1.1.................... moves to amend S.F. No. 1675, as amended to insert the language of
1.2H.F. 1967, the second engrossment, as follows:
1.3Page 167, after line 13, insert:


1.6    Section 1. Minnesota Statutes 2011 Supplement, section 144A.071, subdivision 3,
1.7is amended to read:
1.8    Subd. 3. Exceptions authorizing increase in beds; hardship areas. (a) The
1.9commissioner of health, in coordination with the commissioner of human services, may
1.10approve the addition of new licensed and Medicare and Medicaid certified nursing home
1.11beds, using the criteria and process set forth in this subdivision.
1.12(b) The commissioner, in cooperation with the commissioner of human services,
1.13shall consider the following criteria when determining that an area of the state is a
1.14hardship area with regard to access to nursing facility services:
1.15(1) a low number of beds per thousand in a specified area using as a standard the
1.16beds per thousand people age 65 and older, in five year age groups, using data from the
1.17most recent census and population projections, weighted by each group's most recent
1.18nursing home utilization, of the county at the 20th percentile, as determined by the
1.19commissioner of human services;
1.20(2) a high level of out-migration for nursing facility services associated with a
1.21described area from the county or counties of residence to other Minnesota counties, as
1.22determined by the commissioner of human services, using as a standard an amount greater
1.23than the out-migration of the county ranked at the 50th percentile;
1.24(3) an adequate level of availability of noninstitutional long-term care services
1.25measured as public spending for home and community-based long-term care services per
1.26individual age 65 and older, in five year age groups, using data from the most recent
2.1census and population projections, weighted by each group's most recent nursing home
2.2utilization, as determined by the commissioner of human services using as a standard an
2.3amount greater than the 50th percentile of counties;
2.4(4) there must be a declaration of hardship resulting from insufficient access to
2.5nursing home beds by local county agencies and area agencies on aging; and
2.6(5) other factors that may demonstrate the need to add new nursing facility beds.
2.7(c) On August 15 of odd-numbered years, the commissioner, in cooperation with
2.8the commissioner of human services, may publish in the State Register a request for
2.9information in which interested parties, using the data provided under section 144A.351,
2.10along with any other relevant data, demonstrate that a specified area is a hardship area
2.11with regard to access to nursing facility services. For a response to be considered, the
2.12commissioner must receive it by November 15. The commissioner shall make responses
2.13to the request for information available to the public and shall allow 30 days for comment.
2.14The commissioner shall review responses and comments and determine if any areas of
2.15the state are to be declared hardship areas.
2.16(d) For each designated hardship area determined in paragraph (c), the commissioner
2.17shall publish a request for proposals in accordance with section 144A.073 and Minnesota
2.18Rules, parts 4655.1070 to 4655.1098. The request for proposals must be published in the
2.19State Register by March 15 following receipt of responses to the request for information.
2.20The request for proposals must specify the number of new beds which may be added
2.21in the designated hardship area, which must not exceed the number which, if added to
2.22the existing number of beds in the area, including beds in layaway status, would have
2.23prevented it from being determined to be a hardship area under paragraph (b), clause
2.24(1). Beginning July 1, 2011, the number of new beds approved must not exceed 200
2.25beds statewide per biennium. After June 30, 2019, the number of new beds that may be
2.26approved in a biennium must not exceed 300 statewide. For a proposal to be considered,
2.27the commissioner must receive it within six months of the publication of the request for
2.28proposals. The commissioner shall review responses to the request for proposals and
2.29shall approve or disapprove each proposal by the following July 15, in accordance with
2.30section 144A.073 and Minnesota Rules, parts 4655.1070 to 4655.1098. The commissioner
2.31shall base approvals or disapprovals on a comparison and ranking of proposals using
2.32only the criteria in subdivision 4a. Approval of a proposal expires after 18 months
2.33unless the facility has added the new beds using existing space, subject to approval
2.34by the commissioner, or has commenced construction as defined in section 144A.071,
2.35subdivision 1a, paragraph (d). Operating If, after the approved beds have been added,
2.36fewer than 50 percent of the beds in a facility are newly licensed, the operating payment
3.1rates previously in effect shall remain. If, after the approved beds have been added, 50
3.2percent or more of the beds in a facility are newly licensed, operating payment rates shall
3.3be determined according to Minnesota Rules, part 9549.0057, using the limits under
3.4section 256B.441. External fixed payment rates must be determined according to section
3.5256B.441, subdivision 53 . Property payment rates for facilities with beds added under this
3.6subdivision must be determined in the same manner as rate determinations resulting from
3.7projects approved and completed under section 144A.073.
3.8(e) The commissioner may:
3.9(1) certify or license new beds in a new facility that is to be operated by the
3.10commissioner of veterans affairs or when the costs of constructing and operating the new
3.11beds are to be reimbursed by the commissioner of veterans affairs or the United States
3.12Veterans Administration; and
3.13(2) license or certify beds in a facility that has been involuntarily delicensed or
3.14decertified for participation in the medical assistance program, provided that an application
3.15for relicensure or recertification is submitted to the commissioner by an organization that
3.16is not a related organization as defined in section 256B.441, subdivision 34, to the prior
3.17licensee within 120 days after delicensure or decertification.

