013, made to Minnesota hospitals for inpatient services
155.4before third-party liability and spenddown, shall be increased by 30 percent from the
155.5current statutory rates. The commissioner shall not adjust rates paid to a prepaid health
155.6plan under contract with the commissioner to reflect payments provided in this paragraph.
155.7The commissioner shall adjust rates and payments in excess of the Medicare upper limits
155.8on payments according to section 256.9685, subdivision 2.
155.9EFFECTIVE DATE.This section is effective July 1, 2013.

155.10    Sec. 4. Minnesota Statutes 2012, section 256B.055, subdivision 14, is amended to read:
155.11    Subd. 14. Persons detained by law. (a) Medical assistance may be paid for an
155.12inmate of a correctional facility who is conditionally released as authorized under section
155.13241.26 , 244.065, or 631.425, if the individual does not require the security of a public
155.14detention facility and is housed in a halfway house or community correction center, or
155.15under house arrest and monitored by electronic surveillance in a residence approved
155.16by the commissioner of corrections, and if the individual meets the other eligibility
155.17requirements of this chapter.
155.18    (b) An individual who is enrolled in medical assistance, and who is charged with a
155.19crime and incarcerated for less than 12 months shall be suspended from eligibility at the
155.20time of incarceration until the individual is released. Upon release, medical assistance
155.21eligibility is reinstated without reapplication using a reinstatement process and form, if the
155.22individual is otherwise eligible.
155.23    (c) An individual, regardless of age, who is considered an inmate of a public
155.24institution as defined in Code of Federal Regulations, title 42, section 435.1010, and
155.25who meets the eligibility requirements in section 256B.056, is not eligible for medical
155.26assistance, except for covered services received while an inpatient in a medical institution
155.27as defined in the Code of Federal Regulations, title 42, section 435.1010. Security issues
155.28related to the inpatient treatment of an inmate are the responsibility of the entity with
155.29jurisdiction over the inmate. The non federal share of the cost of the services shall be paid
155.30by the entity with jurisdiction over the inmate.
155.31EFFECTIVE DATE.This section is effective January 1, 2014.

155.32    Sec. 5. Minnesota Statutes 2012, section 256B.06, subdivision 4, is amended to read:
156.1    Subd. 4. Citizenship requirements. (a) Eligibility for medical assistance is limited
156.2to citizens of the United States, qualified noncitizens as defined in this subdivision, and
156.3other persons residing lawfully in the United States. Citizens or nationals of the United
156.4States must cooperate in obtaining satisfactory documentary evidence of citizenship or
156.5nationality according to the requirements of the federal Deficit Reduction Act of 2005,
156.6Public Law 109-171.
156.7(b) "Qualified noncitizen" means a person who meets one of the following
156.8immigration criteria:
156.9(1) admitted for lawful permanent residence according to United States Code, title 8;
156.10(2) admitted to the United States as a refugee according to United States Code,
156.11title 8, section 1157;
156.12(3) granted asylum according to United States Code, title 8, section 1158;
156.13(4) granted withholding of deportation according to United States Code, title 8,
156.14section 1253(h);
156.15(5) paroled for a period of at least one year according to United States Code, title 8,
156.16section 1182(d)(5);
156.17(6) granted conditional entrant status according to United States Code, title 8,
156.18section 1153(a)(7);
156.19(7) determined to be a battered noncitizen by the United States Attorney General
156.20according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
156.21title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
156.22(8) is a child of a noncitizen determined to be a battered noncitizen by the United
156.23States Attorney General according to the Illegal Immigration Reform and Immigrant
156.24Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
156.25Public Law 104-200; or
156.26(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
156.27Law 96-422, the Refugee Education Assistance Act of 1980.
156.28(c) All qualified noncitizens who were residing in the United States before August
156.2922, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
156.30medical assistance with federal financial participation.
156.31(d) Beginning December 1, 1996, qualified noncitizens who entered the United
156.32States on or after August 22, 1996, and who otherwise meet the eligibility requirements
156.33of this chapter are eligible for medical assistance with federal participation for five years
156.34if they meet one of the following criteria:
156.35(1) refugees admitted to the United States according to United States Code, title 8,
156.36section 1157;
157.1(2) persons granted asylum according to United States Code, title 8, section 1158;
157.2(3) persons granted withholding of deportation according to United States Code,
157.3title 8, section 1253(h);
157.4(4) veterans of the United States armed forces with an honorable discharge for
157.5a reason other than noncitizen status, their spouses and unmarried minor dependent
157.6children; or
157.7(5) persons on active duty in the United States armed forces, other than for training,
157.8their spouses and unmarried minor dependent children.
157.9 Beginning July 1, 2010, children and pregnant women who are noncitizens
157.10described in paragraph (b) or who are lawfully present in the United States as defined
157.11in Code of Federal Regulations, title 8, section 103.12, and who otherwise meet
157.12eligibility requirements of this chapter, are eligible for medical assistance with federal
157.13financial participation as provided by the federal Children's Health Insurance Program
157.14Reauthorization Act of 2009, Public Law 111-3.
157.15(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
157.16are eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this
157.17subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
157.18Code, title 8, section 1101(a)(15).
157.19(f) Payment shall also be made for care and services that are furnished to noncitizens,
157.20regardless of immigration status, who otherwise meet the eligibility requirements of
157.21this chapter, if such care and services are necessary for the treatment of an emergency
157.22medical condition.
157.23(g) For purposes of this subdivision, the term "emergency medical condition" means
157.24a medical condition that meets the requirements of United States Code, title 42, section
157.251396b(v).
157.26(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment
157.27of an emergency medical condition are limited to the following:
157.28(i) services delivered in an emergency room or by an ambulance service licensed
157.29under chapter 144E that are directly related to the treatment of an emergency medical
157.30condition;
157.31(ii) services delivered in an inpatient hospital setting following admission from an
157.32emergency room or clinic for an acute emergency condition; and
157.33(iii) follow-up services that are directly related to the original service provided
157.34to treat the emergency medical condition and are covered by the global payment made
157.35to the provider.
157.36    (2) Services for the treatment of emergency medical conditions do not include:
158.1(i) services delivered in an emergency room or inpatient setting to treat a
158.2nonemergency condition;
158.3(ii) organ transplants, stem cell transplants, and related care;
158.4(iii) services for routine prenatal care;
158.5(iv) continuing care, including long-term care, nursing facility services, home health
158.6care, adult day care, day training, or supportive living services;
158.7(v) elective surgery;
158.8(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as
158.9part of an emergency room visit;
158.10(vii) preventative health care and family planning services;
158.11(viii) dialysis;
158.12(ix) chemotherapy or therapeutic radiation services;
158.13(x) (viii) rehabilitation services;
158.14(xi) (ix) physical, occupational, or speech therapy;
158.15(xii) (x) transportation services;
158.16(xiii) (xi) case management;
158.17(xiv) (xii) prosthetics, orthotics, durable medical equipment, or medical supplies;
158.18(xv) (xiii) dental services;
158.19(xvi) (xiv) hospice care;
158.20(xvii) (xv) audiology services and hearing aids;
158.21(xviii) (xvi) podiatry services;
158.22(xix) (xvii) chiropractic services;
158.23(xx) (xviii) immunizations;
158.24(xxi) (xix) vision services and eyeglasses;
158.25(xxii) (xx) waiver services;
158.26(xxiii) (xxi) individualized education programs; or
158.27(xxiv) (xxii) chemical dependency treatment.
158.28(i) Beginning July 1, 2009, pregnant noncitizens who are undocumented,
158.29nonimmigrants, or lawfully present in the United States as defined in Code of Federal
158.30Regulations, title 8, section 103.12, are not covered by a group health plan or health
158.31insurance coverage according to Code of Federal Regulations, title 42, section 457.310,
158.32and who otherwise meet the eligibility requirements of this chapter, are eligible for
158.33medical assistance through the period of pregnancy, including labor and delivery, and 60
158.34days postpartum, to the extent federal funds are available under title XXI of the Social
158.35Security Act, and the state children's health insurance program.
159.1(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation
159.2services from a nonprofit center established to serve victims of torture and are otherwise
159.3ineligible for medical assistance under this chapter are eligible for medical assistance
159.4without federal financial participation. These individuals are eligible only for the period
159.5during which they are receiving services from the center. Individuals eligible under this
159.6paragraph shall not be required to participate in prepaid medical assistance.
159.7(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
159.8emergency medical conditions under paragraph (f) except where coverage is prohibited
159.9under federal law:
159.10(1) dialysis services provided in a hospital or freestanding dialysis facility; and
159.11(2) surgery and the administration of chemotherapy, radiation, and related services
159.12necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission
159.13and requires surgery, chemotherapy, or radiation treatment.
159.14EFFECTIVE DATE.This section is effective July 1, 2013.

159.15    Sec. 6. Minnesota Statutes 2012, section 256B.0625, subdivision 9, is amended to read:
159.16    Subd. 9. Dental services. (a) Medical assistance covers dental services.
159.17(b) Medical assistance dental coverage for nonpregnant adults is limited to the
159.18following services:
159.19(1) comprehensive exams, limited to once every five years;
159.20(2) periodic exams, limited to one per year;
159.21(3) limited exams;
159.22(4) bitewing x-rays, limited to one per year;
159.23(5) periapical x-rays;
159.24(6) panoramic x-rays, limited to one every five years except (1) when medically
159.25necessary for the diagnosis and follow-up of oral and maxillofacial pathology and trauma
159.26or (2) once every two years for patients who cannot cooperate for intraoral film due to
159.27a developmental disability or medical condition that does not allow for intraoral film
159.28placement;
159.29(7) prophylaxis, limited to one per year;
159.30(8) application of fluoride varnish, limited to one per year;
159.31(9) posterior fillings, all at the amalgam rate;
159.32(10) anterior fillings;
159.33(11) endodontics, limited to root canals on the anterior and premolars only;
159.34(12) removable prostheses, each dental arch limited to one every six years;
160.1(13) oral surgery, limited to extractions, biopsies, and incision and drainage of
160.2abscesses;
160.3(14) palliative treatment and sedative fillings for relief of pain; and
160.4(15) full-mouth debridement, limited to one every five years.
160.5(c) In addition to the services specified in paragraph (b), medical assistance
160.6covers the following services for adults, if provided in an outpatient hospital setting or
160.7freestanding ambulatory surgical center as part of outpatient dental surgery:
160.8(1) periodontics, limited to periodontal scaling and root planing once every two years;
160.9(2) general anesthesia; and
160.10(3) full-mouth survey once every five years.
160.11(d) Medical assistance covers medically necessary dental services for children and
160.12pregnant women. The following guidelines apply:
160.13(1) posterior fillings are paid at the amalgam rate;
160.14(2) application of sealants are covered once every five years per permanent molar for
160.15children only;
160.16(3) application of fluoride varnish is covered once every six months; and
160.17(4) orthodontia is eligible for coverage for children only.
160.18(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
160.19covers the following services for adults:
160.20(1) house calls or extended care facility calls for on-site delivery of covered services;
160.21(2) behavioral management when additional staff time is required to accommodate
160.22behavioral challenges and sedation is not used;
160.23(3) oral or IV sedation, if the covered dental service cannot be performed safely
160.24without it or would otherwise require the service to be performed under general anesthesia
160.25in a hospital or surgical center; and
160.26(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
160.27no more than four times per year.

160.28    Sec. 7. Minnesota Statutes 2012, section 256B.0625, subdivision 13e, is amended to
160.29read:
160.30    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment
160.31shall be the lower of the actual acquisition costs of the drugs or the maximum allowable
160.32cost by the commissioner plus the fixed dispensing fee; or the usual and customary price
160.33charged to the public. The amount of payment basis must be reduced to reflect all discount
160.34amounts applied to the charge by any provider/insurer agreement or contract for submitted
160.35charges to medical assistance programs. The net submitted charge may not be greater
161.1than the patient liability for the service. The pharmacy dispensing fee shall be $3.65,
161.2except that the dispensing fee for intravenous solutions which must be compounded by
161.3the pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and
161.4$30 per bag for total parenteral nutritional products dispensed in one liter quantities,
161.5or $44 per bag for total parenteral nutritional products dispensed in quantities greater
161.6than one liter. Actual acquisition cost includes quantity and other special discounts
161.7except time and cash discounts. The actual acquisition cost of a drug shall be estimated
161.8by the commissioner at wholesale acquisition cost plus four percent for independently
161.9owned pharmacies located in a designated rural area within Minnesota, and at wholesale
161.10acquisition cost plus two percent for all other pharmacies. A pharmacy is "independently
161.11owned" if it is one of four or fewer pharmacies under the same ownership nationally.
161.12A "designated rural area" means an area defined as a small rural area or isolated rural
161.13area according to the four-category classification of the Rural Urban Commuting Area
161.14system developed for the United States Health Resources and Services Administration.
161.15The actual acquisition cost of a drug acquired through the federal 340B Drug Pricing
161.16Program shall be estimated by the commissioner at wholesale acquisition cost minus 44
161.17percent. Wholesale acquisition cost is defined as the manufacturer's list price for a drug or
161.18biological to wholesalers or direct purchasers in the United States, not including prompt
161.19pay or other discounts, rebates, or reductions in price, for the most recent month for which
161.20information is available, as reported in wholesale price guides or other publications of
161.21drug or biological pricing data. The maximum allowable cost of a multisource drug may
161.22be set by the commissioner and it shall be comparable to, but no higher than, the maximum
161.23amount paid by other third-party payors in this state who have maximum allowable cost
161.24programs. Establishment of the amount of payment for drugs shall not be subject to the
161.25requirements of the Administrative Procedure Act.
161.26    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
161.27to pharmacists for legend drug prescriptions dispensed to residents of long-term care
161.28facilities when a unit dose blister card system, approved by the department, is used. Under
161.29this type of dispensing system, the pharmacist must dispense a 30-day supply of drug. The
161.30National Drug Code (NDC) from the drug container used to fill the blister card must be
161.31identified on the claim to the department. The unit dose blister card containing the drug
161.32must meet the packaging standards set forth in Minnesota Rules, part 6800.2700, that
161.33govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider will
161.34be required to credit the department for the actual acquisition cost of all unused drugs that
161.35are eligible for reuse. The commissioner may permit the drug clozapine to be dispensed in
161.36a quantity that is less than a 30-day supply.
162.1    (c) Whenever a maximum allowable cost has been set for a multisource drug,
162.2payment shall be the lower of the usual and customary price charged to the public or the
162.3maximum allowable cost established by the commissioner unless prior authorization
162.4for the brand name product has been granted according to the criteria established by
162.5the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the
162.6prescriber has indicated "dispense as written" on the prescription in a manner consistent
162.7with section 151.21, subdivision 2.
162.8    (d) The basis for determining the amount of payment for drugs administered in an
162.9outpatient setting shall be the lower of the usual and customary cost submitted by the
162.10provider or, 106 percent of the average sales price as determined by the United States
162.11Department of Health and Human Services pursuant to title XVIII, section 1847a of the
162.12federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
162.13set by the commissioner. If average sales price is unavailable, the amount of payment
162.14must be lower of the usual and customary cost submitted by the provider or, the wholesale
162.15acquisition cost, the specialty pharmacy rate, or the maximum allowable cost set by the
162.16commissioner. The commissioner shall discount the payment rate for drugs obtained
162.17through the federal 340B Drug Pricing Program by 33 percent. The payment for drugs
162.18administered in an outpatient setting shall be made to the administering facility or
162.19practitioner. A retail or specialty pharmacy dispensing a drug for administration in an
162.20outpatient setting is not eligible for direct reimbursement.
162.21    (e) The commissioner may negotiate lower reimbursement rates for specialty
162.22pharmacy products than the rates specified in paragraph (a). The commissioner may
162.23require individuals enrolled in the health care programs administered by the department
162.24to obtain specialty pharmacy products from providers with whom the commissioner has
162.25negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
162.26used by a small number of recipients or recipients with complex and chronic diseases
162.27that require expensive and challenging drug regimens. Examples of these conditions
162.28include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
162.29C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
162.30of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
162.31biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies
162.32that require complex care. The commissioner shall consult with the formulary committee
162.33to develop a list of specialty pharmacy products subject to this paragraph. In consulting
162.34with the formulary committee in developing this list, the commissioner shall take into
162.35consideration the population served by specialty pharmacy products, the current delivery
163.1system and standard of care in the state, and access to care issues. The commissioner shall
163.2have the discretion to adjust the reimbursement rate to prevent access to care issues.
163.3(f) Home infusion therapy services provided by home infusion therapy pharmacies
163.4must be paid at rates according to subdivision 8d.
163.5EFFECTIVE DATE.This section is effective January 1, 2014.

