1.1.................... moves to amend H.F. No. 2294, the delete everything amendment
1.2(H2294DE2), as follows:
1.3Page 4, after line 31, insert:

1.4    "Sec. 6. Minnesota Statutes 2010, section 256B.441, is amended by adding a
1.5subdivision to read:
1.6    Subd. 63. Special needs nursing facility rate adjustment. The commissioner may
1.7increase the medical assistance payment rate for a nursing facility that is participating
1.8in a health care delivery system demonstration project under sections 256B.0755 or
1.9256B.0756, or another care coordination project, if the nursing facility has agreed to
1.10accept patients enrolled in the project in order to reduce hospital or emergency room
1.11admissions or readmissions, shorten the length of inpatient hospital stays, or prevent a
1.12medical emergency that would require more costly treatment. The higher rate must reflect
1.13the higher costs of participating in the care coordination demonstration project and the
1.14higher costs of serving patients with more complex medical, dental, mental health, and
1.15socioeconomic conditions.

1.16    Sec. 7. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 5a, is
1.17amended to read:
1.18    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
1.19and section 256L.12 shall be entered into or renewed on a calendar year basis beginning
1.20January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to
1.21renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December
1.2231, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may
1.23issue separate contracts with requirements specific to services to medical assistance
1.24recipients age 65 and older.
1.25    (b) A prepaid health plan providing covered health services for eligible persons
1.26pursuant to chapters 256B and 256L is responsible for complying with the terms of its
2.1contract with the commissioner. Requirements applicable to managed care programs
2.2under chapters 256B and 256L established after the effective date of a contract with the
2.3commissioner take effect when the contract is next issued or renewed.
2.4    (c) Effective for services rendered on or after January 1, 2003, the commissioner
2.5shall withhold five percent of managed care plan payments under this section and
2.6county-based purchasing plan payments under section 256B.692 for the prepaid medical
2.7assistance program pending completion of performance targets. Each performance
2.8target must be quantifiable, objective, measurable, and reasonably attainable, except
2.9in the case of a performance target based on a federal or state law or rule. Criteria for
2.10assessment of each performance target must be outlined in writing prior to the contract
2.11effective date. Clinical or utilization performance targets and their related criteria
2.12must be based on evidence-based research showing they can be achieved through
2.13reasonable interventions, and developed with input from independent clinical experts
2.14and stakeholders, including managed care plans and providers. The managed care plan
2.15must demonstrate, to the commissioner's satisfaction, that the data submitted regarding
2.16attainment of the performance target is accurate. The commissioner shall periodically
2.17change the administrative measures used as performance targets in order to improve plan
2.18performance across a broader range of administrative services. The performance targets
2.19must include measurement of plan efforts to contain spending on health care services and
2.20administrative activities. The commissioner may adopt plan-specific performance targets
2.21that take into account factors affecting only one plan, including characteristics of the
2.22plan's enrollee population. The withheld funds must be returned no sooner than July of the
2.23following year if performance targets in the contract are achieved. The commissioner may
2.24exclude special demonstration projects under subdivision 23.
2.25    (d) Effective for services rendered on or after January 1, 2009, through December
2.2631, 2009, the commissioner shall withhold three percent of managed care plan payments
2.27under this section and county-based purchasing plan payments under section 256B.692
2.28for the prepaid medical assistance program. The withheld funds must be returned no
2.29sooner than July 1 and no later than July 31 of the following year. The commissioner may
2.30exclude special demonstration projects under subdivision 23.
2.31    (e) Effective for services provided on or after January 1, 2010, the commissioner
2.32shall require that managed care plans use the assessment and authorization processes,
2.33forms, timelines, standards, documentation, and data reporting requirements, protocols,
2.34billing processes, and policies consistent with medical assistance fee-for-service or the
2.35Department of Human Services contract requirements consistent with medical assistance
3.1fee-for-service or the Department of Human Services contract requirements for all
3.2personal care assistance services under section 256B.0659.
3.3    (f) Effective for services rendered on or after January 1, 2010, through December
3.431, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments
3.5under this section and county-based purchasing plan payments under section 256B.692
3.6for the prepaid medical assistance program. The withheld funds must be returned no
3.7sooner than July 1 and no later than July 31 of the following year. The commissioner may
3.8exclude special demonstration projects under subdivision 23.
3.9    (g) Effective for services rendered on or after January 1, 2011, through December
3.1031, 2011, the commissioner shall include as part of the performance targets described
3.11in paragraph (c) a reduction in the health plan's emergency room utilization rate for
3.12state health care program enrollees by a measurable rate of five percent from the plan's
3.13utilization rate for state health care program enrollees for the previous calendar year.
3.14Effective for services rendered on or after January 1, 2012, the commissioner shall include
3.15as part of the performance targets described in paragraph (c) a reduction in the health
3.16plan's emergency department utilization rate for medical assistance and MinnesotaCare
3.17enrollees, as determined by the commissioner. For calendar year 2012, the reduction shall
3.18be based on the health plan's utilization in calendar year 2009, and to earn the return of
3.19the withhold for that year, the plan must achieve a qualifying reduction of no less than
3.20ten percent compared to calendar year 2009. To earn the return of the withhold each
3.21subsequent year, the managed care plan or county-based purchasing plan must achieve
3.22a qualifying reduction of no less than ten percent of the plan's emergency department
3.23utilization rate for medical assistance and MinnesotaCare enrollees, excluding Medicare
3.24enrollees, compared to the previous calendar year, until the final performance target is
3.25reached. Measurement of performance shall take into account the difference in health risk
3.26in a plan's membership in the baseline year compared to the measurement year.
3.27    The withheld funds must be returned no sooner than July 1 and no later than July 31
3.28of the following calendar year if the managed care plan or county-based purchasing plan
3.29demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
3.30was achieved. The commissioner shall structure the withhold so that the commissioner
3.31returns a portion of the withheld funds in amounts commensurate with achieved reductions
3.32in utilization less than the targeted amount.
3.33    The withhold described in this paragraph shall continue for each consecutive
3.34contract period until the plan's emergency room utilization rate for state health care
3.35program enrollees is reduced by 25 percent of the plan's emergency room utilization
3.36rate for medical assistance and MinnesotaCare enrollees for calendar year 20112009.
4.1Hospitals shall cooperate with the health plans in meeting this performance target and
4.2shall accept payment withholds that may be returned to the hospitals if the performance
4.3target is achieved.
4.4    (h) Effective for services rendered on or after January 1, 2012, the commissioner
4.5shall include as part of the performance targets described in paragraph (c) a reduction
4.6in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
4.7enrollees, as determined by the commissioner. To earn the return of the withhold each
4.8year, the managed care plan or county-based purchasing plan must achieve a qualifying
4.9reduction of no less than five percent of the plan's hospital admission rate for medical
4.10assistance and MinnesotaCare enrollees, excluding Medicare enrollees, compared to the
4.11previous calendar year until the final performance target is reached. Measurement of
4.12performance shall take into account the difference in health risk in a plan's membership
4.13in the baseline year compared to the measurement year.
4.14    The withheld funds must be returned no sooner than July 1 and no later than July
4.1531 of the following calendar year if the managed care plan or county-based purchasing
4.16plan demonstrates to the satisfaction of the commissioner that this reduction in the
4.17hospitalization rate was achieved. The commissioner shall structure the withhold so that
4.18the commissioner returns a portion of the withheld funds in amounts commensurate with
4.19achieved reductions in utilization less than the targeted amount.
4.20    The withhold described in this paragraph shall continue until there is a 25 percent
4.21reduction in the hospital admission rate compared to the hospital admission rates in
4.22calendar year 2011, as determined by the commissioner. The hospital admissions in this
4.23performance target do not include the admissions applicable to the subsequent hospital
4.24admission performance target under paragraph (i). Hospitals shall cooperate with the
4.25plans in meeting this performance target and shall accept payment withholds that may be
4.26returned to the hospitals if the performance target is achieved.
4.27    (i) Effective for services rendered on or after January 1, 2012, the commissioner
4.28shall include as part of the performance targets described in paragraph (c) a reduction in
4.29the plan's hospitalization admission rates for subsequent hospitalizations within 30 days
4.30of a previous hospitalization of a patient regardless of the reason, for medical assistance
4.31and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of
4.32the withhold each year, the managed care plan or county-based purchasing plan must
4.33achieve a qualifying reduction of the subsequent hospitalization rate for medical assistance
4.34and MinnesotaCare enrollees, excluding Medicare enrollees, of no less than five percent
4.35compared to the previous calendar year until the final performance target is reached.
5.1    The withheld funds must be returned no sooner than July 1 and no later than July
5.231 of the following calendar year if the managed care plan or county-based purchasing
5.3plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in
5.4the subsequent hospitalization rate was achieved. The commissioner shall structure the
5.5withhold so that the commissioner returns a portion of the withheld funds in amounts
5.6commensurate with achieved reductions in utilization less than the targeted amount.
5.7    The withhold described in this paragraph must continue for each consecutive
5.8contract period until the plan's subsequent hospitalization rate for medical assistance and
5.9MinnesotaCare enrollees, excluding Medicare enrollees, is reduced by 25 percent of the
5.10plan's subsequent hospitalization rate for calendar year 2011. Hospitals shall cooperate
5.11with the plans in meeting this performance target and shall accept payment withholds that
5.12must be returned to the hospitals if the performance target is achieved.
5.13    (j) Effective for services rendered on or after January 1, 2011, through December 31,
5.142011, the commissioner shall withhold 4.5 percent of managed care plan payments under
5.15this section and county-based purchasing plan payments under section 256B.692 for the
5.16prepaid medical assistance program. The withheld funds must be returned no sooner than
5.17July 1 and no later than July 31 of the following year. The commissioner may exclude
5.18special demonstration projects under subdivision 23.
5.19    (k) Effective for services rendered on or after January 1, 2012, through December
5.2031, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
5.21under this section and county-based purchasing plan payments under section 256B.692
5.22for the prepaid medical assistance program. The withheld funds must be returned no
5.23sooner than July 1 and no later than July 31 of the following year. The commissioner may
5.24exclude special demonstration projects under subdivision 23.
5.25    (l) Effective for services rendered on or after January 1, 2013, through December 31,
5.262013, the commissioner shall withhold 4.5 percent of managed care plan payments under
5.27this section and county-based purchasing plan payments under section 256B.692 for the
5.28prepaid medical assistance program. The withheld funds must be returned no sooner than
5.29July 1 and no later than July 31 of the following year. The commissioner may exclude
5.30special demonstration projects under subdivision 23.
5.31    (m) Effective for services rendered on or after January 1, 2014, the commissioner
5.32shall withhold three percent of managed care plan payments under this section and
5.33county-based purchasing plan payments under section 256B.692 for the prepaid medical
5.34assistance program. The withheld funds must be returned no sooner than July 1 and
5.35no later than July 31 of the following year. The commissioner may exclude special
5.36demonstration projects under subdivision 23.
6.1    (n) A managed care plan or a county-based purchasing plan under section 256B.692
6.2may include as admitted assets under section 62D.044 any amount withheld under this
6.3section that is reasonably expected to be returned.
6.4    (o) Contracts between the commissioner and a prepaid health plan are exempt from
6.5the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
6.6(a), and 7.
6.7    (p) The return of the withhold under paragraphs (d), (f), and (j) to (m) is not subject
6.8to the requirements of paragraph (c).