3.18    Sec. 2. Minnesota Statutes 2011 Supplement, section 144A.071, subdivision 4a,
3.19is amended to read:
3.20    Subd. 4a. Exceptions for replacement beds. It is in the best interest of the state
3.21to ensure that nursing homes and boarding care homes continue to meet the physical
3.22plant licensing and certification requirements by permitting certain construction projects.
3.23Facilities should be maintained in condition to satisfy the physical and emotional needs
3.24of residents while allowing the state to maintain control over nursing home expenditure
3.25growth.
3.26    The commissioner of health in coordination with the commissioner of human
3.27services, may approve the renovation, replacement, upgrading, or relocation of a nursing
3.28home or boarding care home, under the following conditions:
3.29    (a) to license or certify beds in a new facility constructed to replace a facility or to
3.30make repairs in an existing facility that was destroyed or damaged after June 30, 1987, by
3.31fire, lightning, or other hazard provided:
3.32    (i) destruction was not caused by the intentional act of or at the direction of a
3.33controlling person of the facility;
4.1    (ii) at the time the facility was destroyed or damaged the controlling persons of the
4.2facility maintained insurance coverage for the type of hazard that occurred in an amount
4.3that a reasonable person would conclude was adequate;
4.4    (iii) the net proceeds from an insurance settlement for the damages caused by the
4.5hazard are applied to the cost of the new facility or repairs;
4.6    (iv) the number of licensed and certified beds in the new facility does not exceed the
4.7number of licensed and certified beds in the destroyed facility; and
4.8    (v) the commissioner determines that the replacement beds are needed to prevent an
4.9inadequate supply of beds.
4.10Project construction costs incurred for repairs authorized under this clause shall not be
4.11considered in the dollar threshold amount defined in subdivision 2;
4.12    (b) to license or certify beds that are moved from one location to another within a
4.13nursing home facility, provided the total costs of remodeling performed in conjunction
4.14with the relocation of beds does not exceed $1,000,000;
4.15    (c) to license or certify beds in a project recommended for approval under section
4.16144A.073 ;
4.17    (d) to license or certify beds that are moved from an existing state nursing home to
4.18a different state facility, provided there is no net increase in the number of state nursing
4.19home beds;
4.20    (e) to certify and license as nursing home beds boarding care beds in a certified
4.21boarding care facility if the beds meet the standards for nursing home licensure, or in a
4.22facility that was granted an exception to the moratorium under section 144A.073, and if
4.23the cost of any remodeling of the facility does not exceed $1,000,000. If boarding care
4.24beds are licensed as nursing home beds, the number of boarding care beds in the facility
4.25must not increase beyond the number remaining at the time of the upgrade in licensure.
4.26The provisions contained in section 144A.073 regarding the upgrading of the facilities
4.27do not apply to facilities that satisfy these requirements;
4.28    (f) to license and certify up to 40 beds transferred from an existing facility owned and
4.29operated by the Amherst H. Wilder Foundation in the city of St. Paul to a new unit at the
4.30same location as the existing facility that will serve persons with Alzheimer's disease and
4.31other related disorders. The transfer of beds may occur gradually or in stages, provided
4.32the total number of beds transferred does not exceed 40. At the time of licensure and
4.33certification of a bed or beds in the new unit, the commissioner of health shall delicense
4.34and decertify the same number of beds in the existing facility. As a condition of receiving
4.35a license or certification under this clause, the facility must make a written commitment
5.1to the commissioner of human services that it will not seek to receive an increase in its
5.2property-related payment rate as a result of the transfers allowed under this paragraph;
5.3    (g) to license and certify nursing home beds to replace currently licensed and certified
5.4boarding care beds which may be located either in a remodeled or renovated boarding care
5.5or nursing home facility or in a remodeled, renovated, newly constructed, or replacement
5.6nursing home facility within the identifiable complex of health care facilities in which the
5.7currently licensed boarding care beds are presently located, provided that the number of
5.8boarding care beds in the facility or complex are decreased by the number to be licensed
5.9as nursing home beds and further provided that, if the total costs of new construction,
5.10replacement, remodeling, or renovation exceed ten percent of the appraised value of
5.11the facility or $200,000, whichever is less, the facility makes a written commitment to
5.12the commissioner of human services that it will not seek to receive an increase in its
5.13property-related payment rate by reason of the new construction, replacement, remodeling,
5.14or renovation. The provisions contained in section 144A.073 regarding the upgrading of
5.15facilities do not apply to facilities that satisfy these requirements;
5.16    (h) to license as a nursing home and certify as a nursing facility a facility that is
5.17licensed as a boarding care facility but not certified under the medical assistance program,
5.18but only if the commissioner of human services certifies to the commissioner of health that
5.19licensing the facility as a nursing home and certifying the facility as a nursing facility will
5.20result in a net annual savings to the state general fund of $200,000 or more;
5.21    (i) to certify, after September 30, 1992, and prior to July 1, 1993, existing nursing
5.22home beds in a facility that was licensed and in operation prior to January 1, 1992;
5.23    (j) to license and certify new nursing home beds to replace beds in a facility acquired
5.24by the Minneapolis Community Development Agency as part of redevelopment activities
5.25in a city of the first class, provided the new facility is located within three miles of the site
5.26of the old facility. Operating and property costs for the new facility must be determined
5.27and allowed under section 256B.431 or 256B.434;
5.28    (k) to license and certify up to 20 new nursing home beds in a community-operated
5.29hospital and attached convalescent and nursing care facility with 40 beds on April 21,
5.301991, that suspended operation of the hospital in April 1986. The commissioner of human
5.31services shall provide the facility with the same per diem property-related payment rate
5.32for each additional licensed and certified bed as it will receive for its existing 40 beds;
5.33    (l) to license or certify beds in renovation, replacement, or upgrading projects as
5.34defined in section 144A.073, subdivision 1, so long as the cumulative total costs of the
5.35facility's remodeling projects do not exceed $1,000,000;
6.1    (m) to license and certify beds that are moved from one location to another for the
6.2purposes of converting up to five four-bed wards to single or double occupancy rooms
6.3in a nursing home that, as of January 1, 1993, was county-owned and had a licensed
6.4capacity of 115 beds;
6.5    (n) to allow a facility that on April 16, 1993, was a 106-bed licensed and certified
6.6nursing facility located in Minneapolis to layaway all of its licensed and certified nursing
6.7home beds. These beds may be relicensed and recertified in a newly constructed teaching
6.8nursing home facility affiliated with a teaching hospital upon approval by the legislature.
6.9The proposal must be developed in consultation with the interagency committee on
6.10long-term care planning. The beds on layaway status shall have the same status as
6.11voluntarily delicensed and decertified beds, except that beds on layaway status remain
6.12subject to the surcharge in section 256.9657. This layaway provision expires July 1, 1998;
6.13    (o) to allow a project which will be completed in conjunction with an approved
6.14moratorium exception project for a nursing home in southern Cass County and which is
6.15directly related to that portion of the facility that must be repaired, renovated, or replaced,
6.16to correct an emergency plumbing problem for which a state correction order has been
6.17issued and which must be corrected by August 31, 1993;
6.18    (p) to allow a facility that on April 16, 1993, was a 368-bed licensed and certified
6.19nursing facility located in Minneapolis to layaway, upon 30 days prior written notice to
6.20the commissioner, up to 30 of the facility's licensed and certified beds by converting
6.21three-bed wards to single or double occupancy. Beds on layaway status shall have the
6.22same status as voluntarily delicensed and decertified beds except that beds on layaway
6.23status remain subject to the surcharge in section 256.9657, remain subject to the license
6.24application and renewal fees under section 144A.07 and shall be subject to a $100 per bed
6.25reactivation fee. In addition, at any time within three years of the effective date of the
6.26layaway, the beds on layaway status may be:
6.27    (1) relicensed and recertified upon relocation and reactivation of some or all of
6.28the beds to an existing licensed and certified facility or facilities located in Pine River,
6.29Brainerd, or International Falls; provided that the total project construction costs related to
6.30the relocation of beds from layaway status for any facility receiving relocated beds may
6.31not exceed the dollar threshold provided in subdivision 2 unless the construction project
6.32has been approved through the moratorium exception process under section 144A.073;
6.33    (2) relicensed and recertified, upon reactivation of some or all of the beds within the
6.34facility which placed the beds in layaway status, if the commissioner has determined a
6.35need for the reactivation of the beds on layaway status.
7.1    The property-related payment rate of a facility placing beds on layaway status
7.2must be adjusted by the incremental change in its rental per diem after recalculating the
7.3rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The
7.4property-related payment rate for a facility relicensing and recertifying beds from layaway
7.5status must be adjusted by the incremental change in its rental per diem after recalculating
7.6its rental per diem using the number of beds after the relicensing to establish the facility's
7.7capacity day divisor, which shall be effective the first day of the month following the
7.8month in which the relicensing and recertification became effective. Any beds remaining
7.9on layaway status more than three years after the date the layaway status became effective
7.10must be removed from layaway status and immediately delicensed and decertified;
7.11    (q) to license and certify beds in a renovation and remodeling project to convert 12
7.12four-bed wards into 24 two-bed rooms, expand space, and add improvements in a nursing
7.13home that, as of January 1, 1994, met the following conditions: the nursing home was
7.14located in Ramsey County; had a licensed capacity of 154 beds; and had been ranked
7.15among the top 15 applicants by the 1993 moratorium exceptions advisory review panel.
7.16The total project construction cost estimate for this project must not exceed the cost
7.17estimate submitted in connection with the 1993 moratorium exception process;
7.18    (r) to license and certify up to 117 beds that are relocated from a licensed and
7.19certified 138-bed nursing facility located in St. Paul to a hospital with 130 licensed
7.20hospital beds located in South St. Paul, provided that the nursing facility and hospital are
7.21owned by the same or a related organization and that prior to the date the relocation is
7.22completed the hospital ceases operation of its inpatient hospital services at that hospital.
7.23After relocation, the nursing facility's status under section 256B.431, subdivision 2j, shall
7.24be the same as it was prior to relocation. The nursing facility's property-related payment
7.25rate resulting from the project authorized in this paragraph shall become effective no
7.26earlier than April 1, 1996. For purposes of calculating the incremental change in the
7.27facility's rental per diem resulting from this project, the allowable appraised value of
7.28the nursing facility portion of the existing health care facility physical plant prior to the
7.29renovation and relocation may not exceed $2,490,000;
7.30    (s) to license and certify two beds in a facility to replace beds that were voluntarily
7.31delicensed and decertified on June 28, 1991;
7.32    (t) to allow 16 licensed and certified beds located on July 1, 1994, in a 142-bed
7.33nursing home and 21-bed boarding care home facility in Minneapolis, notwithstanding
7.34the licensure and certification after July 1, 1995, of the Minneapolis facility as a 147-bed
7.35nursing home facility after completion of a construction project approved in 1993 under
7.36section 144A.073, to be laid away upon 30 days' prior written notice to the commissioner.
8.1Beds on layaway status shall have the same status as voluntarily delicensed or decertified
8.2beds except that they shall remain subject to the surcharge in section 256.9657. The
8.316 beds on layaway status may be relicensed as nursing home beds and recertified at
8.4any time within five years of the effective date of the layaway upon relocation of some
8.5or all of the beds to a licensed and certified facility located in Watertown, provided that
8.6the total project construction costs related to the relocation of beds from layaway status
8.7for the Watertown facility may not exceed the dollar threshold provided in subdivision
8.82 unless the construction project has been approved through the moratorium exception
8.9process under section 144A.073.
8.10    The property-related payment rate of the facility placing beds on layaway status
8.11must be adjusted by the incremental change in its rental per diem after recalculating the
8.12rental per diem as provided in section 256B.431, subdivision 3a, paragraph (c). The
8.13property-related payment rate for the facility relicensing and recertifying beds from
8.14layaway status must be adjusted by the incremental change in its rental per diem after
8.15recalculating its rental per diem using the number of beds after the relicensing to establish
8.16the facility's capacity day divisor, which shall be effective the first day of the month
8.17following the month in which the relicensing and recertification became effective. Any
8.18beds remaining on layaway status more than five years after the date the layaway status
8.19became effective must be removed from layaway status and immediately delicensed
8.20and decertified;
8.21    (u) to license and certify beds that are moved within an existing area of a facility or
8.22to a newly constructed addition which is built for the purpose of eliminating three- and
8.23four-bed rooms and adding space for dining, lounge areas, bathing rooms, and ancillary
8.24service areas in a nursing home that, as of January 1, 1995, was located in Fridley and had
8.25a licensed capacity of 129 beds;
8.26    (v) to relocate 36 beds in Crow Wing County and four beds from Hennepin County
8.27to a 160-bed facility in Crow Wing County, provided all the affected beds are under
8.28common ownership;
8.29    (w) to license and certify a total replacement project of up to 49 beds located in
8.30Norman County that are relocated from a nursing home destroyed by flood and whose
8.31residents were relocated to other nursing homes. The operating cost payment rates for
8.32the new nursing facility shall be determined based on the interim and settle-up payment
8.33provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
8.34section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until
8.35the second rate year after the settle-up cost report is filed. Property-related reimbursement
9.1rates shall be determined under section 256B.431, taking into account any federal or state
9.2flood-related loans or grants provided to the facility;
9.3    (x) to license and certify a total replacement project of up to 129 beds located
9.4in Polk County that are relocated from a nursing home destroyed by flood and whose
9.5residents were relocated to other nursing homes. The operating cost payment rates for
9.6the new nursing facility shall be determined based on the interim and settle-up payment
9.7provisions of Minnesota Rules, part 9549.0057, and the reimbursement provisions of
9.8section 256B.431, except that subdivision 26, paragraphs (a) and (b), shall not apply until
9.9the second rate year after the settle-up cost report is filed. Property-related reimbursement
9.10rates shall be determined under section 256B.431, taking into account any federal or state
9.11flood-related loans or grants provided to the facility;
9.12    (y) to license and certify beds in a renovation and remodeling project to convert 13
9.13three-bed wards into 13 two-bed rooms and 13 single-bed rooms, expand space, and
9.14add improvements in a nursing home that, as of January 1, 1994, met the following
9.15conditions: the nursing home was located in Ramsey County, was not owned by a hospital
9.16corporation, had a licensed capacity of 64 beds, and had been ranked among the top 15
9.17applicants by the 1993 moratorium exceptions advisory review panel. The total project
9.18construction cost estimate for this project must not exceed the cost estimate submitted in
9.19connection with the 1993 moratorium exception process;
9.20    (z) to license and certify up to 150 nursing home beds to replace an existing 285
9.21bed nursing facility located in St. Paul. The replacement project shall include both the
9.22renovation of existing buildings and the construction of new facilities at the existing
9.23site. The reduction in the licensed capacity of the existing facility shall occur during the
9.24construction project as beds are taken out of service due to the construction process. Prior
9.25to the start of the construction process, the facility shall provide written information to the
9.26commissioner of health describing the process for bed reduction, plans for the relocation
9.27of residents, and the estimated construction schedule. The relocation of residents shall be
9.28in accordance with the provisions of law and rule;
9.29    (aa) to allow the commissioner of human services to license an additional 36 beds
9.30to provide residential services for the physically disabled under Minnesota Rules, parts
9.319570.2000 to 9570.3400, in a 198-bed nursing home located in Red Wing, provided that
9.32the total number of licensed and certified beds at the facility does not increase;
9.33    (bb) to license and certify a new facility in St. Louis County with 44 beds
9.34constructed to replace an existing facility in St. Louis County with 31 beds, which has
9.35resident rooms on two separate floors and an antiquated elevator that creates safety
10.1concerns for residents and prevents nonambulatory residents from residing on the second
10.2floor. The project shall include the elimination of three- and four-bed rooms;
10.3    (cc) to license and certify four beds in a 16-bed certified boarding care home in
10.4Minneapolis to replace beds that were voluntarily delicensed and decertified on or
10.5before March 31, 1992. The licensure and certification is conditional upon the facility
10.6periodically assessing and adjusting its resident mix and other factors which may
10.7contribute to a potential institution for mental disease declaration. The commissioner of
10.8human services shall retain the authority to audit the facility at any time and shall require
10.9the facility to comply with any requirements necessary to prevent an institution for mental
10.10disease declaration, including delicensure and decertification of beds, if necessary;
10.11    (dd) to license and certify 72 beds in an existing facility in Mille Lacs County with
10.1280 beds as part of a renovation project. The renovation must include construction of
10.13an addition to accommodate ten residents with beginning and midstage dementia in a
10.14self-contained living unit; creation of three resident households where dining, activities,
10.15and support spaces are located near resident living quarters; designation of four beds
10.16for rehabilitation in a self-contained area; designation of 30 private rooms; and other
10.17improvements;
10.18    (ee) to license and certify beds in a facility that has undergone replacement or
10.19remodeling as part of a planned closure under section 256B.437;
10.20    (ff) to license and certify a total replacement project of up to 124 beds located
10.21in Wilkin County that are in need of relocation from a nursing home significantly
10.22damaged by flood. The operating cost payment rates for the new nursing facility shall
10.23be determined based on the interim and settle-up payment provisions of Minnesota
10.24Rules, part 9549.0057, and the reimbursement provisions of section 256B.431, except
10.25that section 256B.431, subdivision 26, paragraphs (a) and (b), shall not apply until the
10.26second rate year after the settle-up cost report is filed. Property-related reimbursement
10.27rates shall be determined under section 256B.431, taking into account any federal or state
10.28flood-related loans or grants provided to the facility;
10.29    (gg) to allow the commissioner of human services to license an additional nine beds
10.30to provide residential services for the physically disabled under Minnesota Rules, parts
10.319570.2000 to 9570.3400, in a 240-bed nursing home located in Duluth, provided that the
10.32total number of licensed and certified beds at the facility does not increase;
10.33    (hh) to license and certify up to 120 new nursing facility beds to replace beds in a
10.34facility in Anoka County, which was licensed for 98 beds as of July 1, 2000, provided the
10.35new facility is located within four miles of the existing facility and is in Anoka County.
10.36Operating and property rates shall be determined and allowed under section 256B.431
11.1and Minnesota Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 256B.435.
11.2The provisions of section 256B.431, subdivision 26, paragraphs (a) and (b), do not apply
11.3until the second rate year following settle-up 256B.441; or
11.4    (ii) to transfer up to 98 beds of a 129-licensed bed facility located in Anoka County
11.5that, as of March 25, 2001, is in the active process of closing, to a 122-licensed bed
11.6nonprofit nursing facility located in the city of Columbia Heights or its affiliate. The
11.7transfer is effective when the receiving facility notifies the commissioner in writing of the
11.8number of beds accepted. The commissioner shall place all transferred beds on layaway
11.9status held in the name of the receiving facility. The layaway adjustment provisions of
11.10section 256B.431, subdivision 30, do not apply to this layaway. The receiving facility
11.11may only remove the beds from layaway for recertification and relicensure at the receiving
11.12facility's current site, or at a newly constructed facility located in Anoka County. The
11.13receiving facility must receive statutory authorization before removing these beds from
11.14layaway status, or may remove these beds from layaway status if removal from layaway
11.15status is part of a moratorium exception project approved by the commissioner under
11.16section 144A.073.

11.17    Sec. 3. Minnesota Statutes 2011 Supplement, section 245A.03, subdivision 7, is
11.18amended to read:
11.19    Subd. 7. Licensing moratorium. (a) The commissioner shall not issue an
11.20initial license for child foster care licensed under Minnesota Rules, parts 2960.3000 to
11.212960.3340, or adult foster care licensed under Minnesota Rules, parts 9555.5105 to
11.229555.6265, under this chapter for a physical location that will not be the primary residence
11.23of the license holder for the entire period of licensure. If a license is issued during this
11.24moratorium, and the license holder changes the license holder's primary residence away
11.25from the physical location of the foster care license, the commissioner shall revoke the
11.26license according to section 245A.07. Exceptions to the moratorium include:
11.27    (1) foster care settings that are required to be registered under chapter 144D;
11.28    (2) foster care licenses replacing foster care licenses in existence on May 15, 2009,
11.29and determined to be needed by the commissioner under paragraph (b);
11.30    (3) new foster care licenses determined to be needed by the commissioner under
11.31paragraph (b) for the closure of a nursing facility, ICF/MR, or regional treatment center, or
11.32restructuring of state-operated services that limits the capacity of state-operated facilities;
11.33    (4) new foster care licenses determined to be needed by the commissioner under
11.34paragraph (b) for persons requiring hospital level care; or
12.1    (5) new foster care licenses determined to be needed by the commissioner for the
12.2transition of people from personal care assistance to the home and community-based
12.3services.
12.4    (b) The commissioner shall determine the need for newly licensed foster care homes
12.5as defined under this subdivision. As part of the determination, the commissioner shall
12.6consider the availability of foster care capacity in the area in which the licensee seeks to
12.7operate, and the recommendation of the local county board. The determination by the
12.8commissioner must be final. A determination of need is not required for a change in
12.9ownership at the same address.
12.10    (c) Residential settings that would otherwise be subject to the moratorium established
12.11in paragraph (a), that are in the process of receiving an adult or child foster care license as
12.12of July 1, 2009, shall be allowed to continue to complete the process of receiving an adult
12.13or child foster care license. For this paragraph, all of the following conditions must be met
12.14to be considered in the process of receiving an adult or child foster care license:
12.15    (1) participants have made decisions to move into the residential setting, including
12.16documentation in each participant's care plan;
12.17    (2) the provider has purchased housing or has made a financial investment in the
12.18property;
12.19    (3) the lead agency has approved the plans, including costs for the residential setting
12.20for each individual;
12.21    (4) the completion of the licensing process, including all necessary inspections, is
12.22the only remaining component prior to being able to provide services; and
12.23    (5) the needs of the individuals cannot be met within the existing capacity in that
12.24county.
12.25To qualify for the process under this paragraph, the lead agency must submit
12.26documentation to the commissioner by August 1, 2009, that all of the above criteria are
12.27met.
12.28    (d) (c) The commissioner shall study the effects of the license moratorium under this
12.29subdivision and shall report back to the legislature by January 15, 2011. This study shall
12.30include, but is not limited to the following:
12.31    (1) the overall capacity and utilization of foster care beds where the physical location
12.32is not the primary residence of the license holder prior to and after implementation
12.33of the moratorium;
12.34    (2) the overall capacity and utilization of foster care beds where the physical
12.35location is the primary residence of the license holder prior to and after implementation
12.36of the moratorium; and
13.1    (3) the number of licensed and occupied ICF/MR beds prior to and after
13.2implementation of the moratorium.
13.3    (e) (d) When a foster care recipient moves out of a foster home that is not the
13.4primary residence of the license holder according to section 256B.49, subdivision 15,
13.5paragraph (f), the county shall immediately inform the Department of Human Services
13.6Licensing Division, and the department shall immediately decrease the licensed capacity
13.7for the home. A decreased licensed capacity according to this paragraph is not subject to
13.8appeal under this chapter.
13.9    (e) At the time of application and reapplication for licensure, the applicant and the
13.10license holder that are subject to the moratorium or an exclusion established in paragraph
13.11(a) are required to inform the commissioner whether the physical location where the foster
13.12care will be provided is or will be the primary residence of the license holder for the entire
13.13period of licensure. If the primary residence of the applicant or license holder changes, the
13.14applicant or license holder must notify the commissioner immediately. The commissioner
13.15shall print on the foster care license certificate whether or not the physical location is the
13.16primary residence of the license holder.
13.17    (f) License holders of foster care homes identified under paragraph (e) that are not
13.18the primary residence of the license holder and that also provide services in the foster care
13.19home that are covered by a federally approved home and community-based services
13.20waiver, as authorized under section 256B.0915, 256B.092, or 256B.49 must inform the
13.21human services licensing division that the license holder provides or intends to provide
13.22these waiver-funded services. These license holders must be considered registered under
13.23section 256B.092, subdivision 11, paragraph (c), and this registration status must be
13.24identified on their license certificates.