163.6    Sec. 8. Minnesota Statutes 2012, section 256B.0625, subdivision 31, is amended to read:
163.7    Subd. 31. Medical supplies and equipment. (a) Medical assistance covers medical
163.8supplies and equipment. Separate payment outside of the facility's payment rate shall
163.9be made for wheelchairs and wheelchair accessories for recipients who are residents
163.10of intermediate care facilities for the developmentally disabled. Reimbursement for
163.11wheelchairs and wheelchair accessories for ICF/MR recipients shall be subject to the same
163.12conditions and limitations as coverage for recipients who do not reside in institutions. A
163.13wheelchair purchased outside of the facility's payment rate is the property of the recipient.
163.14The commissioner may set reimbursement rates for specified categories of medical
163.15supplies at levels below the Medicare payment rate.
163.16(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
163.17must enroll as a Medicare provider.
163.18(c) When necessary to ensure access to durable medical equipment, prosthetics,
163.19orthotics, or medical supplies, the commissioner may exempt a vendor from the Medicare
163.20enrollment requirement if:
163.21(1) the vendor supplies only one type of durable medical equipment, prosthetic,
163.22orthotic, or medical supply;
163.23(2) the vendor serves ten or fewer medical assistance recipients per year;
163.24(3) the commissioner finds that other vendors are not available to provide same or
163.25similar durable medical equipment, prosthetics, orthotics, or medical supplies; and
163.26(4) the vendor complies with all screening requirements in this chapter and Code of
163.27Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
163.28the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
163.29and Medicaid Services approved national accreditation organization as complying with
163.30the Medicare program's supplier and quality standards and the vendor serves primarily
163.31pediatric patients.
163.32(d) Durable medical equipment means a device or equipment that:
163.33(1) can withstand repeated use;
163.34(2) is generally not useful in the absence of an illness, injury, or disability; and
164.1(3) is provided to correct or accommodate a physiological disorder or physical
164.2condition or is generally used primarily for a medical purpose.
164.3(e) Electronic tablets may be considered durable medical equipment if the electronic
164.4tablet will be used as an augmentative and alternative communication system as defined
164.5under subdivision 31a, paragraph (a). To be covered by medical assistance, the device
164.6must be locked in order to prevent use not related to communication.

164.7    Sec. 9. Minnesota Statutes 2012, section 256B.0625, is amended by adding a
164.8subdivision to read:
164.9    Subd. 31b. Preferred diabetic testing supply program. (a) The commissioner
164.10shall adopt and implement a point of sale preferred diabetic testing supply program by
164.11January 1, 2014. Medical assistance coverage for diabetic testing supplies shall conform
164.12to the limitations established under the program. The commissioner may enter into a
164.13contract with a vendor for the purpose of participating in a preferred diabetic testing
164.14supply list and supplemental rebate program. The commissioner shall ensure that any
164.15contract meets all federal requirements and maximizes federal financial participation. The
164.16commissioner shall maintain an accurate and up-to-date list on the agency Web site.
164.17(b) The commissioner may add to, delete from, and otherwise modify the preferred
164.18diabetic testing supply program drug list after consulting with the Drug Formulary
164.19Committee and appropriate medial specialists and providing public notice and the
164.20opportunity for public comment.
164.21(c) The commissioner shall adopt and administer the preferred diabetic testing
164.22supply program as part of the administration of the diabetic testing supply rebate program.
164.23Reimbursement for diabetic testing supplies not on the preferred diabetic testing supply
164.24list may be subject to prior authorization.
164.25(d) All claims for diabetic testing supplies in categories on the preferred diabetic
164.26testing supply list must be submitted by enrolled pharmacy providers using the most
164.27current National Council of Prescription Drug Providers electronic claims standard.
164.28(e) For purposes of this subdivision, "preferred diabetic testing supply list" means a
164.29list of diabetic testing supplies selected by the commissioner, for which prior authorization
164.30is not required.
164.31(f) The commissioner shall seek any federal waivers or approvals necessary to
164.32implement this subdivision.

164.33    Sec. 10. Minnesota Statutes 2012, section 256B.0625, subdivision 39, is amended to
164.34read:
165.1    Subd. 39. Childhood immunizations. Providers who administer pediatric vaccines
165.2within the scope of their licensure, and who are enrolled as a medical assistance provider,
165.3must enroll in the pediatric vaccine administration program established by section 13631
165.4of the Omnibus Budget Reconciliation Act of 1993. Medical assistance shall pay an
165.5$8.50 fee per dose for administration of the vaccine to children eligible for medical
165.6assistance. Medical assistance does not pay for vaccines that are available at no cost from
165.7the pediatric vaccine administration program.

165.8    Sec. 11. Minnesota Statutes 2012, section 256B.0625, subdivision 58, is amended to
165.9read:
165.10    Subd. 58. Early and periodic screening, diagnosis, and treatment services.
165.11Medical assistance covers early and periodic screening, diagnosis, and treatment services
165.12(EPSDT). The payment amount for a complete EPSDT screening shall not include charges
165.13for vaccines that are available at no cost to the provider and shall not exceed the rate
165.14established per Minnesota Rules, part 9505.0445, item M, effective October 1, 2010.

165.15    Sec. 12. Minnesota Statutes 2012, section 256B.0631, subdivision 1, is amended to read:
165.16    Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
165.17assistance benefit plan shall include the following cost-sharing for all recipients, effective
165.18for services provided on or after September 1, 2011:
165.19    (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
165.20of this subdivision, a visit means an episode of service which is required because of
165.21a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
165.22ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
165.23midwife, advanced practice nurse, audiologist, optician, or optometrist;
165.24    (2) $3.50 for nonemergency visits to a hospital-based emergency room, except that
165.25this co-payment shall be increased to $20 upon federal approval;
165.26    (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
165.27subject to a $12 per month maximum for prescription drug co-payments. No co-payments
165.28shall apply to antipsychotic drugs when used for the treatment of mental illness;
165.29(4) effective January 1, 2012, a family deductible equal to the maximum amount
165.30allowed under Code of Federal Regulations, title 42, part 447.54; and
165.31    (5) for individuals identified by the commissioner with income at or below 100
165.32percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
165.33percent of family income. For purposes of this paragraph, family income is the total
166.1earned and unearned income of the individual and the individual's spouse, if the spouse is
166.2enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
166.3    (b) Recipients of medical assistance are responsible for all co-payments and
166.4deductibles in this subdivision.
166.5(c) Notwithstanding paragraph (b), the commissioner, through the contracting
166.6process under sections 256B.69 and 256B.692, may allow managed care plans and
166.7county-based purchasing plans to waive the family deductible under paragraph (a),
166.8clause (4). The value of the family deductible shall not be included in the capitation
166.9payment to managed care plans and county-based purchasing plans. Managed care plans
166.10and county-based purchasing plans shall certify annually to the commissioner the dollar
166.11value of the family deductible.
166.12(d) Notwithstanding paragraph (b), the commissioner may waive the collection of
166.13the family deductible described under paragraph (a), clause (4), from individuals and
166.14allow long-term care and waivered service providers to assume responsibility for payment.
166.15(e) Notwithstanding paragraph (b), the commissioner, through the contracting
166.16process under section 256B.0756 shall allow the pilot program in Hennepin County to
166.17waive co-payments. The value of the co-payments shall not be included in the capitation
166.18amount to the managed care organization.

166.19    Sec. 13. Minnesota Statutes 2012, section 256B.0756, is amended to read:
166.20256B.0756 HENNEPIN AND RAMSEY COUNTIES PILOT PROGRAM.
166.21(a) The commissioner, upon federal approval of a new waiver request or amendment
166.22of an existing demonstration, may establish a pilot program in Hennepin County or Ramsey
166.23County, or both, to test alternative and innovative integrated health care delivery networks.
166.24(b) Individuals eligible for the pilot program shall be individuals who are eligible for
166.25medical assistance under section 256B.055, subdivision 15, and who reside in Hennepin
166.26County or Ramsey County. The commissioner may identify individuals to be enrolled in
166.27the Hennepin County pilot program based on zip code in Hennepin County or whether the
166.28individuals would benefit from an integrated health care delivery network.
166.29(c) Individuals enrolled in the pilot program shall be enrolled in an integrated
166.30health care delivery network in their county of residence. The integrated health care
166.31delivery network in Hennepin County shall be a network, such as an accountable care
166.32organization or a community-based collaborative care network, created by or including
166.33Hennepin County Medical Center. The integrated health care delivery network in Ramsey
166.34County shall be a network, such as an accountable care organization or community-based
166.35collaborative care network, created by or including Regions Hospital.
167.1(d) The commissioner shall cap pilot program enrollment at 7,000 enrollees for
167.2Hennepin County and 3,500 enrollees for Ramsey County.
167.3(e) (d) In developing a payment system for the pilot programs, the commissioner
167.4shall establish a total cost of care for the recipients enrolled in the pilot programs that
167.5equals the cost of care that would otherwise be spent for these enrollees in the prepaid
167.6medical assistance program.
167.7(f) Counties may transfer funds necessary to support the nonfederal share of
167.8payments for integrated health care delivery networks in their county. Such transfers per
167.9county shall not exceed 15 percent of the expected expenses for county enrollees.
167.10(g) (e) The commissioner shall apply to the federal government for, or as appropriate,
167.11cooperate with counties, providers, or other entities that are applying for any applicable
167.12grant or demonstration under the Patient Protection and Affordable Health Care Act, Public
167.13Law 111-148, or the Health Care and Education Reconciliation Act of 2010, Public Law
167.14111-152, that would further the purposes of or assist in the creation of an integrated health
167.15care delivery network for the purposes of this subdivision, including, but not limited to, a
167.16global payment demonstration or the community-based collaborative care network grants.

167.17    Sec. 14. Minnesota Statutes 2012, section 256B.69, subdivision 5c, is amended to read:
167.18    Subd. 5c. Medical education and research fund. (a) The commissioner of human
167.19services shall transfer each year to the medical education and research fund established
167.20under section 62J.692, an amount specified in this subdivision. The commissioner shall
167.21calculate the following:
167.22(1) an amount equal to the reduction in the prepaid medical assistance payments as
167.23specified in this clause. Until January 1, 2002, the county medical assistance capitation
167.24base rate prior to plan specific adjustments and after the regional rate adjustments under
167.25subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
167.26metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
167.27January 1, 2002, the county medical assistance capitation base rate prior to plan specific
167.28adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
167.29metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
167.30facility and elderly waiver payments and demonstration project payments operating
167.31under subdivision 23 are excluded from this reduction. The amount calculated under
167.32this clause shall not be adjusted for periods already paid due to subsequent changes to
167.33the capitation payments;
167.34(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
167.35section;
168.1(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
168.2paid under this section; and
168.3(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
168.4under this section.
168.5(b) This subdivision shall be effective upon approval of a federal waiver which
168.6allows federal financial participation in the medical education and research fund. The
168.7amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount
168.8transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under
168.9paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally
168.10reduce the amount specified under paragraph (a), clause (1).
168.11(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
168.12shall transfer $21,714,000 each fiscal year to the medical education and research fund.
168.13(d) Beginning September 1, 2011, of the amount in paragraph (a), following the
168.14transfer under paragraph (c), the commissioner shall transfer to the medical education
168.15research fund $23,936,000 in fiscal years 2012 and 2013 and $36,744,000 $49,552,000 in
168.16fiscal year 2014 and thereafter.

168.17    Sec. 15. Minnesota Statutes 2012, section 256B.76, is amended by adding a
168.18subdivision to read:
168.19    Subd. 7. Payment for certain primary care services and immunization
168.20administration. Payment for certain primary care services and immunization
168.21administration services rendered on or after January 1, 2013, through December 31, 2014,
168.22shall be made in accordance with section 1902(a)(13) of the Social Security Act.

168.23    Sec. 16. Minnesota Statutes 2012, section 256B.764, is amended to read:
168.24256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
168.25    (a) Effective for services rendered on or after July 1, 2007, payment rates for family
168.26planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
168.27when these services are provided by a community clinic as defined in section 145.9268,
168.28subdivision 1.
168.29    (b) Effective for services rendered on or after July 1, 2013, payment rates for
168.30family planning services shall be increased by 20 percent over the rates in effect June
168.3130, 2013, when these services are provided by a community clinic as defined in section
168.32145.9268, subdivision 1. The commissioner shall adjust capitation rates to managed care
168.33and county-based purchasing plans to reflect this increase, and shall require plans to pass
169.1on the full amount of the rate increase to eligible community clinics, in the form of higher
169.2payment rates for family planning services.
169.3EFFECTIVE DATE.This section is effective July 1, 2013.