6.9    Sec. 8. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 5c, is
6.10amended to read:
6.11    Subd. 5c. Medical education and research fund. (a) The commissioner of human
6.12services shall transfer each year to the medical education and research fund established
6.13under section 62J.692, an amount specified in this subdivision. The commissioner shall
6.14calculate the following:
6.15    (1) an amount equal to the reduction in the prepaid medical assistance payments as
6.16specified in this clause. Until January 1, 2002, the county medical assistance capitation
6.17base rate prior to plan specific adjustments and after the regional rate adjustments under
6.18subdivision 5b is reduced 6.3 percent for Hennepin County, two percent for the remaining
6.19metropolitan counties, and no reduction for nonmetropolitan Minnesota counties; and after
6.20January 1, 2002, the county medical assistance capitation base rate prior to plan specific
6.21adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining
6.22metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing
6.23facility and elderly waiver payments and demonstration project payments operating
6.24under subdivision 23 are excluded from this reduction. The amount calculated under
6.25this clause shall not be adjusted for periods already paid due to subsequent changes to
6.26the capitation payments;
6.27    (2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this
6.28section;
6.29    (3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates
6.30paid under this section; and
6.31    (4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid
6.32under this section.
6.33    (b) This subdivision shall be effective upon approval of a federal waiver which
6.34allows federal financial participation in the medical education and research fund. The
6.35amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount
7.1transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under
7.2paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally
7.3reduce the amount specified under paragraph (a), clause (1).
7.4    (c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner
7.5shall transfer $21,714,000 each fiscal year to the medical education and research fund.
7.6    (d) Beginning September 1, 2011, of the amount in paragraph (a), following the
7.7transfer under paragraph (c), the commissioner shall transfer to the medical education
7.8research fund $23,936,000 in fiscal years year 2012 and, $24,936,000 in fiscal year 2013,
7.9and $36,744,000 in fiscal year 2014 and thereafter."
7.10Page 6, line 7, delete everything after the period
7.11Page 6, delete line 8
7.12Page 7, after line 16, insert:

7.13    "Sec. 10. Minnesota Statutes 2011 Supplement, section 256L.12, subdivision 9,
7.14is amended to read:
7.15    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective,
7.16per capita, where possible. The commissioner may allow health plans to arrange for
7.17inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
7.18an independent actuary to determine appropriate rates.
7.19    (b) For services rendered on or after January 1, 2004, the commissioner shall
7.20withhold five percent of managed care plan payments and county-based purchasing
7.21plan payments under this section pending completion of performance targets. Each
7.22performance target must be quantifiable, objective, measurable, and reasonably attainable,
7.23except in the case of a performance target based on a federal or state law or rule.
7.24Criteria for assessment of each performance target must be outlined in writing prior to
7.25the contract effective date. Clinical or utilization performance targets and their related
7.26criteria must be based on evidence-based research showing they can be achieved through
7.27reasonable interventions, and developed with input from independent clinical experts
7.28and stakeholders, including managed care plans and providers. The managed care plan
7.29must demonstrate, to the commissioner's satisfaction, that the data submitted regarding
7.30attainment of the performance target is accurate. The commissioner shall periodically
7.31change the administrative measures used as performance targets in order to improve plan
7.32performance across a broader range of administrative services. The performance targets
7.33must include measurement of plan efforts to contain spending on health care services
7.34and administrative activities. The commissioner may adopt plan-specific performance
7.35targets that take into account factors affecting only one plan, such as characteristics of
7.36the plan's enrollee population. The withheld funds must be returned no sooner than July
8.11 and no later than July 31 of the following calendar year if performance targets in the
8.2contract are achieved.
8.3    (c) For services rendered on or after January 1, 2011, the commissioner shall
8.4withhold an additional three percent of managed care plan or county-based purchasing
8.5plan payments under this section. The withheld funds must be returned no sooner than
8.6July 1 and no later than July 31 of the following calendar year. The return of the withhold
8.7under this paragraph is not subject to the requirements of paragraph (b).
8.8    (d) Effective for services rendered on or after January 1, 2011, through December
8.931, 2011, the commissioner shall include as part of the performance targets described in
8.10paragraph (b) a reduction in the plan's emergency room utilization rate for state health
8.11care program enrollees by a measurable rate of five percent from the plan's utilization
8.12rate for the previous calendar year. Effective for services rendered on or after January
8.131, 2012, the commissioner shall include as part of the performance targets described in
8.14paragraph (b) a reduction in the health plan's emergency department utilization rate for
8.15medical assistance and MinnesotaCare enrollees, as determined by the commissioner. For
8.16calendar year 2012, the reduction shall be based on the health plan's utilization in calendar
8.17year 2009, and to earn the return of the withhold for that year, the plan must achieve a
8.18qualifying reduction of no less than ten percent compared to calendar year 2009. To earn
8.19the return of the withhold each subsequent year, the managed care plan or county-based
8.20purchasing plan must achieve a qualifying reduction of no less than ten percent of the
8.21plan's utilization rate for medical assistance and MinnesotaCare enrollees, excluding
8.22Medicare enrollees, compared to the previous calendar year, until the final performance
8.23target is reached. Measurement of performance shall take into account the difference in
8.24health risk in a plan's membership in the baseline year compared to the measurement year.
8.25    The withheld funds must be returned no sooner than July 1 and no later than July 31
8.26of the following calendar year if the managed care plan or county-based purchasing plan
8.27demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
8.28was achieved. The commissioner shall structure the withhold so that the commissioner
8.29returns a portion of the withheld funds in amounts commensurate with achieved reductions
8.30in utilization less than the targeted amount.
8.31    The withhold described in this paragraph shall continue for each consecutive contract
8.32period until the plan's emergency room utilization rate for state health care program
8.33enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical
8.34assistance and MinnesotaCare enrollees for calendar year 2011. Hospitals shall cooperate
8.35with the health plans in meeting this performance target and shall accept payment
8.36withholds that may be returned to the hospitals if the performance target is achieved.
9.1    (e) Effective for services rendered on or after January 1, 2012, the commissioner
9.2shall include as part of the performance targets described in paragraph (b) a reduction
9.3in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
9.4enrollees, as determined by the commissioner. To earn the return of the withhold each
9.5year, the managed care plan or county-based purchasing plan must achieve a qualifying
9.6reduction of no less than five percent of the plan's hospital admission rate for medical
9.7assistance and MinnesotaCare enrollees, excluding Medicare enrollees, compared to the
9.8previous calendar year, until the final performance target is reached. Measurement of
9.9performance shall take into account the difference in health risk in a plan's membership
9.10in the baseline year compared to the measurement year.
9.11    The withheld funds must be returned no sooner than July 1 and no later than July
9.1231 of the following calendar year if the managed care plan or county-based purchasing
9.13plan demonstrates to the satisfaction of the commissioner that this reduction in the
9.14hospitalization rate was achieved. The commissioner shall structure the withhold so that
9.15the commissioner returns a portion of the withheld funds in amounts commensurate with
9.16achieved reductions in utilization less than the targeted amount.
9.17    The withhold described in this paragraph shall continue until there is a 25 percent
9.18reduction in the hospitals admission rate compared to the hospital admission rate for
9.19calendar year 2011 as determined by the commissioner. Hospitals shall cooperate with the
9.20plans in meeting this performance target and shall accept payment withholds that may be
9.21returned to the hospitals if the performance target is achieved. The hospital admissions
9.22in this performance target do not include the admissions applicable to the subsequent
9.23hospital admission performance target under paragraph (f).
9.24    (f) Effective for services provided on or after January 1, 2012, the commissioner
9.25shall include as part of the performance targets described in paragraph (b) a reduction
9.26in the plan's hospitalization rate for a subsequent hospitalization within 30 days of a
9.27previous hospitalization of a patient regardless of the reason, for medical assistance and
9.28MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the
9.29withhold each year, the managed care plan or county-based purchasing plan must achieve
9.30a qualifying reduction of the subsequent hospital admissions rate for medical assistance
9.31and MinnesotaCare enrollees, excluding Medicare enrollees, of no less than five percent
9.32compared to the previous calendar year until the final performance target is reached.
9.33    The withheld funds must be returned no sooner than July 1 and no later than July 31
9.34of the following calendar year if the managed care plan or county-based purchasing plan
9.35demonstrates to the satisfaction of the commissioner that a reduction in the subsequent
9.36hospitalization rate was achieved. The commissioner shall structure the withhold so that
10.1the commissioner returns a portion of the withheld funds in amounts commensurate with
10.2achieved reductions in utilization less than the targeted amount.
10.3    The withhold described in this paragraph must continue for each consecutive
10.4contract period until the plan's subsequent hospitalization rate for medical assistance and
10.5MinnesotaCare enrollees is reduced by 25 percent of the plan's subsequent hospitalization
10.6rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this
10.7performance target and shall accept payment withholds that must be returned to the
10.8hospitals if the performance target is achieved.
10.9    (g) A managed care plan or a county-based purchasing plan under section 256B.692
10.10may include as admitted assets under section 62D.044 any amount withheld under this
10.11section that is reasonably expected to be returned."
10.12Page 7, after line 32, insert:

10.13    "Sec. 11. MANAGING MEDICAL ASSISTANCE FEE-FOR-SERVICE CARE
10.14DELIVERY.
10.15    The commissioner of human services shall issue, by July 1, 2012, a request for
10.16proposals to develop and administer a care delivery management system for medical
10.17assistance enrollees served under fee-for-service. The care delivery management system
10.18must improve health care quality and reduce unnecessary health care costs through the:
10.19(1) use of predictive modeling tools and comprehensive patient encounter data to identify
10.20missed preventive care and other gaps in health care delivery and to identify chronically
10.21ill and high-cost enrollees for targeted interventions and care management; (2) use of
10.22claims data to evaluate health care providers for overall quality and cost-effectiveness
10.23and make this information available to enrollees; and (3) establishment of a program
10.24integrity initiative to reduce fraudulent or improper billing. The commissioner shall award
10.25a contract under the request for proposals to a Minnesota-based organization by October
10.261, 2012. The contract must require the organization to implement the care delivery
10.27management system by July 1, 2013.