13.25    Sec. 4. Minnesota Statutes 2010, section 245A.11, subdivision 2a, is amended to read:
13.26    Subd. 2a. Adult foster care license capacity. (a) The commissioner shall issue
13.27adult foster care licenses with a maximum licensed capacity of four beds, including
13.28nonstaff roomers and boarders, except that the commissioner may issue a license with a
13.29capacity of five beds, including roomers and boarders, according to paragraphs (b) to (f).
13.30(b) An adult foster care license holder may have a maximum license capacity of five
13.31if all persons in care are age 55 or over and do not have a serious and persistent mental
13.32illness or a developmental disability.
13.33(c) The commissioner may grant variances to paragraph (b) to allow a foster care
13.34provider with a licensed capacity of five persons to admit an individual under the age of 55
14.1if the variance complies with section 245A.04, subdivision 9, and approval of the variance
14.2is recommended by the county in which the licensed foster care provider is located.
14.3(d) The commissioner may grant variances to paragraph (b) to allow the use of a fifth
14.4bed for emergency crisis services for a person with serious and persistent mental illness
14.5or a developmental disability, regardless of age, if the variance complies with section
14.6245A.04, subdivision 9 , and approval of the variance is recommended by the county in
14.7which the licensed foster care provider is located.
14.8(e) If the 2009 legislature adopts a rate reduction that impacts providers of adult
14.9foster care services, the commissioner may issue an adult foster care license with a
14.10capacity of five adults if the fifth bed does not increase the overall statewide capacity of
14.11licensed adult foster care beds in homes that are not the primary residence of the license
14.12holder, over the licensed capacity in such homes on July 1, 2009, as identified in a plan
14.13submitted to the commissioner by the county, when the capacity is recommended by
14.14the county licensing agency of the county in which the facility is located and if the
14.15recommendation verifies that:
14.16(1) the facility meets the physical environment requirements in the adult foster
14.17care licensing rule;
14.18(2) the five-bed living arrangement is specified for each resident in the resident's:
14.19(i) individualized plan of care;
14.20(ii) individual service plan under section 256B.092, subdivision 1b, if required; or
14.21(iii) individual resident placement agreement under Minnesota Rules, part
14.229555.5105, subpart 19, if required;
14.23(3) the license holder obtains written and signed informed consent from each
14.24resident or resident's legal representative documenting the resident's informed choice to
14.25living in the home and that the resident's refusal to consent would not have resulted in
14.26service termination; and
14.27(4) the facility was licensed for adult foster care before March 1, 2009.
14.28(f) The commissioner shall not issue a new adult foster care license under paragraph
14.29(e) after June 30, 2011 2014. The commissioner shall allow a facility with an adult foster
14.30care license issued under paragraph (e) before June 30, 2011 2016, to continue with a
14.31capacity of five adults if the license holder continues to comply with the requirements in
14.32paragraph (e).

14.33    Sec. 5. Minnesota Statutes 2010, section 245A.11, subdivision 8, is amended to read:
14.34    Subd. 8. Community residential setting license. (a) The commissioner shall
14.35establish provider standards for residential support services that integrate service standards
15.1and the residential setting under one license. The commissioner shall propose statutory
15.2language and an implementation plan for licensing requirements for residential support
15.3services to the legislature by January 15, 2011 2012, as a component of the quality outcome
15.4standards recommendations required by Laws 2010, chapter 352, article 1, section 24.
15.5(b) Providers licensed under chapter 245B, and providing, contracting, or arranging
15.6for services in settings licensed as adult foster care under Minnesota Rules, parts
15.79555.5105 to 9555.6265, or child foster care under Minnesota Rules, parts 2960.3000 to
15.82960.3340; and meeting the provisions of section 256B.092, subdivision 11, paragraph
15.9(b), must be required to obtain a community residential setting license.

15.10    Sec. 6. Minnesota Statutes 2010, section 252.32, subdivision 1a, is amended to read:
15.11    Subd. 1a. Support grants. (a) Provision of support grants must be limited to
15.12families who require support and whose dependents are under the age of 21 and who
15.13have been certified disabled under section 256B.055, subdivision 12, paragraphs (a),
15.14(b), (c), (d), and (e). Families who are receiving: home and community-based waivered
15.15services for persons with developmental disabilities authorized under section 256B.092 or
15.16256B.49; personal care assistance under section 256B.0652; or a consumer support grant
15.17under section 256.476 are not eligible for support grants.
15.18    Families whose annual adjusted gross income is $60,000 or more are not eligible for
15.19support grants except in cases where extreme hardship is demonstrated. Beginning in state
15.20fiscal year 1994, the commissioner shall adjust the income ceiling annually to reflect the
15.21projected change in the average value in the United States Department of Labor Bureau of
15.22Labor Statistics Consumer Price Index (all urban) for that year.
15.23    (b) Support grants may be made available as monthly subsidy grants and lump-sum
15.24grants.
15.25    (c) Support grants may be issued in the form of cash, voucher, and direct county
15.26payment to a vendor.
15.27    (d) Applications for the support grant shall be made by the legal guardian to the
15.28county social service agency. The application shall specify the needs of the families, the
15.29form of the grant requested by the families, and the items and services to be reimbursed.

15.30    Sec. 7. [252.34] REPORT BY COMMISSIONER OF HUMAN SERVICES.
15.31    Beginning January 1, 2013, the commissioner of human services shall provide a
15.32biennial report to the chairs of the legislative committees with jurisdiction over health and
15.33human services policy and funding. The report must provide a summary of overarching
15.34goals and priorities for persons with disabilities, including the status of how each of the
16.1following programs administered by the commissioner is supporting the overarching
16.2goals and priorities:
16.3    (1) home and community-based services waivers for persons with disabilities under
16.4sections 256B.092 and 256B.49;
16.5    (2) home care services under section 256B.0652; and
16.6    (3) other relevant programs and services as determined by the commissioner.

16.7    Sec. 8. Minnesota Statutes 2010, section 252A.21, subdivision 2, is amended to read:
16.8    Subd. 2. Rules. The commissioner shall adopt rules to implement this chapter.
16.9The rules must include standards for performance of guardianship or conservatorship
16.10duties including, but not limited to: twice a year visits with the ward; quarterly reviews
16.11of records from day, residential, and support services; a requirement that the duties of
16.12guardianship or conservatorship and case management not be performed by the same
16.13person; specific standards for action on "do not resuscitate" orders, sterilization requests,
16.14and the use of psychotropic medication and aversive procedures.

16.15    Sec. 9. Minnesota Statutes 2010, section 256.476, subdivision 11, is amended to read:
16.16    Subd. 11. Consumer support grant program after July 1, 2001. Effective
16.17July 1, 2001, the commissioner shall allocate consumer support grant resources to
16.18serve additional individuals based on a review of Medicaid authorization and payment
16.19information of persons eligible for a consumer support grant from the most recent fiscal
16.20year. The commissioner shall use the following methodology to calculate maximum
16.21allowable monthly consumer support grant levels:
16.22    (1) For individuals whose program of origination is medical assistance home care
16.23under sections 256B.0651 and 256B.0653 to 256B.0656, the maximum allowable monthly
16.24grant levels are calculated by:
16.25    (i) determining 50 percent of the average the service authorization for each
16.26individual based on the individual's home care rating assessment;
16.27    (ii) calculating the overall ratio of actual payments to service authorizations by
16.28program;
16.29    (iii) applying the overall ratio to the average 50 percent of the service authorization
16.30level of each home care rating; and
16.31    (iv) adjusting the result for any authorized rate increases changes provided by the
16.32legislature; and.
16.33    (v) adjusting the result for the average monthly utilization per recipient.
17.1    (2) The commissioner may review and evaluate shall ensure the methodology to
17.2reflect changes in is consistent with the home care programs.

17.3    Sec. 10. Minnesota Statutes 2010, section 256.9657, subdivision 1, is amended to read:
17.4    Subdivision 1. Nursing home license surcharge. (a) Effective July 1, 1993,
17.5each non-state-operated nursing home licensed under chapter 144A shall pay to the
17.6commissioner an annual surcharge according to the schedule in subdivision 4. The
17.7surcharge shall be calculated as $620 per licensed bed. If the number of licensed beds
17.8is reduced, the surcharge shall be based on the number of remaining licensed beds the
17.9second month following the receipt of timely notice by the commissioner of human
17.10services that beds have been delicensed. The nursing home must notify the commissioner
17.11of health in writing when beds are delicensed. The commissioner of health must notify
17.12the commissioner of human services within ten working days after receiving written
17.13notification. If the notification is received by the commissioner of human services by
17.14the 15th of the month, the invoice for the second following month must be reduced
17.15to recognize the delicensing of beds. Beds on layaway status continue to be subject to
17.16the surcharge. The commissioner of human services must acknowledge a medical care
17.17surcharge appeal within 30 days of receipt of the written appeal from the provider.
17.18(b) Effective July 1, 1994, the surcharge in paragraph (a) shall be increased to $625.
17.19(c) Effective August 15, 2002, the surcharge under paragraph (b) shall be increased
17.20to $990.
17.21(d) Effective July 15, 2003, the surcharge under paragraph (c) shall be increased
17.22to $2,815.
17.23(e) The commissioner may reduce, and may subsequently restore, the surcharge
17.24under paragraph (d) based on the commissioner's determination of a permissible surcharge.
17.25(f) Between April 1, 2002, and August 15, 2004, a facility governed by this
17.26subdivision may elect to assume full participation in the medical assistance program
17.27by agreeing to comply with all of the requirements of the medical assistance program,
17.28including the rate equalization law in section 256B.48, subdivision 1, paragraph (a), and
17.29all other requirements established in law or rule, and to begin intake of new medical
17.30assistance recipients. Rates will be determined under Minnesota Rules, parts 9549.0010
17.31to 9549.0080. Notwithstanding section 256B.431, subdivision 27, paragraph (i), Rate
17.32calculations will be subject to limits as prescribed in rule and law. Other than the
17.33adjustments in sections 256B.431, subdivisions 30 and 32; 256B.437, subdivision 3,
17.34paragraph (b), Minnesota Rules, part 9549.0057, and any other applicable legislation
17.35enacted prior to the finalization of rates, facilities assuming full participation in medical
18.1assistance under this paragraph are not eligible for any rate adjustments until the July 1
18.2following their settle-up period.

18.3    Sec. 11. Minnesota Statutes 2010, section 256B.0625, subdivision 19c, is amended to
18.4read:
18.5    Subd. 19c. Personal care. Medical assistance covers personal care assistance
18.6services provided by an individual who is qualified to provide the services according to
18.7subdivision 19a and sections 256B.0651 to 256B.0656, provided in accordance with a
18.8plan, and supervised by a qualified professional.
18.9    "Qualified professional" means a mental health professional as defined in section
18.10245.462, subdivision 18 , clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6);
18.11or a registered nurse as defined in sections 148.171 to 148.285, a licensed social worker
18.12as defined in sections 148D.010 and 148D.055, or a qualified developmental disabilities
18.13specialist under section 245B.07, subdivision 4. The qualified professional shall perform
18.14the duties required in section 256B.0659.