169.6    Section 1. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
169.7    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
169.8initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
169.92960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
169.109555.6265, under this chapter for a physical location that will not be the primary residence
169.11of the license holder for the entire period of licensure. If a license is issued during this
169.12moratorium, and the license holder changes the license holder's primary residence away
169.13from the physical location of the foster care license, the commissioner shall revoke the
169.14license according to section 245A.07. Exceptions to the moratorium include:
169.15(1) foster care settings that are required to be registered under chapter 144D;
169.16(2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
169.17and determined to be needed by the commissioner under paragraph (b);
169.18(3) new foster care licenses determined to be needed by the commissioner under
169.19paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or
169.20restructuring of state-operated services that limits the capacity of state-operated facilities;
169.21(4) new foster care licenses determined to be needed by the commissioner under
169.22paragraph (b) for persons requiring hospital level care; or
169.23(5) new foster care licenses determined to be needed by the commissioner for the
169.24transition of people from personal care assistance to the home and community-based
169.25services.
169.26(b) The commissioner shall determine the need for newly licensed foster care homes
169.27as defined under this subdivision. As part of the determination, the commissioner shall
169.28consider the availability of foster care capacity in the area in which the licensee seeks to
169.29operate, and the recommendation of the local county board. The determination by the
169.30commissioner must be final. A determination of need is not required for a change in
169.31ownership at the same address.
169.32(c) The commissioner shall study the effects of the license moratorium under this
169.33subdivision and shall report back to the legislature by January 15, 2011. This study shall
169.34include, but is not limited to the following:
170.1(1) the overall capacity and utilization of foster care beds where the physical location
170.2is not the primary residence of the license holder prior to and after implementation
170.3of the moratorium;
170.4(2) the overall capacity and utilization of foster care beds where the physical
170.5location is the primary residence of the license holder prior to and after implementation
170.6of the moratorium; and
170.7(3) the number of licensed and occupied ICF/MR beds prior to and after
170.8implementation of the moratorium.
170.9(d) (c) When a foster care recipient moves out of a foster home that is not the
170.10primary residence of the license holder according to section 256B.49, subdivision 15,
170.11paragraph (f), the county shall immediately inform the Department of Human Services
170.12Licensing Division. The department shall decrease the statewide licensed capacity for
170.13foster care settings where the physical location is not the primary residence of the license
170.14holder, if the voluntary changes described in paragraph (f) (e) are not sufficient to meet the
170.15savings required by reductions in licensed bed capacity under Laws 2011, First Special
170.16Session chapter 9, article 7, sections 1 and 40, paragraph (f), and maintain statewide
170.17long-term care residential services capacity within budgetary limits. Implementation of
170.18the statewide licensed capacity reduction shall begin on July 1, 2013. The commissioner
170.19shall delicense up to 128 beds by June 30, 2014, using the needs determination process.
170.20Under this paragraph, the commissioner has the authority to reduce unused licensed
170.21capacity of a current foster care program to accomplish the consolidation or closure of
170.22settings. A decreased licensed capacity according to this paragraph is not subject to appeal
170.23under this chapter.
170.24(e) (d) Residential settings that would otherwise be subject to the decreased license
170.25capacity established in paragraph (d) (c) shall be exempt under the following circumstances:
170.26(1) until August 1, 2013, the license holder's beds occupied by residents whose
170.27primary diagnosis is mental illness and the license holder is:
170.28(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
170.29health services (ARMHS) as defined in section 256B.0623;
170.30(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
170.319520.0870;
170.32(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
170.339520.0870; or
170.34(iv) a provider of intensive residential treatment services (IRTS) licensed under
170.35Minnesota Rules, parts 9520.0500 to 9520.0670; or
170.36(2) the license holder is certified under the requirements in subdivision 6a.
171.1(f) (e) A resource need determination process, managed at the state level, using the
171.2available reports required by section 144A.351, and other data and information shall
171.3be used to determine where the reduced capacity required under paragraph (d) (c) will
171.4be implemented. The commissioner shall consult with the stakeholders described in
171.5section 144A.351, and employ a variety of methods to improve the state's capacity to
171.6meet long-term care service needs within budgetary limits, including seeking proposals
171.7from service providers or lead agencies to change service type, capacity, or location to
171.8improve services, increase the independence of residents, and better meet needs identified
171.9by the long-term care services reports and statewide data and information. By February
171.101 of each 2013 and August 1 of 2014 and each following year, the commissioner shall
171.11provide information and data on the overall capacity of licensed long-term care services,
171.12actions taken under this subdivision to manage statewide long-term care services and
171.13supports resources, and any recommendations for change to the legislative committees
171.14with jurisdiction over health and human services budget.
171.15    (g) (f) At the time of application and reapplication for licensure, the applicant and the
171.16license holder that are subject to the moratorium or an exclusion established in paragraph
171.17(a) are required to inform the commissioner whether the physical location where the foster
171.18care will be provided is or will be the primary residence of the license holder for the entire
171.19period of licensure. If the primary residence of the applicant or license holder changes, the
171.20applicant or license holder must notify the commissioner immediately. The commissioner
171.21shall print on the foster care license certificate whether or not the physical location is the
171.22primary residence of the license holder.
171.23    (h) (g) License holders of foster care homes identified under paragraph (g) (f) that
171.24are not the primary residence of the license holder and that also provide services in the
171.25foster care home that are covered by a federally approved home and community-based
171.26services waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must
171.27inform the human services licensing division that the license holder provides or intends to
171.28provide these waiver-funded services. These license holders must be considered registered
171.29under section 256B.092, subdivision 11, paragraph (c), and this registration status must
171.30be identified on their license certificates.

171.31    Sec. 2. Minnesota Statutes 2012, section 256.9657, subdivision 3a, is amended to read:
171.32    Subd. 3a. ICF/MR ICF/DD license surcharge. (a) Effective July 1, 2003, each
171.33non-state-operated facility as defined under section 256B.501, subdivision 1, shall pay
171.34to the commissioner an annual surcharge according to the schedule in subdivision 4,
171.35paragraph (d). The annual surcharge shall be $1,040 per licensed bed. If the number of
172.1licensed beds is reduced, the surcharge shall be based on the number of remaining licensed
172.2beds the second month following the receipt of timely notice by the commissioner of
172.3human services that beds have been delicensed. The facility must notify the commissioner
172.4of health in writing when beds are delicensed. The commissioner of health must notify
172.5the commissioner of human services within ten working days after receiving written
172.6notification. If the notification is received by the commissioner of human services by
172.7the 15th of the month, the invoice for the second following month must be reduced to
172.8recognize the delicensing of beds. The commissioner may reduce, and may subsequently
172.9restore, the surcharge under this subdivision based on the commissioner's determination of
172.10a permissible surcharge.
172.11(b) Effective July 1, 2013, the surcharge under paragraph (a) is increased to $3,717
172.12per licensed bed.
172.13EFFECTIVE DATE.This section is effective July 1, 2013.

172.14    Sec. 3. Minnesota Statutes 2012, section 256B.0911, subdivision 4d, is amended to read:
172.15    Subd. 4d. Preadmission screening of individuals under 65 years of age. (a)
172.16It is the policy of the state of Minnesota to ensure that individuals with disabilities or
172.17chronic illness are served in the most integrated setting appropriate to their needs and have
172.18the necessary information to make informed choices about home and community-based
172.19service options.
172.20    (b) Individuals under 65 years of age who are admitted to a nursing facility from a
172.21hospital must be screened prior to admission as outlined in subdivisions 4a through 4c.
172.22    (c) Individuals under 65 years of age who are admitted to nursing facilities with
172.23only a telephone screening must receive a face-to-face assessment from the long-term
172.24care consultation team member of the county in which the facility is located or from the
172.25recipient's county case manager within 40 calendar days of admission.
172.26    (d) Individuals under 65 years of age who are admitted to a nursing facility
172.27without preadmission screening according to the exemption described in subdivision 4b,
172.28paragraph (a), clause (3), and who remain in the facility longer than 30 days must receive
172.29a face-to-face assessment within 40 days of admission.
172.30    (e) At the face-to-face assessment, the long-term care consultation team member or
172.31county case manager must perform the activities required under subdivision 3b.
172.32    (f) For individuals under 21 years of age, a screening interview which recommends
172.33nursing facility admission must be face-to-face and approved by the commissioner before
172.34the individual is admitted to the nursing facility.
173.1    (g) In the event that an individual under 65 years of age is admitted to a nursing
173.2facility on an emergency basis, the county must be notified of the admission on the
173.3next working day, and a face-to-face assessment as described in paragraph (c) must be
173.4conducted within 40 calendar days of admission.
173.5    (h) At the face-to-face assessment, the long-term care consultation team member or
173.6the case manager must present information about home and community-based options,
173.7including consumer-directed options, so the individual can make informed choices. If the
173.8individual chooses home and community-based services, the long-term care consultation
173.9team member or case manager must complete a written relocation plan within 20 working
173.10days of the visit. The plan shall describe the services needed to move out of the facility
173.11and a time line for the move which is designed to ensure a smooth transition to the
173.12individual's home and community.
173.13    (i) An individual under 65 years of age residing in a nursing facility shall receive a
173.14face-to-face assessment at least every 12 months to review the person's service choices
173.15and available alternatives unless the individual indicates, in writing, that annual visits are
173.16not desired. In this case, the individual must receive a face-to-face assessment at least
173.17once every 36 months for the same purposes.
173.18    (j) Notwithstanding the provisions of subdivision 6, the commissioner may pay
173.19county agencies directly for face-to-face assessments for individuals under 65 years of age
173.20who are being considered for placement or residing in a nursing facility. Until September
173.2130, 2013, payments for individuals under 65 years of age shall be made as described
173.22in this subdivision.

173.23    Sec. 4. Minnesota Statutes 2012, section 256B.0911, subdivision 6, is amended to read:
173.24    Subd. 6. Payment for long-term care consultation services. (a) Until September
173.2530, 2013, payment for long-term care consultation face-to-face assessment shall be made
173.26as described in this subdivision.
173.27    (b) The total payment for each county must be paid monthly by certified nursing
173.28facilities in the county. The monthly amount to be paid by each nursing facility for each
173.29fiscal year must be determined by dividing the county's annual allocation for long-term
173.30care consultation services by 12 to determine the monthly payment and allocating the
173.31monthly payment to each nursing facility based on the number of licensed beds in the
173.32nursing facility. Payments to counties in which there is no certified nursing facility must be
173.33made by increasing the payment rate of the two facilities located nearest to the county seat.
174.1    (b) (c) The commissioner shall include the total annual payment determined under
174.2paragraph (a) for each nursing facility reimbursed under section 256B.431, 256B.434,
174.3or 256B.441.
174.4    (c) (d) In the event of the layaway, delicensure and decertification, or removal from
174.5layaway of 25 percent or more of the beds in a facility, the commissioner may adjust the
174.6per diem payment amount in paragraph (b) (c) and may adjust the monthly payment
174.7amount in paragraph (a). The effective date of an adjustment made under this paragraph
174.8shall be on or after the first day of the month following the effective date of the layaway,
174.9delicensure and decertification, or removal from layaway.
174.10    (d) (e) Payments for long-term care consultation services are available to the county
174.11or counties to cover staff salaries and expenses to provide the services described in
174.12subdivision 1a. The county shall employ, or contract with other agencies to employ,
174.13within the limits of available funding, sufficient personnel to provide long-term care
174.14consultation services while meeting the state's long-term care outcomes and objectives as
174.15defined in subdivision 1. The county shall be accountable for meeting local objectives
174.16as approved by the commissioner in the biennial home and community-based services
174.17quality assurance plan on a form provided by the commissioner.
174.18    (e) (f) Notwithstanding section 256B.0641, overpayments attributable to payment
174.19of the screening costs under the medical assistance program may not be recovered from
174.20a facility.
174.21    (f) (g) The commissioner of human services shall amend the Minnesota medical
174.22assistance plan to include reimbursement for the local consultation teams.
174.23    (g) (h) Until the alternative payment methodology in paragraph (h) (i) is implemented,
174.24the county may bill, as case management services, assessments, support planning, and
174.25follow-along provided to persons determined to be eligible for case management under
174.26Minnesota health care programs. No individual or family member shall be charged for an
174.27initial assessment or initial support plan development provided under subdivision 3a or 3b.
174.28(h) (i) The commissioner shall develop an alternative payment methodology,
174.29effective on October 1, 2013, for long-term care consultation services that includes
174.30the funding available under this subdivision, and for assessments authorized under
174.31sections 256B.092 and 256B.0659. In developing the new payment methodology, the
174.32commissioner shall consider the maximization of other funding sources, including federal
174.33administrative reimbursement through federal financial participation funding, for all
174.34long-term care consultation and preadmission screening activity. The alternative payment
174.35methodology shall include the use of the appropriate time studies and the state financing
174.36of nonfederal share as part of the state's medical assistance program.

175.1    Sec. 5. Minnesota Statutes 2012, section 256B.0916, is amended by adding a
175.2subdivision to read:
175.3    Subd. 11. Excess spending. County and tribal agencies are responsible for spending
175.4in excess of the allocation made by the commissioner. In the event a county or tribal
175.5agency spends in excess of the allocation made by the commissioner for a given allocation
175.6period, they must submit a corrective action plan to the commissioner. The plan must state
175.7the actions the agency will take to correct their overspending for the year following the
175.8period when the overspending occurred. Failure to correct overspending shall result in
175.9recoupment of spending in excess of the allocation. Nothing in this subdivision shall be
175.10construed as reducing the county's responsibility to offer and make available feasible
175.11home and community-based options to eligible waiver recipients within the resources
175.12allocated to them for that purpose.

175.13    Sec. 6. Minnesota Statutes 2012, section 256B.092, subdivision 11, is amended to read:
175.14    Subd. 11. Residential support services. (a) Upon federal approval, there is
175.15established a new service called residential support that is available on the community
175.16alternative care, community alternatives for disabled individuals, developmental
175.17disabilities, and brain injury waivers. Existing waiver service descriptions must be
175.18modified to the extent necessary to ensure there is no duplication between other services.
175.19Residential support services must be provided by vendors licensed as a community
175.20residential setting as defined in section 245A.11, subdivision 8.
175.21    (b) Residential support services must meet the following criteria:
175.22    (1) providers of residential support services must own or control the residential site;
175.23    (2) the residential site must not be the primary residence of the license holder;
175.24    (3) the residential site must have a designated program supervisor responsible for
175.25program oversight, development, and implementation of policies and procedures;
175.26    (4) the provider of residential support services must provide supervision, training,
175.27and assistance as described in the person's coordinated service and support plan; and
175.28    (5) the provider of residential support services must meet the requirements of
175.29licensure and additional requirements of the person's coordinated service and support plan.
175.30    (c) Providers of residential support services that meet the definition in paragraph
175.31(a) must be registered using a process determined by the commissioner beginning July
175.321, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
175.332960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
175.349555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
175.357 , paragraph (g) (f), are considered registered under this section.

176.1    Sec. 7. Minnesota Statutes 2012, section 256B.092, subdivision 12, is amended to read:
176.2    Subd. 12. Waivered services statewide priorities. (a) The commissioner shall
176.3establish statewide priorities for individuals on the waiting list for developmental
176.4disabilities (DD) waiver services, as of January 1, 2010. The statewide priorities must
176.5include, but are not limited to, individuals who continue to have a need for waiver services
176.6after they have maximized the use of state plan services and other funding resources,
176.7including natural supports, prior to accessing waiver services, and who meet at least one
176.8of the following criteria:
176.9(1) have unstable living situations due to the age, incapacity, or sudden loss of
176.10the primary caregivers;
176.11(2) are moving from an institution due to bed closures;
176.12(3) experience a sudden closure of their current living arrangement;
176.13(4) require protection from confirmed abuse, neglect, or exploitation;
176.14(5) experience a sudden change in need that can no longer be met through state plan
176.15services or other funding resources alone; or
176.16(6) meet other priorities established by the department.
176.17(b) When allocating resources to lead agencies, the commissioner must take into
176.18consideration the number of individuals waiting who meet statewide priorities and the
176.19lead agencies' current use of waiver funds and existing service options. The commissioner
176.20has the authority to transfer funds between counties, groups of counties, and tribes to
176.21accommodate statewide priorities and resource needs while accounting for a necessary
176.22base level reserve amount for each county, group of counties, and tribe.
176.23(c) The commissioner shall evaluate the impact of the use of statewide priorities and
176.24provide recommendations to the legislature on whether to continue the use of statewide
176.25priorities in the November 1, 2011, annual report required by the commissioner in sections
176.26256B.0916, subdivision 7, and 256B.49, subdivision 21.