10.28    Sec. 12. DELIVERING HEALTH CARE THROUGH STATE PROGRAMS.
10.29    Subdivision 1. Plan submittal. The commissioner of human services, in
10.30consultation with the commissioners of health and commerce, shall develop and submit to
10.31the legislature, by December 15, 2012, a plan to restructure and reform medical assistance,
10.32MinnesotaCare, and other state health care programs. The plan must be designed to
10.33maintain and improve health care access, quality, cost-effectiveness, and affordability,
10.34in the event that the federal government makes significant changes in Medicaid service
10.35delivery, eligibility, and financing.
11.1    Subd. 2. Plan criteria. The plan submitted by the commissioner must:
11.2    (1) provide for continuity of care and minimize any loss of health care access or
11.3coverage;
11.4    (2) emphasize personal responsibility and involvement in making choices about
11.5health care;
11.6    (3) provide patients and health care providers with financial incentives to use and
11.7deliver health care services efficiently and achieve better health outcomes;
11.8    (4) incorporate innovative and effective health care delivery approaches, including
11.9but not limited to approaches based on defined contributions to enrollees and a system
11.10of coordinated care delivery models; and
11.11    (5) build upon, and be consistent with, recent state health care reform initiatives
11.12related to improving health care quality and increasing transparency in health care."
11.13Page 12, delete section 1 and insert:

11.14    "Section 1. Minnesota Statutes 2010, section 119B.13, subdivision 3a, is amended to
11.15read:
11.16    Subd. 3a. Provider rate differential for accreditation. A family child care
11.17provider or child care center shall be paid a 15 16 percent differential above the maximum
11.18rate established in subdivision 1, up to the actual provider rate, if the provider or center
11.19holds a current early childhood development credential or is accredited. For a family
11.20child care provider, early childhood development credential and accreditation includes
11.21an individual who has earned a child development associate degree, a child development
11.22associate credential, a diploma in child development from a Minnesota state technical
11.23college, or a bachelor's or post baccalaureate degree in early childhood education from
11.24an accredited college or university, or who is accredited by the National Association
11.25for Family Child Care or the Competency Based Training and Assessment Program.
11.26For a child care center, accreditation includes accreditation by that meets the following
11.27criteria: the accrediting organization must demonstrate the use of standards that promote
11.28the physical, social, emotional, and cognitive development of children. The accreditation
11.29standards shall include, but are not limited to, positive interactions between adults and
11.30children, age-appropriate learning activities, a system of tracking children's learning,
11.31use of assessment to meet children's needs, specific qualifications for staff, a learning
11.32environment that supports developmentally appropriate experiences for children, health
11.33and safety requirements, and family engagement strategies. The commissioner of human
11.34services, in conjunction with the commissioners of education and health, will develop an
11.35application and approval process based on the criteria in this section and any additional
11.36criteria. The process developed by the commissioner of human services must address
12.1periodic reassessment of approved accreditations. The commissioner of human services
12.2must report the criteria developed, the application, approval, and reassessment processes,
12.3and any additional recommendations by February 15, 2013, to the chairs and ranking
12.4minority members of the legislative committees having jurisdiction over early childhood
12.5issues. The following accreditations shall be recognized for the provider rate differential
12.6until an approval process is implemented: the National Association for the Education of
12.7Young Children, the Council on Accreditation, the National Early Childhood Program
12.8Accreditation, the National School-Age Care Association, or the National Head Start
12.9Association Program of Excellence. For Montessori programs, accreditation includes
12.10the American Montessori Society, Association of Montessori International-USA, or the
12.11National Center for Montessori Education."
12.12Page 23, line 25, delete "church" and insert "faith-based"
12.13Page 23, line 26, delete "2014" and insert "2013"
12.14Page 24, line 28, before the period, insert "using the resource need determination
12.15process described in paragraph (f)"
12.16Page 24, line 30, after the comma, insert "and other data and information, including"
12.17Page 24, line 32, delete "as a component of"
12.18Page 25, line 31, delete "statewide"
12.19Page 25, line 32, delete the new language and insert "of foster care settings where
12.20the physical location is not the primary residence of the license holder if the voluntary
12.21changes described in paragraph (f) are not sufficient to meet the savings required by 2011
12.22reductions in licensed bed capacity and maintain statewide long-term care residential
12.23services capacity within budgetary limits"
12.24Page 25, line 33, delete everything before the period
12.25Page 26, line 2, delete "will" and insert "and other data and information shall be
12.26used to"
12.27Page 26, after line 13, insert:
12.28"EFFECTIVE DATE.This section is effective the day following final enactment."
12.29Page 33, delete lines 34 and 35
12.30Page 34, delete lines 1 to 10 and insert:
12.31    "(6) when a person enrolled in medical assistance under section 256B.057,
12.32subdivision 9, is age 65 or older and has been enrolled during each of the 24 consecutive
12.33months before the person's 65th birthday, the assets owned by the person and the person's
12.34spouse must be disregarded, up to the limits of section 256B.057, subdivision 9, paragraph
12.35(d), when determining eligibility for medical assistance under section 256B.055,
12.36subdivision 7. The income of a spouse of a person enrolled in medical assistance under
13.1section 256B.057, subdivision 9, during each of the 24 consecutive months before the
13.2person's 65th birthday must be disregarded when determining eligibility for medical
13.3assistance under section 256B.055, subdivision 7. Persons eligible under this clause are
13.4not subject to the provisions in section 256B.059. A person whose 65th birthday occurs in
13.52012 or 2013 is required to have qualified for medical assistance under section 256B.057,
13.6subdivision 9, prior to age 65 for at least 20 months in the 24 months prior to reaching
13.7age 65."
13.8Page 34, after line 13, insert:

13.9    "Sec. 6. Minnesota Statutes 2011 Supplement, section 256B.057, subdivision 9,
13.10is amended to read:
13.11    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid
13.12for a person who is employed and who:
13.13    (1) but for excess earnings or assets, meets the definition of disabled under the
13.14Supplemental Security Income program;
13.15    (2) is at least 16 but less than 65 years of age;
13.16    (3) meets the asset limits in paragraph (d); and
13.17    (4) (3) pays a premium and other obligations under paragraph (e).
13.18    (b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
13.19for medical assistance under this subdivision, a person must have more than $65 of earned
13.20income. Earned income must have Medicare, Social Security, and applicable state and
13.21federal taxes withheld. The person must document earned income tax withholding. Any
13.22spousal income or assets shall be disregarded for purposes of eligibility and premium
13.23determinations.
13.24    (c) After the month of enrollment, a person enrolled in medical assistance under
13.25this subdivision who:
13.26    (1) is temporarily unable to work and without receipt of earned income due to a
13.27medical condition, as verified by a physician; or
13.28    (2) loses employment for reasons not attributable to the enrollee, and is without
13.29receipt of earned income may retain eligibility for up to four consecutive months after the
13.30month of job loss. To receive a four-month extension, enrollees must verify the medical
13.31condition or provide notification of job loss. All other eligibility requirements must be met
13.32and the enrollee must pay all calculated premium costs for continued eligibility.
13.33    (d) For purposes of determining eligibility under this subdivision, a person's assets
13.34must not exceed $20,000, excluding:
13.35    (1) all assets excluded under section 256B.056;
14.1    (2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
14.2Keogh plans, and pension plans;
14.3    (3) medical expense accounts set up through the person's employer; and
14.4    (4) spousal assets, including spouse's share of jointly held assets.
14.5    (e) All enrollees must pay a premium to be eligible for medical assistance under this
14.6subdivision, except as provided under section 256.01, subdivision 18b.
14.7    (1) An enrollee must pay the greater of a $65 premium or the premium calculated
14.8based on the person's gross earned and unearned income and the applicable family size
14.9using a sliding fee scale established by the commissioner, which begins at one percent of
14.10income at 100 percent of the federal poverty guidelines and increases to 7.5 percent of
14.11income for those with incomes at or above 300 percent of the federal poverty guidelines.
14.12    (2) Annual adjustments in the premium schedule based upon changes in the federal
14.13poverty guidelines shall be effective for premiums due in July of each year.
14.14    (3) All enrollees who receive unearned income must pay five percent of unearned
14.15income in addition to the premium amount, except as provided under section 256.01,
14.16subdivision 18b .
14.17    (4) Increases in benefits under title II of the Social Security Act shall not be counted
14.18as income for purposes of this subdivision until July 1 of each year.
14.19    (f) A person's eligibility and premium shall be determined by the local county
14.20agency. Premiums must be paid to the commissioner. All premiums are dedicated to
14.21the commissioner.
14.22    (g) Any required premium shall be determined at application and redetermined at
14.23the enrollee's six-month income review or when a change in income or household size is
14.24reported. Enrollees must report any change in income or household size within ten days
14.25of when the change occurs. A decreased premium resulting from a reported change in
14.26income or household size shall be effective the first day of the next available billing month
14.27after the change is reported. Except for changes occurring from annual cost-of-living
14.28increases, a change resulting in an increased premium shall not affect the premium amount
14.29until the next six-month review.
14.30    (h) Premium payment is due upon notification from the commissioner of the
14.31premium amount required. Premiums may be paid in installments at the discretion of
14.32the commissioner.
14.33    (i) Nonpayment of the premium shall result in denial or termination of medical
14.34assistance unless the person demonstrates good cause for nonpayment. Good cause exists
14.35if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
14.36D, are met. Except when an installment agreement is accepted by the commissioner,
15.1all persons disenrolled for nonpayment of a premium must pay any past due premiums
15.2as well as current premiums due prior to being reenrolled. Nonpayment shall include
15.3payment with a returned, refused, or dishonored instrument. The commissioner may
15.4require a guaranteed form of payment as the only means to replace a returned, refused,
15.5or dishonored instrument.
15.6    (j) The commissioner shall notify enrollees annually beginning at least 24 months
15.7before the person's 65th birthday of the medical assistance eligibility rules affecting
15.8income, assets, and treatment of a spouse's income and assets that will be applied upon
15.9reaching age 65.
15.10    (k) For enrollees whose income does not exceed 200 percent of the federal poverty
15.11guidelines and who are also enrolled in Medicare, the commissioner shall reimburse
15.12the enrollee for Medicare part B premiums under section 256B.0625, subdivision 15,
15.13paragraph (a).
15.14EFFECTIVE DATE.This section is effective April 1, 2012."
15.15Page 47, delete section 16
15.16Page 47, lines 13 and 14, reinstate the stricken language
15.17Page 47, line 15, reinstate the stricken "residential housing" and insert "and the
15.18licensed capacity shall be reduced accordingly, unless the savings required by the 2011
15.19licensed bed closure reductions for foster care settings where the physical location is not
15.20the primary residence of the license holder are met through voluntary changes described
15.21in section 245A.03, subdivision 7, paragraph (f), or as" and reinstate everything after
15.22the stricken "unless"
15.23Page 47, line 16, reinstate the stricken "clauses (3) and (4)" and insert a period
15.24Page 47, line 25, delete "For settings created after July 1, 2013,"
15.25Page 48, line 3, delete "transitioning"
15.26Page 48, line 4, delete "out of foster care settings" and before the period insert
15.27"unless an exception is granted under paragraph (c)"
15.28Page 48, delete lines 21 to 23, and insert:
15.29    "(c) Upon amendment of the home and community-based services waivers,
15.30residential settings which serve persons with disabilities under one of the disability waiver
15.31programs in more than 25 percent of the units in a building, but otherwise meet the
15.32requirements of this section, may request an exception for the number of units in which
15.33services were provided as of January 1, 2012. The commissioner shall grant exception
15.34requests which meet the criteria in this section and maintain a list of those settings that
15.35have approved exceptions and allow home and community-based waiver payments to
15.36be made for services provided."
16.1Page 48, after line 23, insert:

16.2    "Sec. ... Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision 3,
16.3is amended to read:

16.4

Subd. 3.Forecasted Programs

16.5The amounts that may be spent from this
16.6appropriation for each purpose are as follows:

16.7

(a) MFIP/DWP Grants

16.8	Appropriations by Fund
16.9	General	84,680,000	91,978,000
16.10	Federal TANF	84,425,000	75,417,000

16.11

(b) MFIP Child Care Assistance Grants

55,456,000

30,923,000

16.12

(c) General Assistance Grants

49,192,000

46,938,000

16.13General Assistance Standard. The
16.14commissioner shall set the monthly standard
16.15of assistance for general assistance units
16.16consisting of an adult recipient who is
16.17childless and unmarried or living apart
16.18from parents or a legal guardian at $203.
16.19The commissioner may reduce this amount
16.20according to Laws 1997, chapter 85, article
16.213, section 54.
16.22Emergency General Assistance. The
16.23amount appropriated for emergency general
16.24assistance funds is limited to no more
16.25than $6,689,812 in fiscal year 2012 and
16.26$6,729,812 in fiscal year 2013. Funds
16.27to counties shall be allocated by the
16.28commissioner using the allocation method
16.29specified in Minnesota Statutes, section
16.30256D.06 .

16.31

(d) Minnesota Supplemental Aid Grants

38,095,000

39,120,000

16.32

(e) Group Residential Housing Grants

121,080,000

129,238,000

16.33

(f) MinnesotaCare Grants

295,046,000

317,272,000

17.1This appropriation is from the health care
17.2access fund.

17.3

(g) Medical Assistance Grants

4,501,582,000

4,437,282,000

17.4Managed Care Incentive Payments. The
17.5commissioner shall not make managed care
17.6incentive payments for expanding preventive
17.7services during fiscal years beginning July 1,
17.82011, and July 1, 2012.
17.9Reduction of Rates for Congregate
17.10Living for Individuals with Lower Needs.
17.11Beginning October 1, 2011, through June
17.1230, 2012, lead agencies must reduce rates in
17.13effect on January 1, 2011, by ten percent for
17.14individuals with lower needs living in foster
17.15care settings where the license holder does
17.16not share the residence with recipients on
17.17the CADI and DD waivers and customized
17.18living settings for CADI. Beginning July
17.191, 2012, lead agencies must reduce rates in
17.20effect on January 1, 2011, by ten percent,
17.21for individuals living in foster care settings
17.22where the license holder does not share the
17.23residence with recipients on the CADI and
17.24DD waivers and customized living settings
17.25for CADI, in a manner that ensures that:
17.26(1) an identical percentage of recipients
17.27receiving services under each waiver receive
17.28a reduction; and (2) the projected savings
17.29for this provision for fiscal year 2013 are
17.30achieved, notwithstanding whether or not a
17.31recipient is an individual with lower needs.
17.32Lead agencies must adjust contracts within
17.3360 days of the effective date.
17.34Reduction of Lead Agency Waiver
17.35Allocations to Implement Rate Reductions
18.1for Congregate Living for Individuals
18.2with Lower Needs. Beginning October 1,
18.32011, the commissioner shall reduce lead
18.4agency waiver allocations to implement the
18.5reduction of rates for individuals with lower
18.6needs living in foster care settings where the
18.7license holder does not share the residence
18.8with recipients on the CADI and DD waivers
18.9and customized living settings for CADI.
18.10Reduce customized living and 24-hour
18.11customized living component rates.
18.12Effective July 1, 2011, the commissioner
18.13shall reduce elderly waiver customized living
18.14and 24-hour customized living component
18.15service spending by five percent through
18.16reductions in component rates and service
18.17rate limits. The commissioner shall adjust
18.18the elderly waiver capitation payment
18.19rates for managed care organizations paid
18.20under Minnesota Statutes, section 256B.69,
18.21subdivisions 6a and 23, to reflect reductions
18.22in component spending for customized living
18.23services and 24-hour customized living
18.24services under Minnesota Statutes, section
18.25256B.0915, subdivisions 3e and 3h, for the
18.26contract period beginning January 1, 2012.
18.27To implement the reduction specified in
18.28this provision, capitation rates paid by the
18.29commissioner to managed care organizations
18.30under Minnesota Statutes, section 256B.69,
18.31shall reflect a ten percent reduction for the
18.32specified services for the period January 1,
18.332012, to June 30, 2012, and a five percent
18.34reduction for those services on or after July
18.351, 2012.
19.1Limit Growth in the Developmental
19.2Disability Waiver. The commissioner
19.3shall limit growth in the developmental
19.4disability waiver to six diversion allocations
19.5per month beginning July 1, 2011, through
19.6June 30, 2013, and 15 diversion allocations
19.7per month beginning July 1, 2013, through
19.8June 30, 2015. Waiver allocations shall
19.9be targeted to individuals who meet the
19.10priorities for accessing waiver services
19.11identified in Minnesota Statutes, 256B.092,
19.12subdivision 12 . The limits do not include
19.13conversions from intermediate care facilities
19.14for persons with developmental disabilities.
19.15Notwithstanding any contrary provisions in
19.16this article, this paragraph expires June 30,
19.172015.
19.18Limit Growth in the Community
19.19Alternatives for Disabled Individuals
19.20Waiver. The commissioner shall limit
19.21growth in the community alternatives for
19.22disabled individuals waiver to 60 allocations
19.23per month beginning July 1, 2011, through
19.24June 30, 2013, and 85 allocations per
19.25month beginning July 1, 2013, through
19.26June 30, 2015. Waiver allocations must
19.27be targeted to individuals who meet the
19.28priorities for accessing waiver services
19.29identified in Minnesota Statutes, section
19.30256B.49, subdivision 11a . The limits include
19.31conversions and diversions, unless the
19.32commissioner has approved a plan to convert
19.33funding due to the closure or downsizing
19.34of a residential facility or nursing facility
19.35to serve directly affected individuals on
19.36the community alternatives for disabled
20.1individuals waiver. Notwithstanding any
20.2contrary provisions in this article, this
20.3paragraph expires June 30, 2015.
20.4Personal Care Assistance Relative
20.5Care. The commissioner shall adjust the
20.6capitation payment rates for managed care
20.7organizations paid under Minnesota Statutes,
20.8section 256B.69, to reflect the rate reductions
20.9for personal care assistance provided by
20.10a relative pursuant to Minnesota Statutes,
20.11section 256B.0659, subdivision 11.