18.15    Sec. 12. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to
18.16read:
18.17    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
18.18paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
18.19    (b) "Activities of daily living" means grooming, dressing, bathing, transferring,
18.20mobility, positioning, eating, and toileting.
18.21    (c) "Behavior," effective January 1, 2010, means a category to determine the home
18.22care rating and is based on the criteria found in this section. "Level I behavior" means
18.23physical aggression towards self, others, or destruction of property that requires the
18.24immediate response of another person.
18.25    (d) "Complex health-related needs," effective January 1, 2010, means a category to
18.26determine the home care rating and is based on the criteria found in this section.
18.27    (e) "Critical activities of daily living," effective January 1, 2010, means transferring,
18.28mobility, eating, and toileting.
18.29    (f) "Dependency in activities of daily living" means a person requires assistance to
18.30begin and complete one or more of the activities of daily living.
18.31    (g) "Extended personal care assistance service" means personal care assistance
18.32services included in a service plan under one of the home and community-based services
18.33waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49,
19.1which exceed the amount, duration, and frequency of the state plan personal care
19.2assistance services for participants who:
19.3    (1) need assistance provided periodically during a week, but less than daily will not
19.4be able to remain in their homes without the assistance, and other replacement services
19.5are more expensive or are not available when personal care assistance services are to
19.6be terminated reduced; or
19.7    (2) need additional personal care assistance services beyond the amount authorized
19.8by the state plan personal care assistance assessment in order to ensure that their safety,
19.9health, and welfare are provided for in their homes.
19.10    (h) "Health-related procedures and tasks" means procedures and tasks that can
19.11be delegated or assigned by a licensed health care professional under state law to be
19.12performed by a personal care assistant.
19.13    (i) "Instrumental activities of daily living" means activities to include meal planning
19.14and preparation; basic assistance with paying bills; shopping for food, clothing, and other
19.15essential items; performing household tasks integral to the personal care assistance
19.16services; communication by telephone and other media; and traveling, including to
19.17medical appointments and to participate in the community.
19.18    (j) "Managing employee" has the same definition as Code of Federal Regulations,
19.19title 42, section 455.
19.20    (k) "Qualified professional" means a professional providing supervision of personal
19.21care assistance services and staff as defined in section 256B.0625, subdivision 19c.
19.22    (l) "Personal care assistance provider agency" means a medical assistance enrolled
19.23provider that provides or assists with providing personal care assistance services and
19.24includes a personal care assistance provider organization, personal care assistance choice
19.25agency, class A licensed nursing agency, and Medicare-certified home health agency.
19.26    (m) "Personal care assistant" or "PCA" means an individual employed by a personal
19.27care assistance agency who provides personal care assistance services.
19.28    (n) "Personal care assistance care plan" means a written description of personal
19.29care assistance services developed by the personal care assistance provider according
19.30to the service plan.
19.31    (o) "Responsible party" means an individual who is capable of providing the support
19.32necessary to assist the recipient to live in the community.
19.33    (p) "Self-administered medication" means medication taken orally, by injection or
19.34insertion, or applied topically without the need for assistance.
19.35    (q) "Service plan" means a written summary of the assessment and description of the
19.36services needed by the recipient.
20.1    (r) "Wages and benefits" means wages and salaries, the employer's share of FICA
20.2taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
20.3mileage reimbursement, health and dental insurance, life insurance, disability insurance,
20.4long-term care insurance, uniform allowance, and contributions to employee retirement
20.5accounts.

20.6    Sec. 13. Minnesota Statutes 2010, section 256B.0659, subdivision 3, is amended to
20.7read:
20.8    Subd. 3. Noncovered personal care assistance services. (a) Personal care
20.9assistance services are not eligible for medical assistance payment under this section
20.10when provided:
20.11    (1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
20.12guardian, licensed foster provider, except as allowed under section 256B.0652, subdivision
20.1310 , or responsible party;
20.14    (2) in lieu of other staffing options order to meet staffing or license requirements in a
20.15residential or child care setting;
20.16    (3) solely as a child care or babysitting service; or
20.17    (4) without authorization by the commissioner or the commissioner's designee.
20.18    (b) The following personal care services are not eligible for medical assistance
20.19payment under this section when provided in residential settings:
20.20    (1) effective January 1, 2010, when the provider of home care services who is not
20.21related by blood, marriage, or adoption owns or otherwise controls the living arrangement,
20.22including licensed or unlicensed services; or
20.23    (2) when personal care assistance services are the responsibility of a residential or
20.24program license holder under the terms of a service agreement and administrative rules.
20.25    (c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
20.26for medical assistance reimbursement for personal care assistance services under this
20.27section include:
20.28    (1) sterile procedures;
20.29    (2) injections of fluids and medications into veins, muscles, or skin;
20.30    (3) home maintenance or chore services;
20.31    (4) homemaker services not an integral part of assessed personal care assistance
20.32services needed by a recipient;
20.33    (5) application of restraints or implementation of procedures under section 245.825;
21.1    (6) instrumental activities of daily living for children under the age of 18, except
21.2when immediate attention is needed for health or hygiene reasons integral to the personal
21.3care services and the need is listed in the service plan by the assessor; and
21.4    (7) assessments for personal care assistance services by personal care assistance
21.5provider agencies or by independently enrolled registered nurses.

21.6    Sec. 14. Minnesota Statutes 2010, section 256B.0659, subdivision 9, is amended to
21.7read:
21.8    Subd. 9. Responsible party; generally. (a) "Responsible party" means an
21.9individual who is capable of providing the support necessary to assist the recipient to live
21.10in the community.
21.11    (b) A responsible party must be 18 years of age, actively participate in planning and
21.12directing of personal care assistance services, and attend all assessments for the recipient.
21.13    (c) A responsible party must not be the:
21.14    (1) personal care assistant;
21.15    (2) qualified professional;
21.16    (3) home care provider agency owner or staff manager; or
21.17    (4) home care provider agency staff unless staff who are not listed in clauses (1) to
21.18(3) are related to the recipient by blood, marriage, or adoption; or
21.19    (3) (5) county staff acting as part of employment.
21.20    (d) A licensed family foster parent who lives with the recipient may be the
21.21responsible party as long as the family foster parent meets the other responsible party
21.22requirements.
21.23    (e) A responsible party is required when:
21.24    (1) the person is a minor according to section 524.5-102, subdivision 10;
21.25    (2) the person is an incapacitated adult according to section 524.5-102, subdivision
21.266 , resulting in a court-appointed guardian; or
21.27    (3) the assessment according to subdivision 3a determines that the recipient is in
21.28need of a responsible party to direct the recipient's care.
21.29    (f) There may be two persons designated as the responsible party for reasons such
21.30as divided households and court-ordered custodies. Each person named as responsible
21.31party must meet the program criteria and responsibilities.
21.32    (g) The recipient or the recipient's legal representative shall appoint a responsible
21.33party if necessary to direct and supervise the care provided to the recipient. The
21.34responsible party must be identified at the time of assessment and listed on the recipient's
21.35service agreement and personal care assistance care plan.

22.1    Sec. 15. Minnesota Statutes 2011 Supplement, section 256B.0659, subdivision 11,
22.2is amended to read:
22.3    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
22.4must meet the following requirements:
22.5    (1) be at least 18 years of age with the exception of persons who are 16 or 17 years
22.6of age with these additional requirements:
22.7    (i) supervision by a qualified professional every 60 days; and
22.8    (ii) employment by only one personal care assistance provider agency responsible
22.9for compliance with current labor laws;
22.10    (2) be employed by a personal care assistance provider agency;
22.11    (3) enroll with the department as a personal care assistant after clearing a background
22.12study. Except as provided in subdivision 11a, before a personal care assistant provides
22.13services, the personal care assistance provider agency must initiate a background study on
22.14the personal care assistant under chapter 245C, and the personal care assistance provider
22.15agency must have received a notice from the commissioner that the personal care assistant
22.16is:
22.17    (i) not disqualified under section 245C.14; or
22.18    (ii) is disqualified, but the personal care assistant has received a set aside of the
22.19disqualification under section 245C.22;
22.20    (4) be able to effectively communicate with the recipient and personal care
22.21assistance provider agency;
22.22    (5) be able to provide covered personal care assistance services according to the
22.23recipient's personal care assistance care plan, respond appropriately to recipient needs,
22.24and report changes in the recipient's condition to the supervising qualified professional
22.25or physician;
22.26    (6) not be a consumer of personal care assistance services;
22.27    (7) maintain daily written records including, but not limited to, time sheets under
22.28subdivision 12;
22.29    (8) effective January 1, 2010, complete standardized training as determined
22.30by the commissioner before completing enrollment. The training must be available
22.31in languages other than English and to those who need accommodations due to
22.32disabilities. Personal care assistant training must include successful completion of the
22.33following training components: basic first aid, vulnerable adult, child maltreatment,
22.34OSHA universal precautions, basic roles and responsibilities of personal care assistants
22.35including information about assistance with lifting and transfers for recipients, emergency
22.36preparedness, orientation to positive behavioral practices, fraud issues, and completion of
23.1time sheets. Upon completion of the training components, the personal care assistant must
23.2demonstrate the competency to provide assistance to recipients;
23.3    (9) complete training and orientation on the needs of the recipient within the first
23.4seven days after the services begin; and
23.5    (10) be limited to providing and being paid for up to 275 hours per month, except
23.6that this limit shall be 275 hours per month for the period July 1, 2009, through June 30,
23.72011, of personal care assistance services regardless of the number of recipients being
23.8served or the number of personal care assistance provider agencies enrolled with. The
23.9number of hours worked per day shall not be disallowed by the department unless in
23.10violation of the law.
23.11    (b) A legal guardian may be a personal care assistant if the guardian is not being paid
23.12for the guardian services and meets the criteria for personal care assistants in paragraph (a).
23.13    (c) Persons who do not qualify as a personal care assistant include parents and,
23.14stepparents, and legal guardians of minors,; spouses,; paid legal guardians, of adults;
23.15family foster care providers, except as otherwise allowed in section 256B.0625,
23.16subdivision 19a , or; and staff of a residential setting. When the personal care assistant is a
23.17relative of the recipient, the commissioner shall pay 80 percent of the provider rate. For
23.18purposes of this section, relative means the parent or adoptive parent of an adult child, a
23.19sibling aged 16 years or older, an adult child, a grandparent, or a grandchild.

23.20    Sec. 16. Minnesota Statutes 2010, section 256B.0659, subdivision 13, is amended to
23.21read:
23.22    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
23.23must work for a personal care assistance provider agency and meet the definition under
23.24section 256B.0625, subdivision 19c. Before a qualified professional provides services, the
23.25personal care assistance provider agency must initiate a background study on the qualified
23.26professional under chapter 245C, and the personal care assistance provider agency must
23.27have received a notice from the commissioner that the qualified professional:
23.28    (1) is not disqualified under section 245C.14; or
23.29    (2) is disqualified, but the qualified professional has received a set aside of the
23.30disqualification under section 245C.22.
23.31    (b) The qualified professional shall perform the duties of training, supervision, and
23.32evaluation of the personal care assistance staff and evaluation of the effectiveness of
23.33personal care assistance services. The qualified professional shall:
23.34    (1) develop and monitor with the recipient a personal care assistance care plan based
23.35on the service plan and individualized needs of the recipient;
24.1    (2) develop and monitor with the recipient a monthly plan for the use of personal
24.2care assistance services;
24.3    (3) review documentation of personal care assistance services provided;
24.4    (4) provide training and ensure competency for the personal care assistant in the
24.5individual needs of the recipient; and
24.6    (5) document all training, communication, evaluations, and needed actions to
24.7improve performance of the personal care assistants.
24.8    (c) Effective July 1, 2010 2011, the qualified professional shall complete the provider
24.9training with basic information about the personal care assistance program approved by
24.10the commissioner. Newly hired qualified professionals must complete the training within
24.11six months of the date hired by a personal care assistance provider agency. Qualified
24.12professionals who have completed the required training as a worker from a personal care
24.13assistance provider agency do not need to repeat the required training if they are hired
24.14by another agency, if they have completed the training within the last three years. The
24.15required training shall must be available in languages other than English and to those who
24.16need accommodations due to disabilities, with meaningful access according to title VI of
24.17the Civil Rights Act and federal regulations adopted under that law or any guidance from
24.18the United States Health and Human Services Department. The required training must
24.19be available online, or by electronic remote connection, and. The required training must
24.20provide for competency testing to demonstrate an understanding of the content without
24.21attending in-person training. A qualified professional is allowed to be employed and is not
24.22subject to the training requirement until the training is offered online or through remote
24.23electronic connection. A qualified professional employed by a personal care assistance
24.24provider agency certified for participation in Medicare as a home health agency is exempt
24.25from the training required in this subdivision. When available, the qualified professional
24.26working for a Medicare-certified home health agency must successfully complete the
24.27competency test. The commissioner shall ensure there is a mechanism in place to verify
24.28the identity of persons completing the competency testing electronically.
24.29EFFECTIVE DATE.This section is effective retroactively from July 1, 2011.

24.30    Sec. 17. Minnesota Statutes 2010, section 256B.0659, subdivision 14, is amended to
24.31read:
24.32    Subd. 14. Qualified professional; duties. (a) Effective January 1, 2010, all personal
24.33care assistants must be supervised by a qualified professional.
25.1    (b) Through direct training, observation, return demonstrations, and consultation
25.2with the staff and the recipient, the qualified professional must ensure and document
25.3that the personal care assistant is:
25.4    (1) capable of providing the required personal care assistance services;
25.5    (2) knowledgeable about the plan of personal care assistance services before services
25.6are performed; and
25.7    (3) able to identify conditions that should be immediately brought to the attention of
25.8the qualified professional.
25.9    (c) The qualified professional shall evaluate the personal care assistant within the
25.10first 14 days of starting to provide regularly scheduled services for a recipient, or sooner as
25.11determined by the qualified professional, except for the personal care assistance choice
25.12option under subdivision 19, paragraph (a), clause (4). For the initial evaluation, the
25.13qualified professional shall evaluate the personal care assistance services for a recipient
25.14through direct observation of a personal care assistant's work. The qualified professional
25.15may conduct additional training and evaluation visits, based upon the needs of the
25.16recipient and the personal care assistant's ability to meet those needs. Subsequent visits to
25.17evaluate the personal care assistance services provided to a recipient do not require direct
25.18observation of each personal care assistant's work and shall occur:
25.19    (1) at least every 90 days thereafter for the first year of a recipient's services;
25.20    (2) every 120 days after the first year of a recipient's service or whenever needed for
25.21response to a recipient's request for increased supervision of the personal care assistance
25.22staff; and
25.23    (3) after the first 180 days of a recipient's service, supervisory visits may alternate
25.24between unscheduled phone or Internet technology and in-person visits, unless the
25.25in-person visits are needed according to the care plan.
25.26    (d) Communication with the recipient is a part of the evaluation process of the
25.27personal care assistance staff.
25.28    (e) At each supervisory visit, the qualified professional shall evaluate personal care
25.29assistance services including the following information:
25.30    (1) satisfaction level of the recipient with personal care assistance services;
25.31    (2) review of the month-to-month plan for use of personal care assistance services;
25.32    (3) review of documentation of personal care assistance services provided;
25.33    (4) whether the personal care assistance services are meeting the goals of the service
25.34as stated in the personal care assistance care plan and service plan;
25.35    (5) a written record of the results of the evaluation and actions taken to correct any
25.36deficiencies in the work of a personal care assistant; and
26.1    (6) revision of the personal care assistance care plan as necessary in consultation
26.2with the recipient or responsible party, to meet the needs of the recipient.
26.3    (f) The qualified professional shall complete the required documentation in the
26.4agency recipient and employee files and the recipient's home, including the following
26.5documentation:
26.6    (1) the personal care assistance care plan based on the service plan and individualized
26.7needs of the recipient;
26.8    (2) a month-to-month plan for use of personal care assistance services;
26.9    (3) changes in need of the recipient requiring a change to the level of service and the
26.10personal care assistance care plan;
26.11    (4) evaluation results of supervision visits and identified issues with personal care
26.12assistance staff with actions taken;
26.13    (5) all communication with the recipient and personal care assistance staff; and
26.14    (6) hands-on training or individualized training for the care of the recipient.
26.15    (g) The documentation in paragraph (f) must be done on agency forms templates.
26.16    (h) The services that are not eligible for payment as qualified professional services
26.17include:
26.18    (1) direct professional nursing tasks that could be assessed and authorized as skilled
26.19nursing tasks;
26.20    (2) supervision of personal care assistance completed by telephone;
26.21    (3) (2) agency administrative activities;
26.22    (4) (3) training other than the individualized training required to provide care for a
26.23recipient; and
26.24    (5) (4) any other activity that is not described in this section.