176.27    Sec. 8. [256B.0949] AUTISM EARLY INTENSIVE INTERVENTION BENEFIT.
176.28    Subdivision 1. Purpose. This section creates a new benefit available under the
176.29medical assistance state plan 1915(i) option to provide early intensive intervention to a
176.30child with an autism spectrum disorder diagnosis. This benefit must provide coverage for
176.31the comprehensive, multidisciplinary diagnostic assessment, ongoing progress evaluation,
176.32and medically necessary treatment of autism spectrum disorder. This option must be
176.33available upon federal approval, but not earlier than March 1, 2014.
176.34    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
176.35this subdivision have the meanings given.
177.1(b) "Autism spectrum disorder diagnosis" is defined by diagnostic code 299 in the
177.2Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
177.3(c) "Child" means a person under the age of 18.
177.4(d) "Early intensive intervention benefit" means autism treatment options based in
177.5behavioral and developmental science, which may include modalities such as applied
177.6behavioral analysis, developmental treatment approaches, and naturalistic and parent
177.7training models.
177.8(e) "Commissioner" means the commissioner of human services, unless otherwise
177.9specified.
177.10(f) "Generalizable" means goals or gains that are observed in a variety of activities
177.11with different people, such as providers, family members, other adults, and children and
177.12in different environments including, but not limited to, clinics, homes, schools, and the
177.13community.
177.14    Subd. 3. Initial eligibility. (a) This benefit is available to a child receiving medical
177.15assistance who has an autism spectrum disorder diagnosis and who meets the criteria for
177.16medically necessary early intensive intervention services.
177.17(b) A comprehensive diagnosis must be based upon current DSM criteria including
177.18direct observations and parental or caregiver reports. The comprehensive diagnosis
177.19must reflect both medical and mental health input as provided by a licensed health care
177.20professional and a licensed mental health professional.
177.21(c) Additional diagnostic assessments may be provided as needed by professionals
177.22who are licensed experts in the fields of medicine, speech and language, psychology,
177.23occupational therapy, and physical therapy.
177.24(d) Special education assessments may also be considered in the diagnostic
177.25assessment.
177.26(e) The multidisciplinary diagnostic assessment must lead to an individualized
177.27treatment plan.
177.28    Subd. 4. Treatment plan. (a) Each child's treatment plan must be family centered,
177.29culturally sensitive, and individualized based on the child's needs and developmental
177.30status. The treatment plan must specify developmentally appropriate, functional,
177.31generalizable goals, treatment modality, intensity, and setting. Treatment must be overseen
177.32by a licensed health care or mental health professional with expertise and training in
177.33autism and child development.
177.34(b) A functional assessment must identify the child's developmental skills, needs,
177.35and capacities based on direct observation of the child. It may include, but is not limited
177.36to, input provided by the child's special education teacher.
178.1(c) An assessment of parental or caregiver resilience and ability to participate in
178.2therapy must be conducted to determine the nature and level of parental or caregiver
178.3involvement and training.
178.4(d) The treatment plan must be submitted to the commissioner for approval in a
178.5manner determined by the commissioner for this purpose.
178.6(e) The commissioner must authorize services consistent with approved treatment
178.7plans.
178.8    Subd. 5. Ongoing eligibility. A child receiving this benefit must receive an
178.9independent progress evaluation by a licensed mental health professional every six
178.10months, or more frequently as determined by the commissioner, to determine if progress is
178.11being made toward achieving generalizable gains and meeting functional goals contained
178.12in the treatment plan. The progress evaluation must determine if the treatment plan
178.13needs modification. This progress evaluation must include the treating provider's report,
178.14parental or caregiver input, and an independent observation of the child. For children
178.15participating in special education, the observation component of this progress evaluation
178.16may be performed by the child's special education teacher. Progress evaluations must be
178.17submitted to the commissioner in a manner determined by the commissioner for this
178.18purpose. A child who continues to achieve generalizable gains and treatment goals as
178.19contained in the treatment plan is eligible to continue receiving this benefit.
178.20    Subd. 6. Refining the benefit with stakeholders. The commissioner must develop
178.21the implementation details of the benefit in consultation with stakeholders and consider
178.22recommendations from the Health Services Advisory Council, the Autism Spectrum
178.23Disorder Advisory Council, and the Interagency Task Force of the Departments of Health,
178.24Education, and Human Services. The commissioner must release these details for a 30-day
178.25public comment period prior to submission to the federal government for approval. The
178.26implementation details include, but are not limited to, the following:
178.27(1) defining the qualifications, standards, and roles of the treatment team;
178.28(2) developing initial, uniform parameters for multidisciplinary diagnostic
178.29assessment and progress evaluation standards;
178.30(3) developing an effective and consistent process for assessing parent and caregiver
178.31resilience and capacity to participate in the child's early intervention treatment;
178.32(4) forming a collaborative process in which professionals have opportunities to
178.33collectively inform diagnostic assessment and progress evaluation processes and standards
178.34and to support quality improvement of early intensive intervention services;
178.35(5) coordination with and interaction of this benefit with other services provided by
178.36the Departments of Human Services and Education; and
179.1(6) ongoing evaluation of and research regarding the program and treatment
179.2modalities provided to children under this benefit.
179.3    Subd. 7. Revision of treatment options. The commissioner may revise covered
179.4treatment options as needed to ensure consistency with evolving evidence.
179.5    Subd. 8. Coordination between agencies. The commissioners of human services
179.6and education must coordinate diagnostic and educational assessment, service delivery,
179.7and progress evaluations across health and education sectors.

179.8    Sec. 9. Minnesota Statutes 2012, section 256B.434, subdivision 4, is amended to read:
179.9    Subd. 4. Alternate rates for nursing facilities. (a) For nursing facilities which
179.10have their payment rates determined under this section rather than section 256B.431, the
179.11commissioner shall establish a rate under this subdivision. The nursing facility must enter
179.12into a written contract with the commissioner.
179.13    (b) A nursing facility's case mix payment rate for the first rate year of a facility's
179.14contract under this section is the payment rate the facility would have received under
179.15section 256B.431.
179.16    (c) A nursing facility's case mix payment rates for the second and subsequent years
179.17of a facility's contract under this section are the previous rate year's contract payment
179.18rates plus an inflation adjustment and, for facilities reimbursed under this section or
179.19section 256B.431, an adjustment to include the cost of any increase in Health Department
179.20licensing fees for the facility taking effect on or after July 1, 2001. The index for the
179.21inflation adjustment must be based on the change in the Consumer Price Index-All Items
179.22(United States City average) (CPI-U) forecasted by the commissioner of management and
179.23budget's national economic consultant, as forecasted in the fourth quarter of the calendar
179.24year preceding the rate year. The inflation adjustment must be based on the 12-month
179.25period from the midpoint of the previous rate year to the midpoint of the rate year for
179.26which the rate is being determined. For the rate years beginning on July 1, 1999, July 1,
179.272000, July 1, 2001, July 1, 2002, July 1, 2003, July 1, 2004, July 1, 2005, July 1, 2006,
179.28July 1, 2007, July 1, 2008, October 1, 2009, and October 1, 2010, this paragraph shall
179.29apply only to the property-related payment rate. For the rate years beginning on October
179.301, 2011, and October 1, 2012, October 1, 2013, October 1, 2014, October 1, 2015, and
179.31October 1, 2016, the rate adjustment under this paragraph shall be suspended. Beginning
179.32in 2005, adjustment to the property payment rate under this section and section 256B.431
179.33shall be effective on October 1. In determining the amount of the property-related payment
179.34rate adjustment under this paragraph, the commissioner shall determine the proportion of
179.35the facility's rates that are property-related based on the facility's most recent cost report.
180.1    (d) The commissioner shall develop additional incentive-based payments of up to
180.2five percent above a facility's operating payment rate for achieving outcomes specified
180.3in a contract. The commissioner may solicit contract amendments and implement those
180.4which, on a competitive basis, best meet the state's policy objectives. The commissioner
180.5shall limit the amount of any incentive payment and the number of contract amendments
180.6under this paragraph to operate the incentive payments within funds appropriated for this
180.7purpose. The contract amendments may specify various levels of payment for various
180.8levels of performance. Incentive payments to facilities under this paragraph may be in the
180.9form of time-limited rate adjustments or onetime supplemental payments. In establishing
180.10the specified outcomes and related criteria, the commissioner shall consider the following
180.11state policy objectives:
180.12    (1) successful diversion or discharge of residents to the residents' prior home or other
180.13community-based alternatives;
180.14    (2) adoption of new technology to improve quality or efficiency;
180.15    (3) improved quality as measured in the Nursing Home Report Card;
180.16    (4) reduced acute care costs; and
180.17    (5) any additional outcomes proposed by a nursing facility that the commissioner
180.18finds desirable.
180.19    (e) Notwithstanding the threshold in section 256B.431, subdivision 16, facilities that
180.20take action to come into compliance with existing or pending requirements of the life
180.21safety code provisions or federal regulations governing sprinkler systems must receive
180.22reimbursement for the costs associated with compliance if all of the following conditions
180.23are met:
180.24    (1) the expenses associated with compliance occurred on or after January 1, 2005,
180.25and before December 31, 2008;
180.26    (2) the costs were not otherwise reimbursed under subdivision 4f or section
180.27144A.071 or 144A.073; and
180.28    (3) the total allowable costs reported under this paragraph are less than the minimum
180.29threshold established under section 256B.431, subdivision 15, paragraph (e), and
180.30subdivision 16.
180.31The commissioner shall use money appropriated for this purpose to provide to qualifying
180.32nursing facilities a rate adjustment beginning October 1, 2007, and ending September 30,
180.332008. Nursing facilities that have spent money or anticipate the need to spend money
180.34to satisfy the most recent life safety code requirements by (1) installing a sprinkler
180.35system or (2) replacing all or portions of an existing sprinkler system may submit to the
180.36commissioner by June 30, 2007, on a form provided by the commissioner the actual
181.1costs of a completed project or the estimated costs, based on a project bid, of a planned
181.2project. The commissioner shall calculate a rate adjustment equal to the allowable
181.3costs of the project divided by the resident days reported for the report year ending
181.4September 30, 2006. If the costs from all projects exceed the appropriation for this
181.5purpose, the commissioner shall allocate the money appropriated on a pro rata basis to the
181.6qualifying facilities by reducing the rate adjustment determined for each facility by an
181.7equal percentage. Facilities that used estimated costs when requesting the rate adjustment
181.8shall report to the commissioner by January 31, 2009, on the use of this money on a
181.9form provided by the commissioner. If the nursing facility fails to provide the report, the
181.10commissioner shall recoup the money paid to the facility for this purpose. If the facility
181.11reports expenditures allowable under this subdivision that are less than the amount received
181.12in the facility's annualized rate adjustment, the commissioner shall recoup the difference.

181.13    Sec. 10. Minnesota Statutes 2012, section 256B.434, is amended by adding a
181.14subdivision to read:
181.15    Subd. 19a. Nursing facility rate adjustments beginning October 1, 2013. (a)
181.16For the rate year beginning October 1, 2013, the commissioner shall make available to
181.17each nursing facility reimbursed under this section a two percent operating payment
181.18rate increase.
181.19(b) Seventy-five percent of the money resulting from the rate adjustment under
181.20paragraph (a) must be used for increases in compensation-related costs for employees
181.21directly employed by the nursing facility on or after the effective date of the rate
181.22adjustment, except:
181.23(1) the administrator;
181.24(2) persons employed in the central office of a corporation that has an ownership
181.25interest in the nursing facility or exercises control over the nursing facility; and
181.26(3) persons paid by the nursing facility under a management contract.
181.27(c) The commissioner shall allow as compensation-related costs all costs for:
181.28(1) wages and salaries;
181.29(2) FICA taxes, Medicare taxes, state and federal unemployment taxes, and workers'
181.30compensation;
181.31(3) the employer's share of health and dental insurance, life insurance, disability
181.32insurance, long-term care insurance, uniform allowance, and pensions; and
181.33(4) other benefits provided and workforce needs including the recruiting and training
181.34of employees, subject to the approval of the commissioner.
182.1(d) The portion of the rate adjustment under paragraph (a) that is not subject to the
182.2requirements of paragraph (b) shall be provided to nursing facilities effective October 1.
182.3Nursing facilities may apply for the portion of the rate adjustment under paragraph (a)
182.4that is subject to the requirements in paragraph (b). The application must be submitted
182.5to the commissioner within six months of the effective date of the rate adjustment, and
182.6the nursing facility must provide additional information required by the commissioner
182.7within nine months of the effective date of the rate adjustment. The commissioner must
182.8respond to all applications within three weeks of receipt. The commissioner may waive
182.9the deadlines in this paragraph under extraordinary circumstances, to be determined at the
182.10sole discretion of the commissioner. The application must contain:
182.11(1) an estimate of the amounts of money that must be used as specified in paragraph
182.12(b);
182.13(2) a detailed distribution plan specifying the allowable compensation-related and
182.14wage increases the nursing facility will implement to use the funds available in clause (1);
182.15(3) a description of how the nursing facility will notify eligible employees of
182.16the contents of the approved application, which must provide for giving each eligible
182.17employee a copy of the approved application, excluding the information required in clause
182.18(1), or posting a copy of the approved application, excluding the information required in
182.19clause (1), for a period of at least six weeks in an area of the nursing facility to which all
182.20eligible employees have access; and
182.21(4) instructions for employees who believe they have not received the
182.22compensation-related or wage increases specified in clause (2), as approved by the
182.23commissioner, and which must include a mailing address, e-mail address, and the
182.24telephone number that may be used by the employee to contact the commissioner or the
182.25commissioner's representative.
182.26(e) For the October 1, 2013, rate increase, the commissioner shall ensure that cost
182.27increases in distribution plans under paragraph (d), clause (2), that may be included in
182.28approved applications, comply with the following requirements:
182.29(1) a portion of the costs resulting from tenure-related wage or salary increases
182.30may be considered to be allowable wage increases, according to formulas that the
182.31commissioner shall provide, where employee retention is above the average statewide
182.32rate of retention of direct care employees;
182.33(2) the annualized amount of increases in costs for the employer's share of health
182.34and dental insurance, life insurance, disability insurance, and workers' compensation
182.35shall be allowable compensation-related increases if they are effective on or after April
182.361, 2013, and prior to April 1, 2014; and
183.1(3) for nursing facilities in which employees are represented by an exclusive
183.2bargaining representative, the commissioner shall approve the application only upon
183.3receipt of a letter of acceptance of the distribution plan, in regard to members of the
183.4bargaining unit, signed by the exclusive bargaining agent and dated after May 25, 2013.
183.5Upon receipt of the letter of acceptance, the commissioner shall deem all requirements of
183.6this provision as having been met in regard to the members of the bargaining unit.
183.7(f) The commissioner shall review applications received under paragraph (e) and
183.8shall provide the portion of the rate adjustment under paragraph (b) if the requirements
183.9of this statute have been met. The rate adjustment shall be effective October 1.
183.10Notwithstanding paragraph (a), if the approved application distributes less money than is
183.11available, the amount of the rate adjustment shall be reduced so that the amount of money
183.12made available is equal to the amount to be distributed.
183.13(g) The increase in this subdivision shall be applied as a total percentage to
183.14operating rates effective September 30, 2013, except that they shall not increase any
183.15performance-based incentive payments under section 256B.434, subdivision 4, paragraph
183.16(d), awarded prior to the effective date of the rate adjustment. Facilities receiving equitable
183.17cost-sharing for publicly owned nursing facilities program rate adjustments under section
183.18256B.441, subdivision 55a, must have rate increases under this paragraph computed based
183.19on rates in effect before the increases given under section 256B.441, subdivision 55a.