20.12

(h) Alternative Care Grants

46,421,000

46,035,000

20.13Alternative Care Transfer. Any money
20.14allocated to the alternative care program that
20.15is not spent for the purposes indicated does
20.16not cancel but shall be transferred to the
20.17medical assistance account.

20.18

(i) Chemical Dependency Entitlement Grants

94,675,000

93,298,000

20.19    Sec. .... Laws 2011, First Special Session chapter 9, article 10, section 3, subdivision 4,
20.20is amended to read:

20.21

Subd. 4.Grant Programs

20.22The amounts that may be spent from this
20.23appropriation for each purpose are as follows:

20.24

(a) Support Services Grants

20.25	Appropriations by Fund
20.26	General	8,715,000	8,715,000
20.27	Federal TANF	100,525,000	94,611,000

20.28MFIP Consolidated Fund Grants. The
20.29TANF fund base is reduced by $10,000,000
20.30each year beginning in fiscal year 2012.
20.31Subsidized Employment Funding Through
20.32ARRA. The commissioner is authorized to
21.1apply for TANF emergency fund grants for
21.2subsidized employment activities. Growth
21.3in expenditures for subsidized employment
21.4within the supported work program and the
21.5MFIP consolidated fund over the amount
21.6expended in the calendar year quarters in
21.7the TANF emergency fund base year shall
21.8be used to leverage the TANF emergency
21.9fund grants for subsidized employment and
21.10to fund supported work. The commissioner
21.11shall develop procedures to maximize
21.12reimbursement of these expenditures over the
21.13TANF emergency fund base year quarters,
21.14and may contract directly with employers
21.15and providers to maximize these TANF
21.16emergency fund grants.

21.17 21.18

(b) Basic Sliding Fee Child Care Assistance Grants

37,144,000

38,678,000

21.19Base Adjustment. The general fund base is
21.20decreased by $990,000 in fiscal year 2014
21.21and $979,000 in fiscal year 2015.
21.22Child Care and Development Fund
21.23Unexpended Balance. In addition to
21.24the amount provided in this section, the
21.25commissioner shall expend $5,000,000
21.26in fiscal year 2012 from the federal child
21.27care and development fund unexpended
21.28balance for basic sliding fee child care under
21.29Minnesota Statutes, section 119B.03. The
21.30commissioner shall ensure that all child
21.31care and development funds are expended
21.32according to the federal child care and
21.33development fund regulations.

21.34

(c) Child Care Development Grants

774,000

774,000

22.1Base Adjustment. The general fund base is
22.2increased by $713,000 in fiscal years 2014
22.3and 2015.

22.4

(d) Child Support Enforcement Grants

50,000

50,000

22.5Federal Child Support Demonstration
22.6Grants. Federal administrative
22.7reimbursement resulting from the federal
22.8child support grant expenditures authorized
22.9under section 1115a of the Social Security
22.10Act is appropriated to the commissioner for
22.11this activity.

22.12

(e) Children's Services Grants

22.13	Appropriations by Fund
22.14	General	47,949,000	48,507,000
22.15	Federal TANF	140,000	140,000

22.16Adoption Assistance and Relative Custody
22.17Assistance Transfer. The commissioner
22.18may transfer unencumbered appropriation
22.19balances for adoption assistance and relative
22.20custody assistance between fiscal years and
22.21between programs.
22.22Privatized Adoption Grants. Federal
22.23reimbursement for privatized adoption grant
22.24and foster care recruitment grant expenditures
22.25is appropriated to the commissioner for
22.26adoption grants and foster care and adoption
22.27administrative purposes.
22.28Adoption Assistance Incentive Grants.
22.29Federal funds available during fiscal year
22.302012 and fiscal year 2013 for adoption
22.31incentive grants are appropriated to the
22.32commissioner for these purposes.

22.33

(f) Children and Community Services Grants

53,301,000

53,301,000

22.34

(g) Children and Economic Support Grants

23.1	Appropriations by Fund
23.2	General	16,103,000	16,180,000
23.3	Federal TANF	700,000	0

23.4Long-Term Homeless Services. $700,000
23.5is appropriated from the federal TANF
23.6fund for the biennium beginning July
23.71, 2011, to the commissioner of human
23.8services for long-term homeless services
23.9for low-income homeless families under
23.10Minnesota Statutes, section 256K.26. This
23.11is a onetime appropriation and is not added
23.12to the base.
23.13Base Adjustment. The general fund base is
23.14increased by $42,000 in fiscal year 2014 and
23.15$43,000 in fiscal year 2015.
23.16Minnesota Food Assistance Program.
23.17$333,000 in fiscal year 2012 and $408,000 in
23.18fiscal year 2013 are to increase the general
23.19fund base for the Minnesota food assistance
23.20program. Unexpended funds for fiscal year
23.212012 do not cancel but are available to the
23.22commissioner for this purpose in fiscal year
23.232013.

23.24

(h) Health Care Grants

23.25	Appropriations by Fund
23.26	General	26,000	66,000
23.27	Health Care Access	190,000	190,000

23.28Base Adjustment. The general fund base is
23.29increased by $24,000 in each of fiscal years
23.302014 and 2015.