26.25    Sec. 18. Minnesota Statutes 2010, section 256B.0659, subdivision 19, is amended to
26.26read:
26.27    Subd. 19. Personal care assistance choice option; qualifications; duties. (a)
26.28Under personal care assistance choice, the recipient or responsible party shall:
26.29    (1) recruit, hire, schedule, and terminate personal care assistants according to the
26.30terms of the written agreement required under subdivision 20, paragraph (a);
26.31    (2) develop a personal care assistance care plan based on the assessed needs
26.32and addressing the health and safety of the recipient with the assistance of a qualified
26.33professional as needed;
26.34    (3) orient and train the personal care assistant with assistance as needed from the
26.35qualified professional;
27.1    (4) effective January 1, 2010, supervise and evaluate the personal care assistant with
27.2the qualified professional, who is required to visit the recipient at least every 180 days;
27.3    (5) monitor and verify in writing and report to the personal care assistance choice
27.4agency the number of hours worked by the personal care assistant and the qualified
27.5professional;
27.6    (6) engage in an annual face-to-face reassessment to determine continuing eligibility
27.7and service authorization; and
27.8    (7) use the same personal care assistance choice provider agency if shared personal
27.9assistance care is being used.
27.10    (b) The personal care assistance choice provider agency shall:
27.11    (1) meet all personal care assistance provider agency standards;
27.12    (2) enter into a written agreement with the recipient, responsible party, and personal
27.13care assistants;
27.14    (3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
27.15professional, or the personal care assistant; and
27.16    (4) ensure arm's-length transactions without undue influence or coercion with the
27.17recipient and personal care assistant.
27.18    (c) The duties of the personal care assistance choice provider agency are to:
27.19    (1) be the employer of the personal care assistant and the qualified professional for
27.20employment law and related regulations including, but not limited to, purchasing and
27.21maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
27.22and liability insurance, and submit any or all necessary documentation including, but not
27.23limited to, workers' compensation and unemployment insurance;
27.24    (2) bill the medical assistance program for personal care assistance services and
27.25qualified professional services;
27.26    (3) request and complete background studies that comply with the requirements for
27.27personal care assistants and qualified professionals;
27.28    (4) pay the personal care assistant and qualified professional based on actual hours
27.29of services provided;
27.30    (5) withhold and pay all applicable federal and state taxes;
27.31    (6) verify and keep records of hours worked by the personal care assistant and
27.32qualified professional;
27.33    (7) make the arrangements and pay taxes and other benefits, if any, and comply with
27.34any legal requirements for a Minnesota employer;
27.35    (8) enroll in the medical assistance program as a personal care assistance choice
27.36agency; and
28.1    (9) enter into a written agreement as specified in subdivision 20 before services
28.2are provided.

28.3    Sec. 19. Minnesota Statutes 2010, section 256B.0659, subdivision 21, is amended to
28.4read:
28.5    Subd. 21. Requirements for initial enrollment of personal care assistance
28.6provider agencies. (a) All personal care assistance provider agencies must provide, at the
28.7time of enrollment as a personal care assistance provider agency in a format determined
28.8by the commissioner, information and documentation that includes, but is not limited to,
28.9the following:
28.10    (1) the personal care assistance provider agency's current contact information
28.11including address, telephone number, and e-mail address;
28.12    (2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
28.13provider's payments from Medicaid in the previous year, whichever is less;
28.14    (3) proof of fidelity bond coverage in the amount of $20,000;
28.15    (4) proof of workers' compensation insurance coverage;
28.16    (5) proof of liability insurance;
28.17    (6) a description of the personal care assistance provider agency's organization
28.18identifying the names of all owners, managing employees, staff, board of directors, and
28.19the affiliations of the directors, owners, or staff to other service providers;
28.20    (7) a copy of the personal care assistance provider agency's written policies and
28.21procedures including: hiring of employees; training requirements; service delivery;
28.22and employee and consumer safety including process for notification and resolution
28.23of consumer grievances, identification and prevention of communicable diseases, and
28.24employee misconduct;
28.25    (8) copies of all other forms the personal care assistance provider agency uses in
28.26the course of daily business including, but not limited to:
28.27    (i) a copy of the personal care assistance provider agency's time sheet if the time
28.28sheet varies from the standard time sheet for personal care assistance services approved
28.29by the commissioner, and a letter requesting approval of the personal care assistance
28.30provider agency's nonstandard time sheet;
28.31    (ii) the personal care assistance provider agency's template for the personal care
28.32assistance care plan; and
28.33    (iii) the personal care assistance provider agency's template for the written
28.34agreement in subdivision 20 for recipients using the personal care assistance choice
28.35option, if applicable;
29.1    (9) a list of all training and classes that the personal care assistance provider agency
29.2requires of its staff providing personal care assistance services;
29.3    (10) documentation that the personal care assistance provider agency and staff have
29.4successfully completed all the training required by this section;
29.5    (11) documentation of the agency's marketing practices;
29.6    (12) disclosure of ownership, leasing, or management of all residential properties
29.7that is used or could be used for providing home care services;
29.8    (13) documentation that the agency will use the following percentages of revenue
29.9generated from the medical assistance rate paid for personal care assistance services
29.10for employee personal care assistant wages and benefits: 72.5 percent of revenue in the
29.11personal care assistance choice option and 72.5 percent of revenue from other personal
29.12care assistance providers; and
29.13    (14) effective May 15, 2010, documentation that the agency does not burden
29.14recipients' free exercise of their right to choose service providers by requiring personal
29.15care assistants to sign an agreement not to work with any particular personal care
29.16assistance recipient or for another personal care assistance provider agency after leaving
29.17the agency and that the agency is not taking action on any such agreements or requirements
29.18regardless of the date signed.
29.19    (b) Personal care assistance provider agencies shall provide the information specified
29.20in paragraph (a) to the commissioner at the time the personal care assistance provider
29.21agency enrolls as a vendor or upon request from the commissioner. The commissioner
29.22shall collect the information specified in paragraph (a) from all personal care assistance
29.23providers beginning July 1, 2009.
29.24    (c) All personal care assistance provider agencies shall require all employees in
29.25management and supervisory positions and owners of the agency who are active in the
29.26day-to-day management and operations of the agency to complete mandatory training
29.27as determined by the commissioner before enrollment of the agency as a provider.
29.28Employees in management and supervisory positions and owners who are active in
29.29the day-to-day operations of an agency who have completed the required training as
29.30an employee with a personal care assistance provider agency do not need to repeat
29.31the required training if they are hired by another agency, if they have completed the
29.32training within the past three years. By September 1, 2010, the required training must be
29.33available in languages other than English and to those who need accommodations due
29.34to disabilities, with meaningful access according to title VI of the Civil Rights Act and
29.35federal regulations adopted under that law or any guidance from the United States Health
29.36and Human Services Department. The required training must be available online, or by
30.1electronic remote connection, and. The required training must provide for competency
30.2testing. Personal care assistance provider agency billing staff shall complete training about
30.3personal care assistance program financial management. This training is effective July 1,
30.42009. Any personal care assistance provider agency enrolled before that date shall, if it
30.5has not already, complete the provider training within 18 months of July 1, 2009. Any new
30.6owners or employees in management and supervisory positions involved in the day-to-day
30.7operations are required to complete mandatory training as a requisite of working for the
30.8agency. Personal care assistance provider agencies certified for participation in Medicare
30.9as home health agencies are exempt from the training required in this subdivision. When
30.10available, Medicare-certified home health agency owners, supervisors, or managers must
30.11successfully complete the competency test.

30.12    Sec. 20. Minnesota Statutes 2010, section 256B.0659, subdivision 30, is amended to
30.13read:
30.14    Subd. 30. Notice of service changes to recipients. The commissioner must provide:
30.15    (1) by October 31, 2009, information to recipients likely to be affected that (i)
30.16describes the changes to the personal care assistance program that may result in the
30.17loss of access to personal care assistance services, and (ii) includes resources to obtain
30.18further information; and
30.19    (2) notice of changes in medical assistance personal care assistance services to each
30.20affected recipient at least 30 days before the effective date of the change.
30.21The notice shall include how to get further information on the changes, how to get help to
30.22obtain other services, a list of community resources, and appeal rights. Notwithstanding
30.23section 256.045, a recipient may request continued services pending appeal within the
30.24time period allowed to request an appeal; and
30.25    (3) (2) a service agreement authorizing personal care assistance hours of service at
30.26the previously authorized level, throughout the appeal process period, when a recipient
30.27requests services pending an appeal.
30.28EFFECTIVE DATE.This section is effective July 1, 2012.

30.29    Sec. 21. Minnesota Statutes 2010, section 256B.0916, subdivision 7, is amended to
30.30read:
30.31    Subd. 7. Annual report by commissioner. (a) Beginning November 1, 2001, and
30.32each November 1 thereafter, the commissioner shall issue an annual report on county and
30.33state use of available resources for the home and community-based waiver for persons with
30.34developmental disabilities. For each county or county partnership, the report shall include:
31.1    (1) the amount of funds allocated but not used;
31.2    (2) the county specific allowed reserve amount approved and used;
31.3    (3) the number, ages, and living situations of individuals screened and waiting for
31.4services;
31.5    (4) the urgency of need for services to begin within one, two, or more than two
31.6years for each individual;
31.7    (5) the services needed;
31.8    (6) the number of additional persons served by approval of increased capacity within
31.9existing allocations;
31.10    (7) results of action by the commissioner to streamline administrative requirements
31.11and improve county resource management; and
31.12    (8) additional action that would decrease the number of those eligible and waiting
31.13for waivered services.
31.14The commissioner shall specify intended outcomes for the program and the degree to
31.15which these specified outcomes are attained.
31.16    (b) This subdivision expires January 1, 2013.

31.17    Sec. 22. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to
31.18read:
31.19    Subd. 11. Residential support services. (a) Upon federal approval, there is
31.20established a new service called residential support that is available on the community
31.21alternative care, community alternatives for disabled individuals, developmental
31.22disabilities, and traumatic brain injury waivers. Existing waiver service descriptions
31.23must be modified to the extent necessary to ensure there is no duplication between
31.24other services. Residential support services must be provided by vendors licensed as a
31.25community residential setting as defined in section 245A.11, subdivision 8.
31.26    (b) Residential support services must meet the following criteria:
31.27    (1) providers of residential support services must own or control the residential site;
31.28    (2) the residential site must not be the primary residence of the license holder;
31.29    (3) the residential site must have a designated program supervisor responsible for
31.30program oversight, development, and implementation of policies and procedures;
31.31    (4) the provider of residential support services must provide supervision, training,
31.32and assistance as described in the person's community support plan; and
31.33    (5) the provider of residential support services must meet the requirements of
31.34licensure and additional requirements of the person's community support plan.
32.1    (c) Providers of residential support services that meet the definition in paragraph
32.2(a) must be registered using a process determined by the commissioner beginning July
32.31, 2009. Providers licensed to provide child foster care under Minnesota Rules, parts
32.42960.3000 to 2960.3340, or adult foster care licensed under Minnesota Rules, parts
32.59555.5105 to 9555.6265, and that meet the requirements in section 245A.03, subdivision
32.67, paragraph (e), are considered registered under this section.

32.7    Sec. 23. Minnesota Statutes 2010, section 256B.096, subdivision 5, is amended to read:
32.8    Subd. 5. Biennial report. (a) The commissioner shall provide a biennial report to
32.9the chairs of the legislative committees with jurisdiction over health and human services
32.10policy and funding beginning January 15, 2009, on the development and activities of the
32.11quality management, assurance, and improvement system designed to meet the federal
32.12requirements under the home and community-based services waiver programs for persons
32.13with disabilities. By January 15, 2008, the commissioner shall provide a preliminary
32.14report on priorities for meeting the federal requirements, progress on development and
32.15field testing of the annual survey, appropriations necessary to implement an annual survey
32.16of service recipients once field testing is completed, recommendations for improvements
32.17in the incident reporting system, and a plan for incorporating quality assurance efforts
32.18under section 256B.095 and other regional efforts into the statewide system.
32.19    (b) This subdivision expires January 1, 2013.

32.20    Sec. 24. Minnesota Statutes 2010, section 256B.441, subdivision 13, is amended to
32.21read:
32.22    Subd. 13. External fixed costs. "External fixed costs" means costs related to the
32.23nursing home surcharge under section 256.9657, subdivision 1; licensure fees under
32.24section 144.122; long-term care consultation fees under section 256B.0911, subdivision 6;
32.25family advisory council fee under section 144A.33; scholarships under section 256B.431,
32.26subdivision 36 ; planned closure rate adjustments under section 256B.436 or 256B.437; or
32.27single bed room incentives under section 256B.431, subdivision 42; property taxes and
32.28property insurance; and PERA.