183.20    Sec. 11. Minnesota Statutes 2012, section 256B.437, subdivision 6, is amended to read:
183.21    Subd. 6. Planned closure rate adjustment. (a) The commissioner of human
183.22services shall calculate the amount of the planned closure rate adjustment available under
183.23subdivision 3, paragraph (b), for up to 5,140 beds according to clauses (1) to (4):
183.24(1) the amount available is the net reduction of nursing facility beds multiplied
183.25by $2,080;
183.26(2) the total number of beds in the nursing facility or facilities receiving the planned
183.27closure rate adjustment must be identified;
183.28(3) capacity days are determined by multiplying the number determined under
183.29clause (2) by 365; and
183.30(4) the planned closure rate adjustment is the amount available in clause (1), divided
183.31by capacity days determined under clause (3).
183.32(b) A planned closure rate adjustment under this section is effective on the first day
183.33of the month following completion of closure of the facility designated for closure in
183.34the application and becomes part of the nursing facility's total operating external fixed
183.35 payment rate.
184.1(c) Applicants may use the planned closure rate adjustment to allow for a property
184.2payment for a new nursing facility or an addition to an existing nursing facility or as
184.3an operating payment external fixed rate adjustment. Applications approved under this
184.4subdivision are exempt from other requirements for moratorium exceptions under section
184.5144A.073 , subdivisions 2 and 3.
184.6(d) Upon the request of a closing facility, the commissioner must allow the facility a
184.7closure rate adjustment as provided under section 144A.161, subdivision 10.
184.8(e) A facility that has received a planned closure rate adjustment may reassign it
184.9to another facility that is under the same ownership at any time within three years of its
184.10effective date. The amount of the adjustment shall be computed according to paragraph (a).
184.11(f) If the per bed dollar amount specified in paragraph (a), clause (1), is increased,
184.12the commissioner shall recalculate planned closure rate adjustments for facilities that
184.13delicense beds under this section on or after July 1, 2001, to reflect the increase in the per
184.14bed dollar amount. The recalculated planned closure rate adjustment shall be effective
184.15from the date the per bed dollar amount is increased.
184.16(g) For planned closures approved after June 30, 2009, the commissioner of human
184.17services shall calculate the amount of the planned closure rate adjustment available under
184.18subdivision 3, paragraph (b), according to paragraph (a), clauses (1) to (4).
184.19(h) Beginning Between July 16, 2011, and June 30, 2013, the commissioner shall no
184.20longer not accept applications for planned closure rate adjustments under subdivision 3.

184.21    Sec. 12. Minnesota Statutes 2012, section 256B.441, subdivision 13, is amended to read:
184.22    Subd. 13. External fixed costs. "External fixed costs" means costs related to the
184.23nursing home surcharge under section 256.9657, subdivision 1; licensure fees under
184.24section 144.122; until September 30, 2013, long-term care consultation fees under
184.25section 256B.0911, subdivision 6; family advisory council fee under section 144A.33;
184.26scholarships under section 256B.431, subdivision 36; planned closure rate adjustments
184.27under section 256B.437; or single bed room incentives under section 256B.431,
184.28subdivision 42 ; property taxes and property insurance; and PERA.

184.29    Sec. 13. Minnesota Statutes 2012, section 256B.441, subdivision 53, is amended to read:
184.30    Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
184.31shall calculate a payment rate for external fixed costs.
184.32    (a) For a facility licensed as a nursing home, the portion related to section 256.9657
184.33shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
185.1home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
185.2result of its number of nursing home beds divided by its total number of licensed beds.
185.3    (b) The portion related to the licensure fee under section 144.122, paragraph (d),
185.4shall be the amount of the fee divided by actual resident days.
185.5    (c) The portion related to scholarships shall be determined under section 256B.431,
185.6subdivision 36.
185.7    (d) Until September 30, 2013, the portion related to long-term care consultation shall
185.8be determined according to section 256B.0911, subdivision 6.
185.9    (e) The portion related to development and education of resident and family advisory
185.10councils under section 144A.33 shall be $5 divided by 365.
185.11    (f) The portion related to planned closure rate adjustments shall be as determined
185.12under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.
185.13Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
185.14be included in the payment rate for external fixed costs beginning October 1, 2016.
185.15Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
185.16longer be included in the payment rate for external fixed costs beginning on October 1 of
185.17the first year not less than two years after their effective date.
185.18    (g) The portions related to property insurance, real estate taxes, special assessments,
185.19and payments made in lieu of real estate taxes directly identified or allocated to the nursing
185.20facility shall be the actual amounts divided by actual resident days.
185.21    (h) The portion related to the Public Employees Retirement Association shall be
185.22actual costs divided by resident days.
185.23    (i) The single bed room incentives shall be as determined under section 256B.431,
185.24subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
185.25no longer be included in the payment rate for external fixed costs beginning October 1,
185.262016. Single bed room incentives that take effect on or after October 1, 2014, shall no
185.27longer be included in the payment rate for external fixed costs beginning on October 1 of
185.28the first year not less than two years after their effective date.
185.29    (j) The payment rate for external fixed costs shall be the sum of the amounts in
185.30paragraphs (a) to (i).

185.31    Sec. 14. Minnesota Statutes 2012, section 256B.49, subdivision 11a, is amended to read:
185.32    Subd. 11a. Waivered services statewide priorities. (a) The commissioner shall
185.33establish statewide priorities for individuals on the waiting list for community alternative
185.34care, community alternatives for disabled individuals, and brain injury waiver services,
185.35as of January 1, 2010. The statewide priorities must include, but are not limited to,
186.1individuals who continue to have a need for waiver services after they have maximized the
186.2use of state plan services and other funding resources, including natural supports, prior to
186.3accessing waiver services, and who meet at least one of the following criteria:
186.4(1) have unstable living situations due to the age, incapacity, or sudden loss of
186.5the primary caregivers;
186.6(2) are moving from an institution due to bed closures;
186.7(3) experience a sudden closure of their current living arrangement;
186.8(4) require protection from confirmed abuse, neglect, or exploitation;
186.9(5) experience a sudden change in need that can no longer be met through state plan
186.10services or other funding resources alone; or
186.11(6) meet other priorities established by the department.
186.12(b) When allocating resources to lead agencies, the commissioner must take into
186.13consideration the number of individuals waiting who meet statewide priorities and the
186.14lead agencies' current use of waiver funds and existing service options. The commissioner
186.15has the authority to transfer funds between counties, groups of counties, and tribes to
186.16accommodate statewide priorities and resource needs while accounting for a necessary
186.17base level reserve amount for each county, group of counties, and tribe.
186.18(c) The commissioner shall evaluate the impact of the use of statewide priorities and
186.19provide recommendations to the legislature on whether to continue the use of statewide
186.20priorities in the November 1, 2011, annual report required by the commissioner in sections
186.21256B.0916, subdivision 7, and 256B.49, subdivision 21.

186.22    Sec. 15. Minnesota Statutes 2012, section 256B.49, subdivision 15, is amended to read:
186.23    Subd. 15. Coordinated service and support plan; comprehensive transitional
186.24service plan; maintenance service plan. (a) Each recipient of home and community-based
186.25waivered services shall be provided a copy of the written coordinated service and support
186.26plan which meets the requirements in section 256B.092, subdivision 1b.
186.27(b) In developing the comprehensive transitional service plan, the individual
186.28receiving services, the case manager, and the guardian, if applicable, will identify the
186.29transitional service plan fundamental service outcome and anticipated timeline to achieve
186.30this outcome. Within the first 20 days following a recipient's request for an assessment or
186.31reassessment, the transitional service planning team must be identified. A team leader must
186.32be identified who will be responsible for assigning responsibility and communicating with
186.33team members to ensure implementation of the transition plan and ongoing assessment and
186.34communication process. The team leader should be an individual, such as the case manager
186.35or guardian, who has the opportunity to follow the recipient to the next level of service.
187.1Within ten days following an assessment, a comprehensive transitional service plan
187.2must be developed incorporating elements of a comprehensive functional assessment and
187.3including short-term measurable outcomes and timelines for achievement of and reporting
187.4on these outcomes. Functional milestones must also be identified and reported according
187.5to the timelines agreed upon by the transitional service planning team. In addition, the
187.6comprehensive transitional service plan must identify additional supports that may assist
187.7in the achievement of the fundamental service outcome such as the development of greater
187.8natural community support, increased collaboration among agencies, and technological
187.9supports.
187.10The timelines for reporting on functional milestones will prompt a reassessment of
187.11services provided, the units of services, rates, and appropriate service providers. It is
187.12the responsibility of the transitional service planning team leader to review functional
187.13milestone reporting to determine if the milestones are consistent with observable skills
187.14and that milestone achievement prompts any needed changes to the comprehensive
187.15transitional service plan.
187.16For those whose fundamental transitional service outcome involves the need to
187.17procure housing, a plan for the recipient to seek the resources necessary to secure the least
187.18restrictive housing possible should be incorporated into the plan, including employment
187.19and public supports such as housing access and shelter needy funding.
187.20(c) Counties and other agencies responsible for funding community placement and
187.21ongoing community supportive services are responsible for the implementation of the
187.22comprehensive transitional service plans. Oversight responsibilities include both ensuring
187.23effective transitional service delivery and efficient utilization of funding resources.
187.24(d) Following one year of transitional services, the transitional services planning team
187.25will make a determination as to whether or not the individual receiving services requires
187.26the current level of continuous and consistent support in order to maintain the recipient's
187.27current level of functioning. Recipients who are determined to have not had a significant
187.28change in functioning for 12 months must move from a transitional to a maintenance
187.29service plan. Recipients on a maintenance service plan must be reassessed to determine if
187.30the recipient would benefit from a transitional service plan at least every 12 months and at
187.31other times when there has been a significant change in the recipient's functioning. This
187.32assessment should consider any changes to technological or natural community supports.
187.33(e) When a county is evaluating denials, reductions, or terminations of home and
187.34community-based services under section 256B.49 for an individual, the case manager
187.35shall offer to meet with the individual or the individual's guardian in order to discuss
187.36the prioritization of service needs within the coordinated service and support plan,
188.1comprehensive transitional service plan, or maintenance service plan. The reduction in
188.2the authorized services for an individual due to changes in funding for waivered services
188.3may not exceed the amount needed to ensure medically necessary services to meet the
188.4individual's health, safety, and welfare.
188.5(f) At the time of reassessment, local agency case managers shall assess each recipient
188.6of community alternatives for disabled individuals or brain injury waivered services
188.7currently residing in a licensed adult foster home that is not the primary residence of the
188.8license holder, or in which the license holder is not the primary caregiver, to determine if
188.9that recipient could appropriately be served in a community-living setting. If appropriate
188.10for the recipient, the case manager shall offer the recipient, through a person-centered
188.11planning process, the option to receive alternative housing and service options. In the
188.12event that the recipient chooses to transfer from the adult foster home, the vacated bed
188.13shall not be filled with another recipient of waiver services and group residential housing
188.14and the licensed capacity shall be reduced accordingly, unless the savings required by the
188.15licensed bed closure reductions under Laws 2011, First Special Session chapter 9, article 7,
188.16sections 1 and 40, paragraph (f), for foster care settings where the physical location is not
188.17the primary residence of the license holder are met through voluntary changes described
188.18in section 245A.03, subdivision 7, paragraph (f) (e), or as provided under paragraph (a),
188.19clauses (3) and (4). If the adult foster home becomes no longer viable due to these transfers,
188.20the county agency, with the assistance of the department, shall facilitate a consolidation of
188.21settings or closure. This reassessment process shall be completed by July 1, 2013.

188.22    Sec. 16. Minnesota Statutes 2012, section 256B.49, is amended by adding a
188.23subdivision to read:
188.24    Subd. 25. Excess allocations. County and tribal agencies will be responsible for
188.25authorizations in excess of the allocation made by the commissioner. In the event a county
188.26or tribal agency authorizes in excess of the allocation made by the commissioner for a
188.27given allocation period, they must submit a corrective action plan to the commissioner.
188.28The plan must state the actions the agency will take to correct their over-authorization for
188.29the year following the period when the over-authorization occurred. Failure to correct
188.30over-authorizations shall result in recoupment of authorizations in excess of the allocation.
188.31Nothing in this subdivision shall be construed as reducing the county's responsibility to
188.32offer and make available feasible home and community-based options to eligible waiver
188.33recipients within the resources allocated to them for that purpose.

188.34    Sec. 17. Minnesota Statutes 2012, section 256B.492, is amended to read:
189.1256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
189.2WITH DISABILITIES.
189.3(a) Individuals receiving services under a home and community-based waiver under
189.4section 256B.092 or 256B.49 may receive services in the following settings:
189.5(1) an individual's own home or family home;
189.6(2) a licensed adult foster care setting of up to five people; and
189.7(3) community living settings as defined in section 256B.49, subdivision 23, where
189.8individuals with disabilities may reside in all of the units in a building of four or fewer
189.9units, and no more than the greater of four or 25 percent of the units in a multifamily
189.10building of more than four units, unless required by the Housing Opportunities for Persons
189.11with AIDS program.
189.12(b) The settings in paragraph (a) must not:
189.13(1) be located in a building that is a publicly or privately operated facility that
189.14provides institutional treatment or custodial care;
189.15(2) be located in a building on the grounds of or adjacent to a public or private
189.16institution;
189.17(3) be a housing complex designed expressly around an individual's diagnosis or
189.18disability, unless required by the Housing Opportunities for Persons with AIDS program;
189.19(4) be segregated based on a disability, either physically or because of setting
189.20characteristics, from the larger community; and
189.21(5) have the qualities of an institution which include, but are not limited to:
189.22regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
189.23agreed to and documented in the person's individual service plan shall not result in a
189.24residence having the qualities of an institution as long as the restrictions for the person are
189.25not imposed upon others in the same residence and are the least restrictive alternative,
189.26imposed for the shortest possible time to meet the person's needs.
189.27(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
189.28individuals receive services under a home and community-based waiver as of July 1,
189.292012, and the setting does not meet the criteria of this section.
189.30(d) Notwithstanding paragraph (c), a program in Hennepin County established as
189.31part of a Hennepin County demonstration project is qualified for the exception allowed
189.32under paragraph (c).
189.33(e) The commissioner shall submit an amendment to the waiver plan no later than
189.34December 31, 2012.