23.31

(i) Aging and Adult Services Grants

12,154,000

11,456,000

23.32Aging Grants Reduction. Effective July
23.331, 2011, funding for grants made under
24.1Minnesota Statutes, sections 256.9754 and
24.2256B.0917, subdivision 13 , is reduced by
24.3$3,600,000 for each year of the biennium.
24.4These reductions are onetime and do
24.5not affect base funding for the 2014-2015
24.6biennium. Grants made during the 2012-2013
24.7biennium under Minnesota Statutes, section
24.8256B.9754 , must not be used for new
24.9construction or building renovation.
24.10Essential Community Support Grant
24.11Delay. Upon federal approval to implement
24.12the nursing facility level of care on July
24.131, 2013, essential community supports
24.14grants under Minnesota Statutes, section
24.15256B.0917, subdivision 14 , are reduced by
24.16$6,410,000 in fiscal year 2013. Base level
24.17funding is increased by $5,541,000 in fiscal
24.18year 2014 and $6,410,000 in fiscal year 2015.
24.19Base Level Adjustment. The general fund
24.20base is increased by $10,035,000 in fiscal
24.21year 2014 and increased by $10,901,000 in
24.22fiscal year 2015.

24.23

(j) Deaf and Hard-of-Hearing Grants

1,936,000

1,767,000

24.24

(k) Disabilities Grants

15,945,000

18,284,000

24.25Grants for Housing Access Services. In
24.26fiscal year 2012, the commissioner shall
24.27make available a total of $161,000 in housing
24.28access services grants to individuals who
24.29relocate from an adult foster care home to
24.30a community living setting for assistance
24.31with completion of rental applications or
24.32lease agreements; assistance with publicly
24.33financed housing options; development of
24.34household budgets; and assistance with
25.1funding affordable furnishings and related
25.2household matters.
25.3HIV Grants. The general fund appropriation
25.4for the HIV drug and insurance grant
25.5program shall be reduced by $2,425,000 in
25.6fiscal year 2012 and increased by $2,425,000
25.7in fiscal year 2014. These adjustments are
25.8onetime and shall not be applied to the base.
25.9Notwithstanding any contrary provision, this
25.10provision expires June 30, 2014.
25.11Region 10. Of this appropriation, $100,000
25.12each year is for a grant provided under
25.13Minnesota Statutes, section 256B.097.
25.14Base Level Adjustment. The general fund
25.15base is increased by $2,944,000 in fiscal year
25.162014 and $653,000 in fiscal year 2015.
25.17Local Planning Grants for Creating
25.18Alternatives to Congregate Living for
25.19Individuals with Lower Needs. Of this
25.20appropriation, $100,000 in fiscal year 2013
25.21is for administrative functions related to the
25.22need determination and planning process
25.23required under Minnesota Statutes, sections
25.24144A.351 and 245A.03, subdivision 7,
25.25paragraphs (e) and (f). The commissioner
25.26shall make available a total of $250,000 per
25.27year $400,000 in local and regional planning
25.28grants, beginning July 1, 2011 2012, to assist
25.29lead agencies and provider organizations in
25.30developing alternatives to congregate living
25.31within the available level of resources for the
25.32home and community-based services waivers
25.33for persons with disabilities.
25.34Disability Linkage Line. Of this
25.35appropriation, $125,000 in fiscal year 2012
26.1and $300,000 in fiscal year 2013 are for
26.2assistance to people with disabilities who are
26.3considering enrolling in managed care.

26.4

(l) Adult Mental Health Grants

26.5	Appropriations by Fund
26.6	General	70,570,000	70,570,000
26.7	Health Care Access	750,000	750,000
26.8	Lottery Prize	1,508,000	1,508,000

26.9Funding Usage. Up to 75 percent of a fiscal
26.10year's appropriation for adult mental health
26.11grants may be used to fund allocations in that
26.12portion of the fiscal year ending December
26.1331.
26.14Base Adjustment. The general fund base is
26.15increased by $200,000 in fiscal years 2014
26.16and 2015.

26.17

(m) Children's Mental Health Grants

16,457,000

16,457,000

26.18Funding Usage. Up to 75 percent of a fiscal
26.19year's appropriation for children's mental
26.20health grants may be used to fund allocations
26.21in that portion of the fiscal year ending
26.22December 31.
26.23Base Adjustment. The general fund base is
26.24increased by $225,000 in fiscal years 2014
26.25and 2015.

26.26 26.27

(n) Chemical Dependency Nonentitlement Grants

1,336,000

1,336,000"

26.28Page 49, delete sections 19 and 20
26.29Page 50, delete section 21
26.30Page 50, after line 11, insert:

26.31    "Sec. .... COMMISSIONER AUTHORITY TO REDUCE 2011 CONGREGATE
26.32CARE LOW NEED RATE CUT.
26.33    During fiscal years 2013 and 2014, the commissioner shall reduce the 2011 reduction
26.34of rates for congregate living for individuals with lower needs to the extent actions taken
27.1under Minnesota Statutes, section 245A.03, subdivision 7, paragraph (f), produce savings
27.2beyond the amount needed to meet the licensed bed closure savings requirements of
27.3Minnesota Statutes, section 245A.03, subdivision 7, paragraph (e). Each February 1, the
27.4commissioner shall report to the chairs of the legislative committees with jurisdiction over
27.5health and human services finance on any reductions provided under this section. This
27.6section is effective on July 1, 2012, and expires on June 30, 2014.

27.7    Sec. .... HOME AND COMMUNITY-BASED SERVICES WAIVERS
27.8AMENDMENT FOR EXCEPTION.
27.9    (a) By September 1, 2012, the commissioner of human services shall submit
27.10amendments to the home and community-based waiver plans consistent with the definition
27.11of home and community-based settings under Minnesota Statutes, section 256B.492,
27.12including a request to allow an exception for those settings that serve persons with
27.13disabilities under a home and community-based service waiver in more than 25 percent
27.14of the units in a building as of January 1, 2012, but otherwise meet the definition under
27.15Minnesota Statutes, section 256B.492.
27.16    (b) Notwithstanding paragraph (a), a program in Hennepin County established as
27.17part of a Hennepin County demonstration project by January 1, 2013, is qualified for the
27.18exception allowed under paragraph (a)."
27.19Page 52, after line 23, insert:

27.20    "Sec. .... Minnesota Statutes 2010, section 256B.0943, subdivision 9, is amended to
27.21read:
27.22    Subd. 9. Service delivery criteria. (a) In delivering services under this section, a
27.23certified provider entity must ensure that:
27.24    (1) each individual provider's caseload size permits the provider to deliver services
27.25to both clients with severe, complex needs and clients with less intensive needs. The
27.26provider's caseload size should reasonably enable the provider to play an active role in
27.27service planning, monitoring, and delivering services to meet the client's and client's
27.28family's needs, as specified in each client's individual treatment plan;
27.29    (2) site-based programs, including day treatment and preschool programs, provide
27.30staffing and facilities to ensure the client's health, safety, and protection of rights, and that
27.31the programs are able to implement each client's individual treatment plan;
27.32    (3) a day treatment program is provided to a group of clients by a multidisciplinary
27.33team under the clinical supervision of a mental health professional. The day treatment
27.34program must be provided in and by: (i) an outpatient hospital accredited by the Joint
27.35Commission on Accreditation of Health Organizations and licensed under sections 144.50
28.1to 144.55; (ii) a community mental health center under section 245.62; or (iii) an entity
28.2that is under contract with the county board certified under subdivision 4 to operate a
28.3program that meets the requirements of section 245.4712, subdivision 2, or 245.4884,
28.4subdivision 2 , and Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment
28.5program must stabilize the client's mental health status while developing and improving
28.6the client's independent living and socialization skills. The goal of the day treatment
28.7program must be to reduce or relieve the effects of mental illness and provide training to
28.8enable the client to live in the community. The program must be available at least one day
28.9a week for a two-hour time block. The two-hour time block must include at least one hour
28.10of individual or group psychotherapy. The remainder of the structured treatment program
28.11may include individual or group psychotherapy, and individual or group skills training, if
28.12included in the client's individual treatment plan. Day treatment programs are not part of
28.13inpatient or residential treatment services. A day treatment program may provide fewer
28.14than the minimally required hours for a particular child during a billing period in which
28.15the child is transitioning into, or out of, the program; and
28.16    (4) a therapeutic preschool program is a structured treatment program offered
28.17to a child who is at least 33 months old, but who has not yet reached the first day of
28.18kindergarten, by a preschool multidisciplinary team in a day program licensed under
28.19Minnesota Rules, parts 9503.0005 to 9503.0175. The program must be available two
28.20hours per day, five days per week, and 12 months of each calendar year. The structured
28.21treatment program may include individual or group psychotherapy and individual or
28.22group skills training, if included in the client's individual treatment plan. A therapeutic
28.23preschool program may provide fewer than the minimally required hours for a particular
28.24child during a billing period in which the child is transitioning into, or out of, the program.
28.25    (b) A provider entity must deliver the service components of children's therapeutic
28.26services and supports in compliance with the following requirements:
28.27    (1) individual, family, and group psychotherapy must be delivered as specified in
28.28Minnesota Rules, part 9505.0323;
28.29    (2) individual, family, or group skills training must be provided by a mental health
28.30professional or a mental health practitioner who has a consulting relationship with a
28.31mental health professional who accepts full professional responsibility for the training;
28.32    (3) crisis assistance must be time-limited and designed to resolve or stabilize crisis
28.33through arrangements for direct intervention and support services to the child and the
28.34child's family. Crisis assistance must utilize resources designed to address abrupt or
28.35substantial changes in the functioning of the child or the child's family as evidenced by
29.1a sudden change in behavior with negative consequences for well being, a loss of usual
29.2coping mechanisms, or the presentation of danger to self or others;
29.3    (4) mental health behavioral aide services must be medically necessary treatment
29.4services, identified in the child's individual treatment plan and individual behavior plan,
29.5which are performed minimally by a paraprofessional qualified according to subdivision
29.67, paragraph (b), clause (3), and which are designed to improve the functioning of the
29.7child in the progressive use of developmentally appropriate psychosocial skills. Activities
29.8involve working directly with the child, child-peer groupings, or child-family groupings
29.9to practice, repeat, reintroduce, and master the skills defined in subdivision 1, paragraph
29.10(p), as previously taught by a mental health professional or mental health practitioner
29.11including:
29.12    (i) providing cues or prompts in skill-building peer-to-peer or parent-child
29.13interactions so that the child progressively recognizes and responds to the cues
29.14independently;
29.15    (ii) performing as a practice partner or role-play partner;
29.16    (iii) reinforcing the child's accomplishments;
29.17    (iv) generalizing skill-building activities in the child's multiple natural settings;
29.18    (v) assigning further practice activities; and
29.19    (vi) intervening as necessary to redirect the child's target behavior and to de-escalate
29.20behavior that puts the child or other person at risk of injury.
29.21A mental health behavioral aide must document the delivery of services in written
29.22progress notes. The mental health behavioral aide must implement treatment strategies
29.23in the individual treatment plan and the individual behavior plan. The mental health
29.24behavioral aide must document the delivery of services in written progress notes. Progress
29.25notes must reflect implementation of the treatment strategies, as performed by the mental
29.26health behavioral aide and the child's responses to the treatment strategies; and
29.27    (5) direction of a mental health behavioral aide must include the following:
29.28    (i) a clinical supervision plan approved by the responsible mental health professional;
29.29    (ii) ongoing on-site observation by a mental health professional or mental health
29.30practitioner for at least a total of one hour during every 40 hours of service provided
29.31to a child; and
29.32    (iii) immediate accessibility of the mental health professional or mental health
29.33practitioner to the mental health behavioral aide during service provision."
29.34Page 58, after line 22, insert:
29.35"PCA Relative Care Payment Recovery.
29.36Notwithstanding any law to the contrary, and
30.1if, at the conclusion of the HealthStar Home
30.2Health, Inc et al v. Commissioner of Human
30.3Services litigation, the PCA relative rate
30.4reduction under Minnesota Statutes, section
30.5256B.0659, subdivision 11, paragraph (c),
30.6is upheld, the commissioner is prohibited
30.7from recovering the difference between the
30.8100 percent rate paid to providers and the
30.980 percent rate, during the period of the
30.10temporary injunction issued on October 26,
30.112011. This section does not prohibit the
30.12commissioner from recovering any other
30.13overpayments from providers."
30.14Page 59, line 16, after the period, insert "If the commissioner of human services does
30.15not receive the federal waiver requested under Laws 2011, First Special Session chapter 9,
30.16article 7, section 52, by July 1, 2012, the commissioner shall delay the last payment or
30.17payments in fiscal year 2013 to providers listed in Minnesota Statutes 2011 supplement,
30.18section 256B.5012, subdivision 13, and Laws 2011, First Special Session chapter 9, article
30.197, section 54, as they existed before the repeal in this act, by up to $22,854,000 in state
30.20match, reduced by any cash basis state share savings from implementing the level of care
30.21waiver before July 1, 2013, and make these payments in July 2013. "
30.22Page 59, line 27, after "$22,854,000" insert "in state match"
30.23Page 60, line 14, after the comma, insert "including nursing facilities that provide
30.24services to emergency medical assistance recipients,"
30.25Page 60, line 30, after the period, insert "$236,000 in fiscal year 2013 from the
30.26TANF fund for a one percent increase in accreditation differential."
30.27Page 62, after line 3 insert
30.28"Transitional Housing Services. $.........
30.29is appropriated in fiscal year ........ to the
30.30commissioner of human services from the
30.31TANF fund for transitional housing services,
30.32including the provision of up to four months
30.33of rental assistance under Minnesota Statutes,
30.34section 256E.33. This appropriation must be
30.35used for homeless families with children with
30.36incomes below 115 percent of the federal
31.1poverty guidelines, and must be coordinated
31.2with family stabilization services under
31.3Minnesota Statutes, section 256J.575."
31.4Page 62, delete line 5, and insert: "Community Action Agencies. $250,000"
31.5Page 62, line 7, delete everything after "fund"
31.6Page 62, delete line 8
31.7Page 62, line 9, delete everything before "under" and insert "for grants to community
31.8action agencies"
31.9Page 62, line 10, delete "256E.35" and insert "256E.30"
31.10Page 62, line 22, after the period, insert "$148,000 in fiscal year 2013 from the
31.11TANF fund for a one percent increase in accreditation differential"
31.12Page 64, after line 21, insert:
31.13"Autism Study. $200,000 is for the
31.14commissioner of health, in partnership with
31.15the University of Minnesota, to conduct a
31.16qualitative study focused on cultural and
31.17resource-based aspects of autism spectrum
31.18disorders (ASD) that are unique to the
31.19Somali community. By February 15,
31.202013, the commissioner shall report the
31.21findings of this study to the legislature. The
31.22report must include recommendations as to
31.23establishment of a population-based public
31.24health surveillance system for ASD."
31.25Amend the totals and summaries by fund accordingly
31.26Renumber the sections in sequence and correct the internal references
31.27Amend the title accordingly