32.29    Sec. 25. Minnesota Statutes 2010, section 256B.441, subdivision 31, is amended to
32.30read:
32.31    Subd. 31. Prior system operating cost payment rate. "Prior system operating
32.32cost payment rate" means the operating cost payment rate in effect on September 30,
32.332008, under Minnesota Rules and Minnesota Statutes, not including planned closure rate
33.1adjustments under section 256B.436 or 256B.437, or single bed room incentives under
33.2section 256B.431, subdivision 42.

33.3    Sec. 26. Minnesota Statutes 2010, section 256B.441, subdivision 53, is amended to
33.4read:
33.5    Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
33.6shall calculate a payment rate for external fixed costs.
33.7    (a) For a facility licensed as a nursing home, the portion related to section 256.9657
33.8shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
33.9home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
33.10result of its number of nursing home beds divided by its total number of licensed beds.
33.11    (b) The portion related to the licensure fee under section 144.122, paragraph (d),
33.12shall be the amount of the fee divided by actual resident days.
33.13    (c) The portion related to scholarships shall be determined under section 256B.431,
33.14subdivision 36.
33.15    (d) The portion related to long-term care consultation shall be determined according
33.16to section 256B.0911, subdivision 6.
33.17    (e) The portion related to development and education of resident and family advisory
33.18councils under section 144A.33 shall be $5 divided by 365.
33.19    (f) The portion related to planned closure rate adjustments shall be as determined
33.20under sections 256B.436 and section 256B.437, subdivision 6, and Minnesota Statutes
33.212010, section 256B.436. Planned closure rate adjustments that take effect before October
33.221, 2014, shall no longer be included in the payment rate for external fixed costs beginning
33.23October 1, 2016. Planned closure rate adjustments that take effect on or after October 1,
33.242014, shall no longer be included in the payment rate for external fixed costs beginning on
33.25October 1 of the first year not less than two years after their effective date.
33.26    (g) The portions related to property insurance, real estate taxes, special assessments,
33.27and payments made in lieu of real estate taxes directly identified or allocated to the nursing
33.28facility shall be the actual amounts divided by actual resident days.
33.29    (h) The portion related to the Public Employees Retirement Association shall be
33.30actual costs divided by resident days.
33.31    (i) The single bed room incentives shall be as determined under section 256B.431,
33.32subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
33.33no longer be included in the payment rate for external fixed costs beginning October 1,
33.342016. Single bed room incentives that take effect on or after October 1, 2014, shall no
34.1longer be included in the payment rate for external fixed costs beginning on October 1 of
34.2the first year not less than two years after their effective date.
34.3    (j) The payment rate for external fixed costs shall be the sum of the amounts in
34.4paragraphs (a) to (i).

34.5    Sec. 27. Minnesota Statutes 2010, section 256B.49, subdivision 21, is amended to read:
34.6    Subd. 21. Report. (a) The commissioner shall expand on the annual report required
34.7under section 256B.0916, subdivision 7, to include information on the county of residence
34.8and financial responsibility, age, and major diagnoses for persons eligible for the home
34.9and community-based waivers authorized under subdivision 11 who are:
34.10    (1) receiving those services;
34.11    (2) screened and waiting for waiver services; and
34.12    (3) residing in nursing facilities and are under age 65.
34.13    (b) This subdivision expires January 1, 2013.

34.14    Sec. 28. Minnesota Statutes 2011 Supplement, section 626.557, subdivision 9, is
34.15amended to read:
34.16    Subd. 9. Common entry point designation. (a) Each county board shall designate
34.17a common entry point for reports of suspected maltreatment. Two or more county boards
34.18may jointly designate a single common entry point. The common entry point is the unit
34.19responsible for receiving the report of suspected maltreatment under this section.
34.20(b) The common entry point must be available 24 hours per day to take calls from
34.21reporters of suspected maltreatment. The common entry point shall use a standard intake
34.22form that includes:
34.23(1) the time and date of the report;
34.24(2) the name, address, and telephone number of the person reporting;
34.25(3) the time, date, and location of the incident;
34.26(4) the names of the persons involved, including but not limited to, perpetrators,
34.27alleged victims, and witnesses;
34.28(5) whether there was a risk of imminent danger to the alleged victim;
34.29(6) a description of the suspected maltreatment;
34.30(7) the disability, if any, of the alleged victim;
34.31(8) the relationship of the alleged perpetrator to the alleged victim;
34.32(9) whether a facility was involved and, if so, which agency licenses the facility;
34.33(10) any action taken by the common entry point;
34.34(11) whether law enforcement has been notified;
35.1(12) whether the reporter wishes to receive notification of the initial and final
35.2reports; and
35.3(13) if the report is from a facility with an internal reporting procedure, the name,
35.4mailing address, and telephone number of the person who initiated the report internally.
35.5(c) The common entry point is not required to complete each item on the form prior
35.6to dispatching the report to the appropriate lead investigative agency.
35.7(d) The common entry point shall immediately report to a law enforcement agency
35.8any incident in which there is reason to believe a crime has been committed.
35.9(e) If a report is initially made to a law enforcement agency or a lead investigative
35.10agency, those agencies shall take the report on the appropriate common entry point intake
35.11forms and immediately forward a copy to the common entry point.
35.12(f) The common entry point staff must receive training on how to screen and
35.13dispatch reports efficiently and in accordance with this section.
35.14(g) When a centralized database is available, the common entry point has access to
35.15the centralized database and must log the reports into the database. The commissioner of
35.16human services shall maintain a centralized database for the collection of common entry
35.17point data, lead investigative agency data including maltreatment report disposition, and
35.18appeals data.

35.19    Sec. 29. Minnesota Statutes 2011 Supplement, section 626.5572, subdivision 13,
35.20is amended to read:
35.21    Subd. 13. Lead investigative agency. "Lead investigative agency" is the primary
35.22administrative agency responsible for investigating reports made under section 626.557.
35.23(a) The Department of Health is the lead investigative agency for facilities or
35.24services licensed or required to be licensed as hospitals, home care providers, nursing
35.25homes, boarding care homes, hospice providers, residential facilities that are also federally
35.26certified as intermediate care facilities that serve people with developmental disabilities,
35.27or any other facility or service not listed in this subdivision that is licensed or required to
35.28be licensed by the Department of Health for the care of vulnerable adults. "Home care
35.29provider" has the meaning provided in section 144A.43, subdivision 4, and applies when
35.30care or services are delivered in the vulnerable adult's home, whether a private home or a
35.31housing with services establishment registered under chapter 144D, including those that
35.32offer assisted living services under chapter 144G.
35.33(b) Except as provided under paragraph (c), for services licensed according to
35.34chapter 245D, the Department of Human Services is the lead investigative agency for
35.35facilities or services licensed or required to be licensed as adult day care, adult foster care,
36.1programs for people with developmental disabilities, family adult day services, mental
36.2health programs, mental health clinics, chemical dependency programs, the Minnesota
36.3sex offender program, or any other facility or service not listed in this subdivision that is
36.4licensed or required to be licensed by the Department of Human Services.
36.5(c) The county social service agency or its designee is the lead investigative agency
36.6for all other reports, including, but not limited to, reports involving vulnerable adults
36.7receiving services from a personal care provider organization under section 256B.0659,
36.8or receiving home and community-based services licensed by the Department of Human
36.9Services and subject to chapter 245D.

36.10    Sec. 30. Laws 2009, chapter 79, article 8, section 81, as amended by Laws 2010,
36.11chapter 352, article 1, section 24, is amended to read:
36.12    Sec. 81. ESTABLISHING A SINGLE SET OF STANDARDS.
36.13(a) The commissioner of human services shall consult with disability service
36.14providers, advocates, counties, and consumer families to develop a single set of standards,
36.15to be referred to as "quality outcome standards," governing services for people with
36.16disabilities receiving services under the home and community-based waiver services
36.17program, with the exception of customized living services because the service license
36.18is under the jurisdiction of the Department of Health, to replace all or portions of
36.19existing laws and rules including, but not limited to, data practices, licensure of facilities
36.20and providers, background studies, reporting of maltreatment of minors, reporting of
36.21maltreatment of vulnerable adults, and the psychotropic medication checklist. The
36.22standards must:
36.23(1) enable optimum consumer choice;
36.24(2) be consumer driven;
36.25(3) link services to individual needs and life goals;
36.26(4) be based on quality assurance and individual outcomes;
36.27(5) utilize the people closest to the recipient, who may include family, friends, and
36.28health and service providers, in conjunction with the recipient's risk management plan to
36.29assist the recipient or the recipient's guardian in making decisions that meet the recipient's
36.30needs in a cost-effective manner and assure the recipient's health and safety;
36.31(6) utilize person-centered planning; and
36.32(7) maximize federal financial participation.
36.33(b) The commissioner may consult with existing stakeholder groups convened under
36.34the commissioner's authority, including the home and community-based expert services
37.1panel established by the commissioner in 2008, to meet all or some of the requirements
37.2of this section.
37.3(c) The commissioner shall provide the reports and plans required by this section to
37.4the legislative committees and budget divisions with jurisdiction over health and human
37.5services policy and finance by January 15, 2012.

37.6    Sec. 31. DISABILITY HOME AND COMMUNITY-BASED WAIVER
37.7REQUEST.
37.8By December 1, 2012, the commissioner shall request all federal approvals and
37.9waiver amendments to the disability home and community-based waivers to allow properly
37.10licensed adult foster care homes to provide residential services for up to five individuals.
37.11EFFECTIVE DATE.This section is effective July 1, 2012.

37.12    Sec. 32. HOURLY NURSING DETERMINATION MATRIX.
37.13A service provider applying for medical assistance payments for private duty nursing
37.14services under Minnesota Statutes, section 256B.0654, must complete and submit to the
37.15commissioner of human services an hourly nursing determination matrix for each recipient
37.16of private duty nursing services. The commissioner of human services will collect and
37.17analyze data from the hourly nursing determination matrix.

37.18    Sec. 33. REPEALER.
37.19(a) Minnesota Statutes 2010, sections 256B.431, subdivisions 2c, 2g, 2i, 2j, 2k, 2l,
37.202o, 3c, 11, 14, 17b, 17f, 19, 20, 25, 27, and 29; 256B.434, subdivisions 4a, 4b, 4c, 4d, 4e,
37.214g, 4h, 7, and 8; 256B.435; and 256B.436, are repealed.
37.22(b) Minnesota Statutes 2011 Supplement, section 256B.431, subdivision 26, is
37.23repealed.
37.24(c) Minnesota Rules, part 9555.7700, is repealed.


37.27    Section 1. Minnesota Statutes 2010, section 237.50, is amended to read:
37.28237.50 DEFINITIONS.
37.29    Subdivision 1. Scope. The terms used in sections 237.50 to 237.56 have the
37.30meanings given them in this section.
37.31    Subd. 3. Communication impaired disability. "Communication impaired
37.32disability" means certified as deaf, severely hearing impaired, hard-of-hearing having
38.1a hearing loss, speech impaired, deaf and blind disability, or mobility impaired if the
38.2mobility impairment significantly impedes the ability physical disability that makes it
38.3difficult or impossible to use standard customer premises telecommunications services
38.4and equipment.
38.5    Subd. 4. Communication device. "Communication device" means a device that
38.6when connected to a telephone enables a communication-impaired person to communicate
38.7with another person utilizing the telephone system. A "communication device" includes a
38.8ring signaler, an amplification device, a telephone device for the deaf, a Brailling device
38.9for use with a telephone, and any other device the Department of Human Services deems
38.10necessary.
38.11    Subd. 4a. Deaf. "Deaf" means a hearing impairment loss of such severity that the
38.12individual must depend primarily upon visual communication such as writing, lip reading,
38.13manual communication sign language, and gestures.
38.14    Subd. 4b. Deafblind. "Deafblind" means any combination of vision and hearing
38.15loss which interferes with acquiring information from the environment to the extent that
38.16compensatory strategies and skills are necessary to access that or other information.
38.17    Subd. 5. Exchange. "Exchange" means a unit area established and described by the
38.18tariff of a telephone company for the administration of telephone service in a specified
38.19geographical area, usually embracing a city, town, or village and its environs, and served
38.20by one or more central offices, together with associated facilities used in providing
38.21service within that area.
38.22    Subd. 6. Fund. "Fund" means the telecommunications access Minnesota fund
38.23established in section 237.52.
38.24    Subd. 6a. Hard-of-hearing. "Hard-of-hearing" means a hearing impairment loss
38.25resulting in a functional loss limitation, but not to the extent that the individual must
38.26depend primarily upon visual communication.
38.27    Subd. 7. Interexchange service. "Interexchange service" means telephone service
38.28between points in two or more exchanges.
38.29    Subd. 8. Inter-LATA interexchange service. "Inter-LATA interexchange service"
38.30means interexchange service originating and terminating in different LATAs.
38.31    Subd. 9. Local access and transport area. "Local access and transport area
38.32(LATA)" means a geographical area designated by the Modification of Final Judgment
38.33in U.S. v. Western Electric Co., Inc., 552 F. Supp. 131 (D.D.C. 1982), including
38.34modifications in effect on the effective date of sections 237.51 to 237.54.
38.35    Subd. 10. Local exchange service. "Local exchange service" means telephone
38.36service between points within an exchange.
39.1    Subd. 10a. Telecommunications device. "Telecommunications device" means
39.2a device that (1) allows a person with a communication disability to have access to
39.3telecommunications services as defined in subdivision 13, and (2) is specifically
39.4selected by the Department of Human Services for its capacity to allow persons with
39.5communication disabilities to use telecommunications services in a manner that is
39.6functionally equivalent to the ability of an individual who does not have a communication
39.7disability. A telecommunications device may include a ring signaler, an amplified
39.8telephone, a hands-free telephone, a text telephone, a captioned telephone, a wireless
39.9device, a device that produces Braille output for use with a telephone, and any other
39.10device the Department of Human Services deems appropriate.
39.11    Subd. 11. Telecommunication Telecommunications Relay service Services.
39.12"Telecommunication Telecommunications Relay service Services" or "TRS" means
39.13a central statewide service through which a communication-impaired person,
39.14using a communication device, may send and receive messages to and from a
39.15non-communication-impaired person whose telephone is not equipped with a
39.16communication device and through which a non-communication-impaired person
39.17may, by using voice communication, send and receive messages to and from a
39.18communication-impaired person the telecommunications transmission services required
39.19under Federal Communications Commission (FCC) regulations at Code of Federal
39.20Regulations, title 47, sections 64.604 to 64.606. TRS allows an individual who has
39.21a communication disability to use telecommunications services in a manner that is
39.22functionally equivalent to the ability of an individual who does not have a communication
39.23disability.
39.24    Subd. 12. Telecommunications. "Telecommunications" means the transmission,
39.25between or among points specified by the user, of information of the user's choosing,
39.26without change in the form or content of the information as sent and received.
39.27    Subd. 13. Telecommunications services. "Telecommunications services" means
39.28the offering of telecommunications for fee directly to the public, or to such classes of users
39.29as to be effectively available to the public, regardless of the facilities used.