189.35    Sec. 18. Minnesota Statutes 2012, section 256B.493, subdivision 2, is amended to read:
190.1    Subd. 2. Planned closure process needs determination. The commissioner shall
190.2announce and implement a program for planned closure of adult foster care homes. Planned
190.3closure shall be the preferred method for achieving necessary budgetary savings required by
190.4the licensed bed closure budget reduction in section 245A.03, subdivision 7, paragraph (d)
190.5 (c). If additional closures are required to achieve the necessary savings, the commissioner
190.6shall use the process and priorities in section 245A.03, subdivision 7, paragraph (d) (c).

190.7    Sec. 19. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
190.8subdivision to read:
190.9    Subd. 14. Rate increase effective June 1, 2013. For rate periods beginning on or
190.10after June 1, 2013, the commissioner shall increase the total operating payment rate for
190.11each facility reimbursed under this section by $7.81 per day. The increase shall not be
190.12subject to any annual percentage increase.
190.13EFFECTIVE DATE.This section is effective June 1, 2013.

190.14    Sec. 20. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
190.15subdivision to read:
190.16    Subd. 15. ICF/DD rate increases effective July 1, 2013. (a) Notwithstanding
190.17subdivision 12, for each facility reimbursed under this section, for the rate period
190.18beginning July 1, 2013, the commissioner shall increase operating payments equal to two
190.19percent of the operating payment rates in effect on June 30, 2013.
190.20(b) For each facility, the commissioner shall apply the rate increase based on
190.21occupied beds, using the percentage specified in this subdivision multiplied by the total
190.22payment rate, including the variable rate, but excluding the property-related payment
190.23rate in effect on the preceding date. The total rate increase shall include the adjustment
190.24provided in section 256B.501, subdivision 12.

190.25    Sec. 21. Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision
190.263, as amended by Laws 2012, chapter 247, article 4, section 43, is amended to read:

190.27

Subd. 3.Forecasted Programs

190.28The amounts that may be spent from this
190.29appropriation for each purpose are as follows:

190.30

(a) MFIP/DWP Grants

191.1	Appropriations by Fund
191.2	General	84,680,000	91,978,000
191.3	Federal TANF	84,425,000	75,417,000

191.4

(b) MFIP Child Care Assistance Grants

55,456,000

30,923,000

191.5

(c) General Assistance Grants

49,192,000

46,938,000

191.6General Assistance Standard. The
191.7commissioner shall set the monthly standard
191.8of assistance for general assistance units
191.9consisting of an adult recipient who is
191.10childless and unmarried or living apart
191.11from parents or a legal guardian at $203.
191.12The commissioner may reduce this amount
191.13according to Laws 1997, chapter 85, article
191.143, section 54.
191.15Emergency General Assistance. The
191.16amount appropriated for emergency general
191.17assistance funds is limited to no more than
191.18$6,689,812 in fiscal year 2012 and $6,729,812
191.19in fiscal year 2013. Funds to counties shall
191.20be allocated by the commissioner using the
191.21allocation method specified in Minnesota
191.22Statutes, section 256D.06.

191.23

(d) Minnesota Supplemental Aid Grants

38,095,000

39,120,000

191.24

(e) Group Residential Housing Grants

121,080,000

129,238,000

191.25

(f) MinnesotaCare Grants

295,046,000

317,272,000

191.26This appropriation is from the health care
191.27access fund.

191.28

(g) Medical Assistance Grants

4,501,582,000

4,437,282,000

191.29Managed Care Incentive Payments. The
191.30commissioner shall not make managed care
191.31incentive payments for expanding preventive
191.32services during fiscal years beginning July 1,
191.332011, and July 1, 2012.
192.1Reduction of Rates for Congregate
192.2Living for Individuals with Lower Needs.
192.3Beginning October 1, 2011, lead agencies
192.4must reduce rates in effect on January 1, 2011,
192.5by ten percent for individuals with lower
192.6needs living in foster care settings where the
192.7license holder does not share the residence
192.8with recipients on the CADI and DD waivers
192.9and customized living settings for CADI.
192.10Lead agencies shall consult with providers to
192.11review individual service plans and identify
192.12changes or modifications to reduce the
192.13utilization of services while maintaining the
192.14health and safety of the individual receiving
192.15services. Lead agencies must adjust contracts
192.16within 60 days of the effective date. If
192.17federal waiver approval is obtained under
192.18the long-term care realignment waiver
192.19application submitted on February 13,
192.202012, and federal financial participation is
192.21authorized for the alternative care program,
192.22the commissioner shall adjust this payment
192.23rate reduction from ten to five percent for
192.24services rendered on or after July 1, 2012, or
192.25the first day of the month following federal
192.26approval, whichever is later. Effective
192.27August 1, 2013, this provision does not apply
192.28to individuals whose primary diagnosis is
192.29mental illness and who are living in foster
192.30care settings where the license holder is
192.31also (1) a provider of assertive community
192.32treatment (ACT) or adult rehabilitative
192.33mental health services (ARMHS) as defined
192.34in Minnesota Statutes, section 256B.0623;
192.35(2) a mental health center or mental health
192.36clinic certified under Minnesota Rules, parts
193.19520.0750 to 9520.0870; or (3) a provider
193.2of intensive residential treatment services
193.3(IRTS) licensed under Minnesota Rules,
193.4parts 9520.0500 to 9520.0670.
193.5Reduction of Lead Agency Waiver
193.6Allocations to Implement Rate Reductions
193.7for Congregate Living for Individuals
193.8with Lower Needs. Beginning October 1,
193.92011, the commissioner shall reduce lead
193.10agency waiver allocations to implement the
193.11reduction of rates for individuals with lower
193.12needs living in foster care settings where the
193.13license holder does not share the residence
193.14with recipients on the CADI and DD waivers
193.15and customized living settings for CADI.
193.16Reduce customized living and 24-hour
193.17customized living component rates.
193.18Effective July 1, 2011, the commissioner
193.19shall reduce elderly waiver customized living
193.20and 24-hour customized living component
193.21service spending by five percent through
193.22reductions in component rates and service
193.23rate limits. The commissioner shall adjust
193.24the elderly waiver capitation payment
193.25rates for managed care organizations paid
193.26under Minnesota Statutes, section 256B.69,
193.27subdivisions 6a and 23, to reflect reductions
193.28in component spending for customized living
193.29services and 24-hour customized living
193.30services under Minnesota Statutes, section
193.31256B.0915, subdivisions 3e and 3h, for the
193.32contract period beginning January 1, 2012.
193.33To implement the reduction specified in
193.34this provision, capitation rates paid by the
193.35commissioner to managed care organizations
193.36under Minnesota Statutes, section 256B.69,
194.1shall reflect a ten percent reduction for the
194.2specified services for the period January 1,
194.32012, to June 30, 2012, and a five percent
194.4reduction for those services on or after July
194.51, 2012.
194.6Limit Growth in the Developmental
194.7Disability Waiver. The commissioner
194.8shall limit growth in the developmental
194.9disability waiver to six diversion allocations
194.10per month beginning July 1, 2011, through
194.11June 30, 2013, and 15 diversion allocations
194.12per month beginning July 1, 2013, through
194.13June 30, 2015. Waiver allocations shall
194.14be targeted to individuals who meet the
194.15priorities for accessing waiver services
194.16identified in Minnesota Statutes, 256B.092,
194.17subdivision 12 . The limits do not include
194.18conversions from intermediate care facilities
194.19for persons with developmental disabilities.
194.20Notwithstanding any contrary provisions in
194.21this article, this paragraph expires June 30,
194.222015.
194.23Limit Growth in the Community
194.24Alternatives for Disabled Individuals
194.25Waiver. The commissioner shall limit
194.26growth in the community alternatives for
194.27disabled individuals waiver to 60 allocations
194.28per month beginning July 1, 2011, through
194.29June 30, 2013, and 85 allocations per
194.30month beginning July 1, 2013, through
194.31June 30, 2015. Waiver allocations must
194.32be targeted to individuals who meet the
194.33priorities for accessing waiver services
194.34identified in Minnesota Statutes, section
194.35256B.49, subdivision 11a . The limits include
194.36conversions and diversions, unless the
195.1commissioner has approved a plan to convert
195.2funding due to the closure or downsizing
195.3of a residential facility or nursing facility
195.4to serve directly affected individuals on
195.5the community alternatives for disabled
195.6individuals waiver. Notwithstanding any
195.7contrary provisions in this article, this
195.8paragraph expires June 30, 2015.
195.9Personal Care Assistance Relative
195.10Care. The commissioner shall adjust the
195.11capitation payment rates for managed care
195.12organizations paid under Minnesota Statutes,
195.13section 256B.69, to reflect the rate reductions
195.14for personal care assistance provided by
195.15a relative pursuant to Minnesota Statutes,
195.16section 256B.0659, subdivision 11. This rate
195.17reduction is effective July 1, 2013.

195.18

(h) Alternative Care Grants

46,421,000

46,035,000

195.19Alternative Care Transfer. Any money
195.20allocated to the alternative care program that
195.21is not spent for the purposes indicated does
195.22not cancel but shall be transferred to the
195.23medical assistance account.

195.24

(i) Chemical Dependency Entitlement Grants

94,675,000

93,298,000

195.25EFFECTIVE DATE.This section is effective August 1, 2013.

195.26    Sec. 22. RECOMMENDATIONS FOR CONCENTRATION LIMITS ON HOME
195.27AND COMMUNITY-BASED SETTINGS.
195.28The commissioner of human services shall consult with the Minnesota Olmstead
195.29subcabinet, advocates, providers, and city representatives to develop recommendations
195.30on concentration limits on home and community-based settings, as defined in
195.31Minnesota Statutes, section 256B.492, as well as any other exceptions to the definition.
195.32The recommendations must be consistent with Minnesota's Olmstead plan. The
195.33recommendations and proposed legislation must be submitted to the chairs and ranking
196.1minority members of the legislative committees with jurisdiction over health and human
196.2services policy and finance by February 1, 2014.

196.3    Sec. 23. PROVIDER RATE AND GRANT INCREASES EFFECTIVE JULY
196.41, 2013.
196.5(a) The commissioner of human services shall increase reimbursement rates, grants,
196.6allocations, individual limits, and rate limits, as applicable, by two percent for the rate
196.7period beginning July 1, 2013, for services rendered on or after those dates. County or
196.8tribal contracts for services specified in this section must be amended to pass through
196.9these rate increases within 60 days of the effective date.
196.10(b) The rate changes described in this section must be provided to:
196.11(1) home and community-based waivered services for persons with developmental
196.12disabilities or related conditions, including consumer-directed community supports, under
196.13Minnesota Statutes, section 256B.501;
196.14(2) waivered services under community alternatives for disabled individuals,
196.15including consumer-directed community supports, under Minnesota Statutes, section
196.16256B.49;
196.17(3) community alternative care waivered services, including consumer-directed
196.18community supports, under Minnesota Statutes, section 256B.49;
196.19(4) traumatic brain injury waivered services, including consumer-directed
196.20community supports, under Minnesota Statutes, section 256B.49;
196.21(5) home and community-based waivered services for the elderly under Minnesota
196.22Statutes, section 256B.0915;
196.23(6) nursing services and home health services under Minnesota Statutes, section
196.24256B.0625, subdivision 6a;
196.25(7) personal care services and qualified professional supervision of personal care
196.26services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
196.27(8) private duty nursing services under Minnesota Statutes, section 256B.0625,
196.28subdivision 7;
196.29(9) day training and habilitation services for adults with developmental disabilities
196.30or related conditions under Minnesota Statutes, sections 252.40 to 252.46, including the
196.31additional cost of rate adjustments on day training and habilitation services, provided as a
196.32social service, under Minnesota Statutes, section 256M.60;
196.33(10) alternative care services under Minnesota Statutes, section 256B.0913;
196.34(11) living skills training programs for persons with intractable epilepsy who need
196.35assistance in the transition to independent living under Laws 1988, chapter 689;
197.1(12) semi-independent living services (SILS) under Minnesota Statutes, section
197.2252.275, including SILS funding under county social services grants formerly funded
197.3under Minnesota Statutes, chapter 256I;
197.4(13) consumer support grants under Minnesota Statutes, section 256.476;
197.5(14) family support grants under Minnesota Statutes, section 252.32;
197.6(15) housing access grants under Minnesota Statutes, section 256B.0658;
197.7(16) self-advocacy grants under Laws 2009, chapter 101; and
197.8(17) technology grants under Laws 2009, chapter 79.
197.9(c) A managed care plan receiving state payments for the services in this section
197.10must include these increases in their payments to providers. To implement the rate increase
197.11in this section, capitation rates paid by the commissioner to managed care organizations
197.12under Minnesota Statutes, section 256B.69, shall reflect a two percent increase for the
197.13specified services for the period beginning July 1, 2013.
197.14(d) Counties shall increase the budget for each recipient of consumer-directed
197.15community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).

197.16    Sec. 24. REPEALER.
197.17Minnesota Statutes 2012, section 256B.5012, subdivision 13, and Laws 2011, First
197.18Special Session chapter 9, article 7, section 54, as amended by Laws 2012, chapter 247,
197.19article 4, section 42, and Laws 2012, chapter 298, section 3, are repealed.


197.22    Section 1. Minnesota Statutes 2012, section 145C.01, subdivision 7, is amended to read:
197.23    Subd. 7. Health care facility. "Health care facility" means a hospital or other entity
197.24licensed under sections 144.50 to 144.58, a nursing home licensed to serve adults under
197.25section 144A.02, a home care provider licensed under sections 144A.43 to 144A.47,
197.26an adult foster care provider licensed under chapter 245A and Minnesota Rules, parts
197.279555.5105 to 9555.6265, a community residential setting licensed under chapter 245D, or
197.28a hospice provider licensed under sections 144A.75 to 144A.755.

197.29    Sec. 2. Minnesota Statutes 2012, section 243.166, subdivision 4b, is amended to read:
197.30    Subd. 4b. Health care facility; notice of status. (a) For the purposes of this
197.31subdivision, "health care facility" means a facility:
198.1(1) licensed by the commissioner of health as a hospital, boarding care home or
198.2supervised living facility under sections 144.50 to 144.58, or a nursing home under
198.3chapter 144A;
198.4(2) registered by the commissioner of health as a housing with services establishment
198.5as defined in section 144D.01; or
198.6(3) licensed by the commissioner of human services as a residential facility under
198.7chapter 245A to provide adult foster care, adult mental health treatment, chemical
198.8dependency treatment to adults, or residential services to persons with developmental
198.9 disabilities.
198.10(b) Prior to admission to a health care facility, a person required to register under
198.11this section shall disclose to:
198.12(1) the health care facility employee processing the admission the person's status
198.13as a registered predatory offender under this section; and
198.14(2) the person's corrections agent, or if the person does not have an assigned
198.15corrections agent, the law enforcement authority with whom the person is currently
198.16required to register, that inpatient admission will occur.
198.17(c) A law enforcement authority or corrections agent who receives notice under
198.18paragraph (b) or who knows that a person required to register under this section is
198.19planning to be admitted and receive, or has been admitted and is receiving health care
198.20at a health care facility shall notify the administrator of the facility and deliver a fact
198.21sheet to the administrator containing the following information: (1) name and physical
198.22description of the offender; (2) the offender's conviction history, including the dates of
198.23conviction; (3) the risk level classification assigned to the offender under section 244.052,
198.24if any; and (4) the profile of likely victims.
198.25(d) Except for a hospital licensed under sections 144.50 to 144.58, if a health care
198.26facility receives a fact sheet under paragraph (c) that includes a risk level classification for
198.27the offender, and if the facility admits the offender, the facility shall distribute the fact
198.28sheet to all residents at the facility. If the facility determines that distribution to a resident
198.29is not appropriate given the resident's medical, emotional, or mental status, the facility
198.30shall distribute the fact sheet to the patient's next of kin or emergency contact.

198.31    Sec. 3. [245.8251] POSITIVE SUPPORT STRATEGIES AND EMERGENCY
198.32MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
198.33    Subdivision 1. Rules. The commissioner of human services shall, within 24 months
198.34of enactment of this section, adopt rules governing the use of positive support strategies,
199.1safety interventions, and emergency use of manual restraint in facilities and services
199.2licensed under chapter 245D.
199.3    Subd. 2. Data collection. (a) The commissioner shall, with stakeholder input,
199.4develop data collection elements specific to incidents on the use of controlled procedures
199.5with persons receiving services from providers regulated under Minnesota Rules, parts
199.69525.2700 to 9525.2810, and incidents involving persons receiving services from
199.7providers identified to be licensed under chapter 245D effective January 1, 2014. Providers
199.8shall report the data in a format and at a frequency provided by the commissioner of
199.9human services.
199.10(b) Beginning July 1, 2013, providers regulated under Minnesota Rules, parts
199.119525.2700 to 9525.2810, shall submit data regarding the use of all controlled procedures
199.12in a format and at a frequency provided by the commissioner.

199.13    Sec. 4. Minnesota Statutes 2012, section 245A.02, subdivision 10, is amended to read:
199.14    Subd. 10. Nonresidential program. "Nonresidential program" means care,
199.15supervision, rehabilitation, training or habilitation of a person provided outside the
199.16person's own home and provided for fewer than 24 hours a day, including adult day
199.17care programs; and chemical dependency or chemical abuse programs that are located
199.18in a nursing home or hospital and receive public funds for providing chemical abuse or
199.19chemical dependency treatment services under chapter 254B. Nonresidential programs
199.20include home and community-based services and semi-independent living services for
199.21persons with developmental disabilities or persons age 65 and older that are provided in
199.22or outside of a person's own home under chapter 245D.

199.23    Sec. 5. Minnesota Statutes 2012, section 245A.02, subdivision 14, is amended to read:
199.24    Subd. 14. Residential program. "Residential program" means a program
199.25that provides 24-hour-a-day care, supervision, food, lodging, rehabilitation, training,
199.26education, habilitation, or treatment outside a person's own home, including a program
199.27in an intermediate care facility for four or more persons with developmental disabilities;
199.28and chemical dependency or chemical abuse programs that are located in a hospital
199.29or nursing home and receive public funds for providing chemical abuse or chemical
199.30dependency treatment services under chapter 254B. Residential programs include home
199.31and community-based services for persons with developmental disabilities or persons age
199.3265 and older that are provided in or outside of a person's own home under chapter 245D.

199.33    Sec. 6. Minnesota Statutes 2012, section 245A.03, subdivision 7, is amended to read:
200.1    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an initial
200.2license for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340,
200.3or adult foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under
200.4this chapter for a physical location that will not be the primary residence of the license
200.5holder for the entire period of licensure. If a license is issued during this moratorium, and
200.6the license holder changes the license holder's primary residence away from the physical
200.7location of the foster care license, the commissioner shall revoke the license according
200.8to section 245A.07. The commissioner shall not issue an initial license for a community
200.9residential setting licensed under chapter 245D. Exceptions to the moratorium include:
200.10(1) foster care settings that are required to be registered under chapter 144D;
200.11(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
200.12community residential setting licenses replacing adult foster care licenses in existence on
200.13December 31, 2013, and determined to be needed by the commissioner under paragraph (b);
200.14(3) new foster care licenses or community residential setting licenses determined to
200.15be needed by the commissioner under paragraph (b) for the closure of a nursing facility,
200.16ICF/MR, or regional treatment center, or restructuring of state-operated services that
200.17limits the capacity of state-operated facilities;
200.18(4) new foster care licenses or community residential setting licenses determined
200.19to be needed by the commissioner under paragraph (b) for persons requiring hospital
200.20level care; or
200.21(5) new foster care licenses or community residential setting licenses determined to
200.22be needed by the commissioner for the transition of people from personal care assistance
200.23to the home and community-based services.
200.24(b) The commissioner shall determine the need for newly licensed foster care
200.25homes or community residential settings as defined under this subdivision. As part of the
200.26determination, the commissioner shall consider the availability of foster care capacity in
200.27the area in which the licensee seeks to operate, and the recommendation of the local
200.28county board. The determination by the commissioner must be final. A determination of
200.29need is not required for a change in ownership at the same address.
200.30(c) The commissioner shall study the effects of the license moratorium under this
200.31subdivision and shall report back to the legislature by January 15, 2011. This study shall
200.32include, but is not limited to the following:
200.33(1) the overall capacity and utilization of foster care beds where the physical location
200.34is not the primary residence of the license holder prior to and after implementation
200.35of the moratorium;
201.1(2) the overall capacity and utilization of foster care beds where the physical
201.2location is the primary residence of the license holder prior to and after implementation
201.3of the moratorium; and
201.4(3) the number of licensed and occupied ICF/MR beds prior to and after
201.5implementation of the moratorium.
201.6(d) When a foster care recipient resident served by the program moves out of a
201.7foster home that is not the primary residence of the license holder according to section
201.8256B.49, subdivision 15 , paragraph (f), or the community residential setting, the county
201.9shall immediately inform the Department of Human Services Licensing Division.
201.10The department shall decrease the statewide licensed capacity for foster care settings
201.11where the physical location is not the primary residence of the license holder, or for
201.12community residential settings, if the voluntary changes described in paragraph (f) are
201.13not sufficient to meet the savings required by reductions in licensed bed capacity under
201.14Laws 2011, First Special Session chapter 9, article 7, sections 1 and 40, paragraph (f),
201.15and maintain statewide long-term care residential services capacity within budgetary
201.16limits. Implementation of the statewide licensed capacity reduction shall begin on July
201.171, 2013. The commissioner shall delicense up to 128 beds by June 30, 2014, using the
201.18needs determination process. Under this paragraph, the commissioner has the authority
201.19to reduce unused licensed capacity of a current foster care program, or the community
201.20residential settings, to accomplish the consolidation or closure of settings. A decreased
201.21licensed capacity according to this paragraph is not subject to appeal under this chapter.
201.22(e) Residential settings that would otherwise be subject to the decreased license
201.23capacity established in paragraph (d) shall be exempt under the following circumstances:
201.24(1) until August 1, 2013, the license holder's beds occupied by residents whose
201.25primary diagnosis is mental illness and the license holder is:
201.26(i) a provider of assertive community treatment (ACT) or adult rehabilitative mental
201.27health services (ARMHS) as defined in section 256B.0623;
201.28(ii) a mental health center certified under Minnesota Rules, parts 9520.0750 to
201.299520.0870;
201.30(iii) a mental health clinic certified under Minnesota Rules, parts 9520.0750 to
201.319520.0870; or
201.32(iv) a provider of intensive residential treatment services (IRTS) licensed under
201.33Minnesota Rules, parts 9520.0500 to 9520.0670; or
201.34(2) the license holder is certified under the requirements in subdivision 6a or section
201.35245D.33.
202.1(f) A resource need determination process, managed at the state level, using the
202.2available reports required by section 144A.351, and other data and information shall
202.3be used to determine where the reduced capacity required under paragraph (d) will be
202.4implemented. The commissioner shall consult with the stakeholders described in section
202.5144A.351 , and employ a variety of methods to improve the state's capacity to meet
202.6long-term care service needs within budgetary limits, including seeking proposals from
202.7service providers or lead agencies to change service type, capacity, or location to improve
202.8services, increase the independence of residents, and better meet needs identified by the
202.9long-term care services reports and statewide data and information. By February 1 of each
202.10year, the commissioner shall provide information and data on the overall capacity of
202.11licensed long-term care services, actions taken under this subdivision to manage statewide
202.12long-term care services and supports resources, and any recommendations for change to
202.13the legislative committees with jurisdiction over health and human services budget.
202.14    (g) At the time of application and reapplication for licensure, the applicant and the
202.15license holder that are subject to the moratorium or an exclusion established in paragraph
202.16(a) are required to inform the commissioner whether the physical location where the foster
202.17care will be provided is or will be the primary residence of the license holder for the entire
202.18period of licensure. If the primary residence of the applicant or license holder changes, the
202.19applicant or license holder must notify the commissioner immediately. The commissioner
202.20shall print on the foster care license certificate whether or not the physical location is the
202.21primary residence of the license holder.
202.22    (h) License holders of foster care homes identified under paragraph (g) that are not
202.23the primary residence of the license holder and that also provide services in the foster care
202.24home that are covered by a federally approved home and community-based services
202.25waiver, as authorized under section 256B.0915, 256B.092, or 256B.49, must inform the
202.26human services licensing division that the license holder provides or intends to provide
202.27these waiver-funded services. These license holders must be considered registered under
202.28section 256B.092, subdivision 11, paragraph (c), and this registration status must be
202.29identified on their license certificates.

202.30    Sec. 7. Minnesota Statutes 2012, section 245A.03, subdivision 8, is amended to read:
202.31    Subd. 8. Excluded providers seeking licensure. Nothing in this section shall
202.32prohibit a program that is excluded from licensure under subdivision 2, paragraph
202.33(a), clause (28) (26), from seeking licensure. The commissioner shall ensure that any
202.34application received from such an excluded provider is processed in the same manner as
202.35all other applications for child care center licensure.

203.1    Sec. 8. Minnesota Statutes 2012, section 245A.042, subdivision 3, is amended to read:
203.2    Subd. 3. Implementation. (a) The commissioner shall implement the
203.3responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
203.4only within the limits of available appropriations or other administrative cost recovery
203.5methodology.
203.6(b) The licensure of home and community-based services according to this section
203.7shall be implemented January 1, 2014. License applications shall be received and
203.8processed on a phased-in schedule as determined by the commissioner beginning July
203.91, 2013. Licenses will be issued thereafter upon the commissioner's determination that
203.10the application is complete according to section 245A.04.
203.11(c) Within the limits of available appropriations or other administrative cost recovery
203.12methodology, implementation of compliance monitoring must be phased in after January
203.131, 2014.
203.14(1) Applicants who do not currently hold a license issued under this chapter 245B
203.15 must receive an initial compliance monitoring visit after 12 months of the effective date of
203.16the initial license for the purpose of providing technical assistance on how to achieve and
203.17maintain compliance with the applicable law or rules governing the provision of home and
203.18community-based services under chapter 245D. If during the review the commissioner
203.19finds that the license holder has failed to achieve compliance with an applicable law or
203.20rule and this failure does not imminently endanger the health, safety, or rights of the
203.21persons served by the program, the commissioner may issue a licensing review report with
203.22recommendations for achieving and maintaining compliance.
203.23(2) Applicants who do currently hold a license issued under this chapter must receive
203.24a compliance monitoring visit after 24 months of the effective date of the initial license.
203.25(d) Nothing in this subdivision shall be construed to limit the commissioner's
203.26authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
203.27or make issue correction orders and make a license conditional for failure to comply with
203.28applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
203.29of the violation of law or rule and the effect of the violation on the health, safety, or
203.30rights of persons served by the program.

203.31    Sec. 9. Minnesota Statutes 2012, section 245A.08, subdivision 2a, is amended to read:
203.32    Subd. 2a. Consolidated contested case hearings. (a) When a denial of a license
203.33under section 245A.05 or a licensing sanction under section 245A.07, subdivision 3, is
203.34based on a disqualification for which reconsideration was requested and which was not
203.35set aside under section 245C.22, the scope of the contested case hearing shall include the
204.1disqualification and the licensing sanction or denial of a license, unless otherwise specified
204.2in this subdivision. When the licensing sanction or denial of a license is based on a
204.3determination of maltreatment under section 626.556 or 626.557, or a disqualification for
204.4serious or recurring maltreatment which was not set aside, the scope of the contested case
204.5hearing shall include the maltreatment determination, disqualification, and the licensing
204.6sanction or denial of a license, unless otherwise specified in this subdivision. In such
204.7cases, a fair hearing under section 256.045 shall not be conducted as provided for in
204.8sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision 9d.
204.9    (b) Except for family child care and child foster care, reconsideration of a
204.10maltreatment determination under sections 626.556, subdivision 10i, and 626.557,
204.11subdivision 9d, and reconsideration of a disqualification under section 245C.22, shall
204.12not be conducted when:
204.13    (1) a denial of a license under section 245A.05, or a licensing sanction under section
204.14245A.07 , is based on a determination that the license holder is responsible for maltreatment
204.15or the disqualification of a license holder is based on serious or recurring maltreatment;
204.16    (2) the denial of a license or licensing sanction is issued at the same time as the
204.17maltreatment determination or disqualification; and
204.18    (3) the license holder appeals the maltreatment determination or disqualification,
204.19and denial of a license or licensing sanction. In these cases, a fair hearing shall not be
204.20conducted under sections 245C.27, 626.556, subdivision 10i, and 626.557, subdivision
204.219d. The scope of the contested case hearing must include the maltreatment determination,
204.22disqualification, and denial of a license or licensing sanction.
204.23    Notwithstanding clauses (1) to (3), if the license holder appeals the maltreatment
204.24determination or disqualification, but does not appeal the denial of a license or a licensing
204.25sanction, reconsideration of the maltreatment determination shall be conducted under
204.26sections 626.556, subdivision 10i, and 626.557, subdivision 9d, and reconsideration of the
204.27disqualification shall be conducted under section 245C.22. In such cases, a fair hearing
204.28shall also be conducted as provided under sections 245C.27, 626.556, subdivision 10i, and
204.29626.557, subdivision 9d .
204.30    (c) In consolidated contested case hearings regarding sanctions issued in family child
204.31care, child foster care, family adult day services, and adult foster care, and community
204.32residential settings, the county attorney shall defend the commissioner's orders in
204.33accordance with section 245A.16, subdivision 4.
204.34    (d) The commissioner's final order under subdivision 5 is the final agency action
204.35on the issue of maltreatment and disqualification, including for purposes of subsequent
204.36background studies under chapter 245C and is the only administrative appeal of the final
205.1agency determination, specifically, including a challenge to the accuracy and completeness
205.2of data under section 13.04.
205.3    (e) When consolidated hearings under this subdivision involve a licensing sanction
205.4based on a previous maltreatment determination for which the commissioner has issued
205.5a final order in an appeal of that determination under section 256.045, or the individual
205.6failed to exercise the right to appeal the previous maltreatment determination under
205.7section 626.556, subdivision 10i, or 626.557, subdivision 9d, the commissioner's order is
205.8conclusive on the issue of maltreatment. In such cases, the scope of the administrative
205.9law judge's review shall be limited to the disqualification and the licensing sanction or
205.10denial of a license. In the case of a denial of a license or a licensing sanction issued to
205.11a facility based on a maltreatment determination regarding an individual who is not the
205.12license holder or a household member, the scope of the administrative law judge's review
205.13includes the maltreatment determination.
205.14    (f) The hearings of all parties may be consolidated into a single contested case
205.15hearing upon consent of all parties and the administrative law judge, if:
205.16    (1) a maltreatment determination or disqualification, which was not set aside under
205.17section 245C.22, is the basis for a denial of a license under section 245A.05 or a licensing
205.18sanction under section 245A.07;
205.19    (2) the disqualified subject is an individual other than the license holder and upon
205.20whom a background study must be conducted under section 245C.03; and
205.21    (3) the individual has a hearing right under section 245C.27.
205.22    (g) When a denial of a license under section 245A.05 or a licensing sanction under
205.23section 245A.07 is based on a disqualification for which reconsideration was requested
205.24and was not set aside under section 245C.22, and the individual otherwise has no hearing
205.25right under section 245C.27, the scope of the administrative law judge's review shall
205.26include the denial or sanction and a determination whether the disqualification should
205.27be set aside, unless section 245C.24 prohibits the set-aside of the disqualification. In
205.28determining whether the disqualification should be set aside, the administrative law judge
205.29shall consider the factors under section 245C.22, subdivision 4, to determine whether the
205.30individual poses a risk of harm to any person receiving services from the license holder.
205.31    (h) Notwithstanding section 245C.30, subdivision 5, when a licensing sanction
205.32under section 245A.07 is based on the termination of a variance under section 245C.30,
205.33subdivision 4 , the scope of the administrative law judge's review shall include the sanction
205.34and a determination whether the disqualification should be set aside, unless section
205.35245C.24 prohibits the set-aside of the disqualification. In determining whether the
205.36disqualification should be set aside, the administrative law judge shall consider the factors
206.1under section 245C.22, subdivision 4, to determine whether the individual poses a risk of
206.2harm to any person receiving services from the license holder.