39.30    Sec. 2. Minnesota Statutes 2010, section 237.51, is amended to read:
39.31237.51 TELECOMMUNICATIONS ACCESS MINNESOTA PROGRAM
39.32ADMINISTRATION.
39.33    Subdivision 1. Creation. The commissioner of commerce shall:
40.1(1) administer through interagency agreement with the commissioner of human
40.2services a program to distribute communication telecommunications devices to eligible
40.3communication-impaired persons who have communication disabilities; and
40.4(2) contract with a one or more qualified vendor vendors that serves
40.5communication-impaired serve persons who have communication disabilities to create
40.6and maintain a telecommunication provide telecommunications relay service services.
40.7For purposes of sections 237.51 to 237.56, the Department of Commerce and any
40.8organization with which it contracts pursuant to this section or section 237.54, subdivision
40.92 , are not telephone companies or telecommunications carriers as defined in section
40.10237.01 .
40.11    Subd. 5. Commissioner of commerce duties. In addition to any duties specified
40.12elsewhere in sections 237.51 to 237.56, the commissioner of commerce shall:
40.13(1) prepare the reports required by section 237.55;
40.14(2) administer the fund created in section 237.52; and
40.15(3) adopt rules under chapter 14 to implement the provisions of sections 237.50
40.16to 237.56.
40.17    Subd. 5a. Department Commissioner of human services duties. (a) In addition to
40.18any duties specified elsewhere in sections 237.51 to 237.56, the commissioner of human
40.19services shall:
40.20(1) define economic hardship, special needs, and household criteria so as to
40.21determine the priority of eligible applicants for initial distribution of devices and to
40.22determine circumstances necessitating provision of more than one communication
40.23telecommunications device per household;
40.24(2) establish a method to verify eligibility requirements;
40.25(3) establish specifications for communication telecommunications devices to be
40.26purchased provided under section 237.53, subdivision 3; and
40.27(4) inform the public and specifically the community of communication-impaired
40.28persons who have communication disabilities of the program.; and
40.29(5) provide devices based on the assessed need of eligible applicants.
40.30(b) The commissioner may establish an advisory board to advise the department
40.31in carrying out the duties specified in this section and to advise the commissioner of
40.32commerce in carrying out duties under section 237.54. If so established, the advisory
40.33board must include, at a minimum, the following communication-impaired persons:
40.34(1) at least one member who is deaf;
40.35(2) at least one member who is has a speech impaired disability;
41.1(3) at least one member who is mobility impaired has a physical disability that
41.2makes it difficult or impossible for the person to access telecommunications services; and
41.3(4) at least one member who is hard-of-hearing.
41.4The membership terms, compensation, and removal of members and the filling of
41.5membership vacancies are governed by section 15.059. Advisory board meetings shall be
41.6held at the discretion of the commissioner.

41.7    Sec. 3. Minnesota Statutes 2010, section 237.52, is amended to read:
41.8237.52 TELECOMMUNICATIONS ACCESS MINNESOTA FUND.
41.9    Subdivision 1. Fund established. A telecommunications access Minnesota fund is
41.10established as an account in the state treasury. Earnings, such as interest, dividends, and
41.11any other earnings arising from fund assets, must be credited to the fund.
41.12    Subd. 2. Assessment. (a) The commissioner of commerce, the commissioner
41.13of employment and economic development, and the commissioner of human services
41.14shall annually recommend to the Public Utilities Commission (PUC) an adequate and
41.15appropriate surcharge and budget to implement sections 237.50 to 237.56, 248.062,
41.16and 256C.30, respectively. The maximum annual budget for section 248.062 must not
41.17exceed $100,000 and for section 256C.30 must not exceed $300,000. The Public Utilities
41.18Commission shall review the budgets for reasonableness and may modify the budget
41.19to the extent it is unreasonable. The commission shall annually determine the funding
41.20mechanism to be used within 60 days of receipt of the recommendation of the departments
41.21and shall order the imposition of surcharges effective on the earliest practicable date. The
41.22commission shall establish a monthly charge no greater than 20 cents for each customer
41.23access line, including trunk equivalents as designated by the commission pursuant to
41.24section 403.11, subdivision 1.
41.25(b) If the fund balance falls below a level capable of fully supporting all programs
41.26eligible under subdivision 5 and sections 248.062 and 256C.30, expenditures under
41.27sections 248.062 and 256C.30 shall be reduced on a pro rata basis and expenditures under
41.28sections 237.53 and 237.54 shall be fully funded. Expenditures under sections 248.062
41.29and 256C.30 shall resume at fully funded levels when the commissioner of commerce
41.30determines there is a sufficient fund balance to fully fund those expenditures.
41.31    Subd. 3. Collection. Every telephone company or communications carrier that
41.32provides service provider of services capable of originating a telecommunications relay
41.33TRS call, including cellular communications and other nonwire access services, in this
41.34state shall collect the charges established by the commission under subdivision 2 and
41.35transfer amounts collected to the commissioner of public safety in the same manner as
42.1provided in section 403.11, subdivision 1, paragraph (d). The commissioner of public
42.2safety must deposit the receipts in the fund established in subdivision 1.
42.3    Subd. 4. Appropriation. Money in the fund is appropriated to the commissioner of
42.4commerce to implement sections 237.51 to 237.56, to the commissioner of employment
42.5and economic development to implement section 248.062, and to the commissioner of
42.6human services to implement section 256C.30.
42.7    Subd. 5. Expenditures. (a) Money in the fund may only be used for:
42.8(1) expenses of the Department of Commerce, including personnel cost, public
42.9relations, advisory board members' expenses, preparation of reports, and other reasonable
42.10expenses not to exceed ten percent of total program expenditures;
42.11(2) reimbursing the commissioner of human services for purchases made or services
42.12provided pursuant to section 237.53;
42.13(3) reimbursing telephone companies for purchases made or services provided
42.14under section 237.53, subdivision 5; and
42.15(4) contracting for establishment and operation of the telecommunication relay
42.16service the provision of TRS required by section 237.54.
42.17(b) All costs directly associated with the establishment of the program, the purchase
42.18and distribution of communication telecommunications devices, and the establishment
42.19and operation of the telecommunication relay service provision of TRS are either
42.20reimbursable or directly payable from the fund after authorization by the commissioner
42.21of commerce. The commissioner of commerce shall contract with the message relay
42.22service operator one or more TRS providers to indemnify the local exchange carriers of
42.23the relay telecommunications service providers for any fines imposed by the Federal
42.24Communications Commission related to the failure of the relay service to comply with
42.25federal service standards. Notwithstanding section 16A.41, the commissioner may
42.26advance money to the contractor of the telecommunication relay service TRS providers if
42.27the contractor establishes providers establish to the commissioner's satisfaction that the
42.28advance payment is necessary for the operation provision of the service. The advance
42.29payment may be used only for working capital reserve for the operation of the service.
42.30The advance payment must be offset or repaid by the end of the contract fiscal year
42.31together with interest accrued from the date of payment.

42.32    Sec. 4. Minnesota Statutes 2010, section 237.53, is amended to read:
42.33237.53 COMMUNICATION TELECOMMUNICATIONS DEVICE.
43.1    Subdivision 1. Application. A person applying for a communication
43.2telecommunications device under this section must apply to the program administrator on
43.3a form prescribed by the Department of Human Services.
43.4    Subd. 2. Eligibility. To be eligible to obtain a communication telecommunications
43.5device under this section, a person must be:
43.6(1) be able to benefit from and use the equipment for its intended purpose;
43.7(2) have a communication impaired disability;
43.8(3) be a resident of the state;
43.9(4) be a resident in a household that has a median income at or below the applicable
43.10median household income in the state, except a deaf and blind person who is deafblind
43.11applying for a telebraille unit Braille device may reside in a household that has a median
43.12income no more than 150 percent of the applicable median household income in the
43.13state; and
43.14(5) be a resident in a household that has telephone telecommunications service
43.15or that has made application for service and has been assigned a telephone number; or
43.16a resident in a residential care facility, such as a nursing home or group home where
43.17telephone telecommunications service is not included as part of overall service provision.
43.18    Subd. 3. Distribution. The commissioner of human services shall purchase and
43.19distribute a sufficient number of communication telecommunications devices so that each
43.20eligible household receives an appropriate device devices as determined under section
43.21237.51, subdivision 5a. The commissioner of human services shall distribute the devices
43.22to eligible households in each service area free of charge as determined under section
43.23237.51, subdivision 5a.
43.24    Subd. 4. Training; maintenance. The commissioner of human services shall
43.25maintain the communication telecommunications devices until the warranty period
43.26expires, and provide training, without charge, to first-time users of the devices.
43.27    Subd. 5. Wiring installation. If a communication-impaired person is not served by
43.28telephone service and is subject to economic hardship as determined by the Department
43.29of Human Services, the telephone company providing local service shall at the direction
43.30of the administrator of the program install necessary outside wiring without charge to
43.31the household.
43.32    Subd. 6. Ownership. All communication Telecommunications devices purchased
43.33pursuant to subdivision 3 will become are the property of the state of Minnesota. Policies
43.34and procedures for the return of devices from individuals who withdraw from the program
43.35or whose eligibility status changes shall be determined by the commissioner of human
43.36services.
44.1    Subd. 7. Standards. The communication telecommunications devices distributed
44.2under this section must comply with the electronic industries association alliance standards
44.3and be approved by the Federal Communications Commission. The commissioner of
44.4human services must provide each eligible person a choice of several models of devices,
44.5the retail value of which may not exceed $600 for a communication device for the deaf
44.6text telephone, and a retail value of $7,000 for a telebraille Braille device, or an amount
44.7authorized by the Department of Human Services for a telephone device for the deaf with
44.8auxiliary equipment all other telecommunications devices and auxiliary equipment it
44.9deems cost-effective and appropriate to distribute according to sections 237.51 to 237.56.

44.10    Sec. 5. Minnesota Statutes 2010, section 237.54, is amended to read:
44.11237.54 TELECOMMUNICATION TELECOMMUNICATIONS RELAY
44.12SERVICE SERVICES (TRS).
44.13    Subd. 2. Operation. (a) The commissioner of commerce shall contract with
44.14a one or more qualified vendor vendors for the operation and maintenance of the
44.15telecommunication relay system provision of Telecommunications Relay Services (TRS).
44.16(b) The telecommunication relay service provider TRS providers shall operate the
44.17relay service within the state of Minnesota. The operator of the system TRS providers
44.18shall keep all messages confidential, shall train personnel in the unique needs of
44.19communication-impaired people, and shall inform communication-impaired persons
44.20and the public of the availability and use of the system. Except in the case of a speech-
44.21or mobility-impaired person, the operator shall not relay a message unless it originates
44.22or terminates through a communication device for the deaf or a Brailling device for use
44.23with a telephone comply with all current and subsequent FCC regulations at Code of
44.24Federal Regulations, title 47, sections 64.601 to 64.606, and shall inform persons who
44.25have communication disabilities and the public of the availability and use of TRS.

44.26    Sec. 6. Minnesota Statutes 2010, section 237.55, is amended to read:
44.27237.55 ANNUAL REPORT ON COMMUNICATION
44.28TELECOMMUNICATIONS ACCESS.
44.29The commissioner of commerce must prepare a report for presentation to the Public
44.30Utilities Commission by January 31 of each year. Each report must review the accessibility
44.31of the telephone system to communication-impaired persons, review the ability of
44.32non-communication-impaired persons to communicate with communication-impaired
44.33persons via the telephone system telecommunications services to persons who have
44.34communication disabilities, describe services provided, account for money received and
45.1disbursed annually annual revenues and expenditures for each aspect of the program fund
45.2to date, and include predicted program future operation.

45.3    Sec. 7. Minnesota Statutes 2010, section 237.56, is amended to read:
45.4237.56 ADEQUATE SERVICE ENFORCEMENT.
45.5The services required to be provided under sections 237.50 to 237.55 may be
45.6enforced under section 237.081 upon a complaint of at least two communication-impaired
45.7persons within the service area of any one telephone company telecommunications
45.8service provider, provided that if only one person within the service area of a company
45.9is receiving service under sections 237.50 to 237.55, the commission Public Utilities
45.10Commission may proceed upon a complaint from that person.