206.3    Sec. 10. Minnesota Statutes 2012, section 245A.10, is amended to read:
206.4245A.10 FEES.
206.5    Subdivision 1. Application or license fee required, programs exempt from fee.
206.6(a) Unless exempt under paragraph (b), the commissioner shall charge a fee for evaluation
206.7of applications and inspection of programs which are licensed under this chapter.
206.8(b) Except as provided under subdivision 2, no application or license fee shall be
206.9charged for child foster care, adult foster care, or family and group family child care, or
206.10a community residential setting.
206.11    Subd. 2. County fees for background studies and licensing inspections. (a) For
206.12purposes of family and group family child care licensing under this chapter, a county
206.13agency may charge a fee to an applicant or license holder to recover the actual cost of
206.14background studies, but in any case not to exceed $100 annually. A county agency may
206.15also charge a license fee to an applicant or license holder not to exceed $50 for a one-year
206.16license or $100 for a two-year license.
206.17    (b) A county agency may charge a fee to a legal nonlicensed child care provider or
206.18applicant for authorization to recover the actual cost of background studies completed
206.19under section 119B.125, but in any case not to exceed $100 annually.
206.20    (c) Counties may elect to reduce or waive the fees in paragraph (a) or (b):
206.21    (1) in cases of financial hardship;
206.22    (2) if the county has a shortage of providers in the county's area;
206.23    (3) for new providers; or
206.24    (4) for providers who have attained at least 16 hours of training before seeking
206.25initial licensure.
206.26    (d) Counties may allow providers to pay the applicant fees in paragraph (a) or (b) on
206.27an installment basis for up to one year. If the provider is receiving child care assistance
206.28payments from the state, the provider may have the fees under paragraph (a) or (b)
206.29deducted from the child care assistance payments for up to one year and the state shall
206.30reimburse the county for the county fees collected in this manner.
206.31    (e) For purposes of adult foster care and child foster care licensing, and licensing
206.32the physical plant of a community residential setting, under this chapter, a county agency
206.33may charge a fee to a corporate applicant or corporate license holder to recover the actual
206.34cost of licensing inspections, not to exceed $500 annually.
207.1    (f) Counties may elect to reduce or waive the fees in paragraph (e) under the
207.2following circumstances:
207.3(1) in cases of financial hardship;
207.4(2) if the county has a shortage of providers in the county's area; or
207.5(3) for new providers.
207.6    Subd. 3. Application fee for initial license or certification. (a) For fees required
207.7under subdivision 1, an applicant for an initial license or certification issued by the
207.8commissioner shall submit a $500 application fee with each new application required
207.9under this subdivision. An applicant for an initial day services facility license under
207.10chapter 245D shall submit a $250 application fee with each new application. The
207.11application fee shall not be prorated, is nonrefundable, and is in lieu of the annual license
207.12or certification fee that expires on December 31. The commissioner shall not process an
207.13application until the application fee is paid.
207.14(b) Except as provided in clauses (1) to (4) (3), an applicant shall apply for a license
207.15to provide services at a specific location.
207.16(1) For a license to provide residential-based habilitation services to persons with
207.17developmental disabilities under chapter 245B, an applicant shall submit an application
207.18for each county in which the services will be provided. Upon licensure, the license
207.19holder may provide services to persons in that county plus no more than three persons
207.20at any one time in each of up to ten additional counties. A license holder in one county
207.21may not provide services under the home and community-based waiver for persons with
207.22developmental disabilities to more than three people in a second county without holding
207.23a separate license for that second county. Applicants or licensees providing services
207.24under this clause to not more than three persons remain subject to the inspection fees
207.25established in section 245A.10, subdivision 2, for each location. The license issued by
207.26the commissioner must state the name of each additional county where services are being
207.27provided to persons with developmental disabilities. A license holder must notify the
207.28commissioner before making any changes that would alter the license information listed
207.29under section 245A.04, subdivision 7, paragraph (a), including any additional counties
207.30where persons with developmental disabilities are being served. For a license to provide
207.31home and community-based services to persons with disabilities or age 65 and older under
207.32chapter 245D, an applicant shall submit an application to provide services statewide.
207.33(2) For a license to provide supported employment, crisis respite, or
207.34semi-independent living services to persons with developmental disabilities under chapter
207.35245B, an applicant shall submit a single application to provide services statewide.
208.1(3) For a license to provide independent living assistance for youth under section
208.2245A.22 , an applicant shall submit a single application to provide services statewide.
208.3(4) (3) For a license for a private agency to provide foster care or adoption services
208.4under Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single
208.5application to provide services statewide.
208.6(c) The initial application fee charged under this subdivision does not include the
208.7temporary license surcharge under section 16E.22.
208.8    Subd. 4. License or certification fee for certain programs. (a) Child care centers
208.9shall pay an annual nonrefundable license fee based on the following schedule:

208.10 208.11		Licensed Capacity	Child Care Center License Fee
208.12		1 to 24 persons	$200
208.13		25 to 49 persons	$300
208.14		50 to 74 persons	$400
208.15		75 to 99 persons	$500
208.16		100 to 124 persons	$600
208.17		125 to 149 persons	$700
208.18		150 to 174 persons	$800
208.19		175 to 199 persons	$900
208.20		200 to 224 persons	$1,000
208.21		225 or more persons	$1,100

208.22    (b) A day training and habilitation program serving persons with developmental
208.23disabilities or related conditions shall pay an annual nonrefundable license fee based on
208.24the following schedule:

208.25		Licensed Capacity	License Fee
208.26		1 to 24 persons	$800
208.27		25 to 49 persons	$1,000
208.28		50 to 74 persons	$1,200
208.29		75 to 99 persons	$1,400
208.30		100 to 124 persons	$1,600
208.31		125 to 149 persons	$1,800
208.32		150 or more persons	$2,000

208.33Except as provided in paragraph (c), when a day training and habilitation program
208.34serves more than 50 percent of the same persons in two or more locations in a community,
208.35the day training and habilitation program shall pay a license fee based on the licensed
208.36capacity of the largest facility and the other facility or facilities shall be charged a license
208.37fee based on a licensed capacity of a residential program serving one to 24 persons.
208.38    (c) When a day training and habilitation program serving persons with developmental
208.39disabilities or related conditions seeks a single license allowed under section 245B.07,
209.1subdivision 12, clause (2) or (3), the licensing fee must be based on the combined licensed
209.2capacity for each location.
209.3(d) A program licensed to provide supported employment services to persons
209.4with developmental disabilities under chapter 245B shall pay an annual nonrefundable
209.5license fee of $650.
209.6(e) A program licensed to provide crisis respite services to persons with
209.7developmental disabilities under chapter 245B shall pay an annual nonrefundable license
209.8fee of $700.
209.9(f) A program licensed to provide semi-independent living services to persons
209.10with developmental disabilities under chapter 245B shall pay an annual nonrefundable
209.11license fee of $700.
209.12(g) A program licensed to provide residential-based habilitation services under the
209.13home and community-based waiver for persons with developmental disabilities shall pay
209.14an annual license fee that includes a base rate of $690 plus $60 times the number of clients
209.15served on the first day of July of the current license year.
209.16(h) A residential program certified by the Department of Health as an intermediate
209.17care facility for persons with developmental disabilities (ICF/MR) and a noncertified
209.18residential program licensed to provide health or rehabilitative services for persons
209.19with developmental disabilities shall pay an annual nonrefundable license fee based on
209.20the following schedule:

209.21		Licensed Capacity	License Fee
209.22		1 to 24 persons	$535
209.23		25 to 49 persons	$735
209.24		50 or more persons	$935

209.25(b) A program licensed to provide one or more of the home and community-based
209.26services and supports identified under chapter 245D to persons with disabilities or age
209.2765 and older, shall pay an annual nonrefundable license fee that includes a base rate of
209.28$1,125, plus $92 times the number of persons served on the last day of June of the current
209.29license year for programs serving ten or more persons. The fee is limited to a maximum of
209.30200 persons, regardless of the actual number of persons served. Programs serving nine
209.31or fewer persons pay only the base rate.
209.32(c) A facility licensed under chapter 245D to provide day services shall pay an
209.33annual nonrefundable license fee of $100.
209.34(i) (d) A chemical dependency treatment program licensed under Minnesota Rules,
209.35parts 9530.6405 to 9530.6505, to provide chemical dependency treatment shall pay an
209.36annual nonrefundable license fee based on the following schedule:

210.1		Licensed Capacity	License Fee
210.2		1 to 24 persons	$600
210.3		25 to 49 persons	$800
210.4		50 to 74 persons	$1,000
210.5		75 to 99 persons	$1,200
210.6		100 or more persons	$1,400

210.7(j) (e) A chemical dependency program licensed under Minnesota Rules, parts
210.89530.6510 to 9530.6590, to provide detoxification services shall pay an annual
210.9nonrefundable license fee based on the following schedule:

210.10		Licensed Capacity	License Fee
210.11		1 to 24 persons	$760
210.12		25 to 49 persons	$960
210.13		50 or more persons	$1,160

210.14(k) (f) Except for child foster care, a residential facility licensed under Minnesota
210.15Rules, chapter 2960, to serve children shall pay an annual nonrefundable license fee
210.16based on the following schedule:

210.17		Licensed Capacity	License Fee
210.18		1 to 24 persons	$1,000
210.19		25 to 49 persons	$1,100
210.20		50 to 74 persons	$1,200
210.21		75 to 99 persons	$1,300
210.22		100 or more persons	$1,400

210.23(l) (g) A residential facility licensed under Minnesota Rules, parts 9520.0500 to
210.249520.0670, to serve persons with mental illness shall pay an annual nonrefundable license
210.25fee based on the following schedule:

210.26		Licensed Capacity	License Fee
210.27		1 to 24 persons	$2,525
210.28		25 or more persons	$2,725

210.29(m) (h) A residential facility licensed under Minnesota Rules, parts 9570.2000 to
210.309570.3400, to serve persons with physical disabilities shall pay an annual nonrefundable
210.31license fee based on the following schedule:

210.32		Licensed Capacity	License Fee
210.33		1 to 24 persons	$450
210.34		25 to 49 persons	$650
210.35		50 to 74 persons	$850
210.36		75 to 99 persons	$1,050
210.37		100 or more persons	$1,250

211.1(n) (i) A program licensed to provide independent living assistance for youth under
211.2section 245A.22 shall pay an annual nonrefundable license fee of $1,500.
211.3(o) (j) A private agency licensed to provide foster care and adoption services under
211.4Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable
211.5license fee of $875.
211.6(p) (k) A program licensed as an adult day care center licensed under Minnesota
211.7Rules, parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based
211.8on the following schedule:

211.9		Licensed Capacity	License Fee
211.10		1 to 24 persons	$500
211.11		25 to 49 persons	$700
211.12		50 to 74 persons	$900
211.13		75 to 99 persons	$1,100
211.14		100 or more persons	$1,300

211.15(q) (l) A program licensed to provide treatment services to persons with sexual
211.16psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts
211.179515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.
211.18(r) (m) A mental health center or mental health clinic requesting certification for
211.19purposes of insurance and subscriber contract reimbursement under Minnesota Rules,
211.20parts 9520.0750 to 9520.0870, shall pay a certification fee of $1,550 per year. If the
211.21mental health center or mental health clinic provides services at a primary location with
211.22satellite facilities, the satellite facilities shall be certified with the primary location without
211.23an additional charge.
211.24    Subd. 6. License not issued until license or certification fee is paid. The
211.25commissioner shall not issue a license or certification until the license or certification fee
211.26is paid. The commissioner shall send a bill for the license or certification fee to the billing
211.27address identified by the license holder. If the license holder does not submit the license or
211.28certification fee payment by the due date, the commissioner shall send the license holder
211.29a past due notice. If the license holder fails to pay the license or certification fee by the
211.30due date on the past due notice, the commissioner shall send a final notice to the license
211.31holder informing the license holder that the program license will expire on December 31
211.32unless the license fee is paid before December 31. If a license expires, the program is no
211.33longer licensed and, unless exempt from licensure under section 245A.03, subdivision 2,
211.34must not operate after the expiration date. After a license expires, if the former license
211.35holder wishes to provide licensed services, the former license holder must submit a new
211.36license application and application fee under subdivision 3.
212.1    Subd. 7. Human services licensing fees to recover expenditures. Notwithstanding
212.2section 16A.1285, subdivision 2, related to activities for which the commissioner charges
212.3a fee, the commissioner must plan to fully recover direct expenditures for licensing
212.4activities under this chapter over a five-year period. The commissioner may have
212.5anticipated expenditures in excess of anticipated revenues in a biennium by using surplus
212.6revenues accumulated in previous bienniums.
212.7    Subd. 8. Deposit of license fees. A human services licensing account is created in
212.8the state government special revenue fund. Fees collected under subdivisions 3 and 4 must
212.9be deposited in the human services licensing account a