45.13    Section 1. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 56,
45.14is amended to read:
45.15    Subd. 56. Medical service coordination. (a) Medical assistance covers in-reach
45.16community-based service coordination that is performed in through a hospital emergency
45.17department as an eligible procedure under a state healthcare program or private insurance
45.18for a frequent user. A frequent user is defined as an individual who has frequented the
45.19hospital emergency department for services three or more times in the previous four
45.20consecutive months. In-reach community-based service coordination includes navigating
45.21services to address a client's mental health, chemical health, social, economic, and housing
45.22needs, or any other activity targeted at reducing the incidence of emergency room and
45.23other nonmedically necessary health care utilization.
45.24    (b) Reimbursement must be made in 15-minute increments under current Medicaid
45.25mental health social work reimbursement methodology and allowed for up to 60 days
45.26posthospital discharge based upon the specific identified emergency department visit or
45.27inpatient admitting event. A frequent user who is participating in care coordination within
45.28a health care home framework is ineligible for reimbursement under this subdivision.
45.29In-reach community-based service coordination shall seek to connect frequent users with
45.30existing covered services available to them, including, but not limited to, targeted case
45.31management, waiver case management, or care coordination in a health care home.
45.32Eligible in-reach service coordinators must hold a minimum of a bachelor's degree in
45.33social work, public health, corrections, or a related field. The commissioner shall submit
46.1any necessary application for waivers to the Centers for Medicare and Medicaid Services
46.2to implement this subdivision.
46.3    (c) For the purposes of this subdivision, "in-reach community-based service
46.4coordination" means the practice of a community-based worker with training, knowledge,
46.5skills, and ability to access a continuum of services, including housing, transportation,
46.6chemical and mental health treatment, employment, and peer support services, by working
46.7with an organization's staff to transition an individual back into the individual's living
46.8environment. In-reach community-based service coordination includes working with the
46.9individual during their discharge and for up to a defined amount of time in the individual's
46.10living environment, reducing the individual's need for readmittance.

46.11    Sec. 2. Minnesota Statutes 2010, section 256B.0659, subdivision 1, is amended to read:
46.12    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
46.13paragraphs (b) to (r) have the meanings given unless otherwise provided in text.
46.14    (b) "Activities of daily living" means grooming, dressing, bathing, transferring,
46.15mobility, positioning, eating, and toileting.
46.16    (c) "Behavior," effective January 1, 2010, means a category to determine the home
46.17care rating and is based on the criteria found in this section. "Level I behavior" means
46.18physical aggression towards self, others, or destruction of property that requires the
46.19immediate response of another person.
46.20    (d) "Complex health-related needs," effective January 1, 2010, means a category to
46.21determine the home care rating and is based on the criteria found in this section.
46.22    (e) "Critical activities of daily living," effective January 1, 2010, means transferring,
46.23mobility, eating, and toileting.
46.24    (f) "Dependency in activities of daily living" means a person requires assistance to
46.25begin and complete one or more of the activities of daily living.
46.26    (g) "Extended personal care assistance service" means personal care assistance
46.27services included in a service plan under one of the home and community-based services
46.28waivers authorized under sections 256B.0915, 256B.092, subdivision 5, and 256B.49,
46.29which exceed the amount, duration, and frequency of the state plan personal care
46.30assistance services for participants who:
46.31    (1) need assistance provided periodically during a week, but less than daily will not
46.32be able to remain in their homes without the assistance, and other replacement services
46.33are more expensive or are not available when personal care assistance services are to be
46.34terminated; or
47.1    (2) need additional personal care assistance services beyond the amount authorized
47.2by the state plan personal care assistance assessment in order to ensure that their safety,
47.3health, and welfare are provided for in their homes.
47.4    (h) "Health-related procedures and tasks" means procedures and tasks that can
47.5be delegated or assigned by a licensed health care professional under state law to be
47.6performed by a personal care assistant.
47.7    (i) "Instrumental activities of daily living" means activities to include meal planning
47.8and preparation; basic assistance with paying bills; shopping for food, clothing, and other
47.9essential items; performing household tasks integral to the personal care assistance
47.10services; communication by telephone and other media; and traveling, including to
47.11medical appointments and to participate in the community.
47.12    (j) "Managing employee" has the same definition as Code of Federal Regulations,
47.13title 42, section 455.
47.14    (k) "Qualified professional" means a professional providing supervision of personal
47.15care assistance services and staff as defined in section 256B.0625, subdivision 19c.
47.16    (l) "Personal care assistance provider agency" means a medical assistance enrolled
47.17provider that provides or assists with providing personal care assistance services and
47.18includes a personal care assistance provider organization, personal care assistance choice
47.19agency, class A licensed nursing agency, and Medicare-certified home health agency.
47.20    (m) "Personal care assistant" or "PCA" means an individual employed by a personal
47.21care assistance agency who provides personal care assistance services.
47.22    (n) "Personal care assistance care plan" means a written description of personal
47.23care assistance services developed by the personal care assistance provider according
47.24to the service plan.
47.25    (o) "Responsible party" means an individual who is capable of providing the support
47.26necessary to assist the recipient to live in the community.
47.27    (p) "Self-administered medication" means medication taken orally, by injection,
47.28nebulizer, or insertion, or applied topically without the need for assistance.
47.29    (q) "Service plan" means a written summary of the assessment and description of the
47.30services needed by the recipient.
47.31    (r) "Wages and benefits" means wages and salaries, the employer's share of FICA
47.32taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
47.33mileage reimbursement, health and dental insurance, life insurance, disability insurance,
47.34long-term care insurance, uniform allowance, and contributions to employee retirement
47.35accounts.

48.1    Sec. 3. Minnesota Statutes 2010, section 256B.0659, subdivision 2, is amended to read:
48.2    Subd. 2. Personal care assistance services; covered services. (a) The personal
48.3care assistance services eligible for payment include services and supports furnished
48.4to an individual, as needed, to assist in:
48.5(1) activities of daily living;
48.6(2) health-related procedures and tasks;
48.7(3) observation and redirection of behaviors; and
48.8(4) instrumental activities of daily living.
48.9(b) Activities of daily living include the following covered services:
48.10(1) dressing, including assistance with choosing, application, and changing of
48.11clothing and application of special appliances, wraps, or clothing;
48.12(2) grooming, including assistance with basic hair care, oral care, shaving, applying
48.13cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
48.14except for recipients who are diabetic or have poor circulation;
48.15(3) bathing, including assistance with basic personal hygiene and skin care;
48.16(4) eating, including assistance with hand washing and application of orthotics
48.17required for eating, transfers, and feeding;
48.18(5) transfers, including assistance with transferring the recipient from one seating or
48.19reclining area to another;
48.20(6) mobility, including assistance with ambulation, including use of a wheelchair.
48.21Mobility does not include providing transportation for a recipient;
48.22(7) positioning, including assistance with positioning or turning a recipient for
48.23necessary care and comfort; and
48.24(8) toileting, including assistance with helping recipient with bowel or bladder
48.25elimination and care including transfers, mobility, positioning, feminine hygiene, use of
48.26toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and
48.27adjusting clothing.
48.28(c) Health-related procedures and tasks include the following covered services:
48.29(1) range of motion and passive exercise to maintain a recipient's strength and
48.30muscle functioning;
48.31(2) assistance with self-administered medication as defined by this section, including
48.32reminders to take medication, bringing medication to the recipient, and assistance with
48.33opening medication under the direction of the recipient or responsible party, including
48.34medications given through a nebulizer;
48.35(3) interventions for seizure disorders, including monitoring and observation; and
49.1(4) other activities considered within the scope of the personal care service and
49.2meeting the definition of health-related procedures and tasks under this section.
49.3(d) A personal care assistant may provide health-related procedures and tasks
49.4associated with the complex health-related needs of a recipient if the procedures and
49.5tasks meet the definition of health-related procedures and tasks under this section and the
49.6personal care assistant is trained by a qualified professional and demonstrates competency
49.7to safely complete the procedures and tasks. Delegation of health-related procedures and
49.8tasks and all training must be documented in the personal care assistance care plan and the
49.9recipient's and personal care assistant's files. A personal care assistant must not determine
49.10the medication dose or time for medication.
49.11(e) Effective January 1, 2010, for a personal care assistant to provide the
49.12health-related procedures and tasks of tracheostomy suctioning and services to recipients
49.13on ventilator support there must be:
49.14(1) delegation and training by a registered nurse, certified or licensed respiratory
49.15therapist, or a physician;
49.16(2) utilization of clean rather than sterile procedure;
49.17(3) specialized training about the health-related procedures and tasks and equipment,
49.18including ventilator operation and maintenance;
49.19(4) individualized training regarding the needs of the recipient; and
49.20(5) supervision by a qualified professional who is a registered nurse.
49.21(f) Effective January 1, 2010, a personal care assistant may observe and redirect the
49.22recipient for episodes where there is a need for redirection due to behaviors. Training of
49.23the personal care assistant must occur based on the needs of the recipient, the personal
49.24care assistance care plan, and any other support services provided.
49.25(g) Instrumental activities of daily living under subdivision 1, paragraph (i).

49.26    Sec. 4. Minnesota Statutes 2010, section 256B.0659, subdivision 3a, is amended to
49.27read:
49.28    Subd. 3a. Assessment; defined. (a) "Assessment" means a review and evaluation
49.29of a recipient's need for home personal care assistance services conducted in person.
49.30Assessments for personal care assistance services shall be conducted by the county public
49.31health nurse or a certified public health nurse under contract with the county except when a
49.32long-term care consultation assessment is being conducted for the purposes of determining
49.33a person's eligibility for home and community-based waiver services including personal
49.34care assistance services according to section 256B.0911. An in-person assessment
49.35must include: documentation of health status, determination of need, evaluation of
50.1service effectiveness, identification of appropriate services, service plan development
50.2or modification, coordination of services, referrals and follow-up to appropriate payers
50.3and community resources, completion of required reports, recommendation of service
50.4authorization, and consumer education. Once the need for personal care assistance
50.5services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654,
50.6and 256B.0656, the county public health nurse or certified public health nurse under
50.7contract with the county is responsible for communicating this recommendation to the
50.8commissioner and the recipient. An in-person assessment must occur at least annually or
50.9when there is a significant change in the recipient's condition or when there is a change
50.10in the need for personal care assistance services. A service update may substitute for
50.11the annual face-to-face assessment when there is not a significant change in recipient
50.12condition or a change in the need for personal care assistance service. A service update
50.13may be completed by telephone, used when there is no need for an increase in personal
50.14care assistance services, and used for two consecutive assessments if followed by a
50.15face-to-face assessment. A service update must be completed on a form approved by the
50.16commissioner. A service update or review for temporary increase includes a review of
50.17initial baseline data, evaluation of service effectiveness, redetermination of service need,
50.18modification of service plan and appropriate referrals, update of initial forms, obtaining
50.19service authorization, and on going consumer education. Assessments or reassessments
50.20must be completed on forms provided by the commissioner within 30 days of a request for
50.21home care services by a recipient or responsible party or personal care provider agency.
50.22(b) This subdivision expires when notification is given by the commissioner as
50.23described in section 256B.0911, subdivision 3a.

50.24    Sec. 5. Minnesota Statutes 2010, section 256B.0659, subdivision 4, is amended to read:
50.25    Subd. 4. Assessment for personal care assistance services; limitations. (a) An
50.26assessment as defined in subdivision 3a must be completed for personal care assistance
50.27services.
50.28    (b) The following limitations apply to the assessment:
50.29    (1) a person must be assessed as dependent in an activity of daily living based on the
50.30person's daily need or need on the days during the week the activity is completed for:
50.31    (i) cuing and constant supervision to complete the task; or
50.32    (ii) hands-on assistance to complete the task; and
50.33    (2) a child may not be found to be dependent in an activity of daily living if because
50.34of the child's age an adult would either perform the activity for the child or assist the child
51.1with the activity. Assistance needed is the assistance appropriate for a typical child of
51.2the same age.
51.3    (c) Assessment for complex health-related needs must meet the criteria in this
51.4paragraph. During the assessment process, A recipient qualifies as having complex
51.5health-related needs if the recipient has one or more of the interventions that are ordered
51.6by a physician, specified in a personal care assistance care plan or community support
51.7plan developed under section 256B.0911, and found in the following:
51.8    (1) tube feedings requiring:
51.9    (i) a gastrojejunostomy tube; or
51.10    (ii) continuous tube feeding lasting longer than 12 hours per day;
51.11    (2) wounds described as:
51.12    (i) stage III or stage IV;
51.13    (ii) multiple wounds;
51.14    (iii) requiring sterile or clean dressing changes or a wound vac; or
51.15    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
51.16specialized care;
51.17    (3) parenteral therapy described as:
51.18    (i) IV therapy more than two times per week lasting longer than four hours for
51.19each treatment; or
51.20    (ii) total parenteral nutrition (TPN) daily;
51.21    (4) respiratory interventions, including:
51.22    (i) oxygen required more than eight hours per day;
51.23    (ii) respiratory vest more than one time per day;
51.24    (iii) bronchial drainage treatments more than two times per day;
51.25    (iv) sterile or clean suctioning more than six times per day;
51.26    (v) dependence on another to apply respiratory ventilation augmentation devices
51.27such as BiPAP and CPAP; and
51.28    (vi) ventilator dependence under section 256B.0652;
51.29    (5) insertion and maintenance of catheter, including:
51.30    (i) sterile catheter changes more than one time per month;
51.31    (ii) clean intermittent catheterization, and including self-catheterization more than
51.32six times per day; or
51.33    (iii) bladder irrigations;
51.34    (6) bowel program more than two times per week requiring more than 30 minutes to
51.35perform each time;
51.36    (7) neurological intervention, including:
52.1    (i) seizures more than two times per week and requiring significant physical
52.2assistance to maintain safety; or
52.3    (ii) swallowing disorders diagnosed by a physician and requiring specialized
52.4assistance from another on a daily basis; and
52.5    (8) other congenital or acquired diseases creating a need for significantly increased
52.6direct hands-on assistance and interventions in six to eight activities of daily living.
52.7    (d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
52.8qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
52.9assistance at least four times per week and shows one or more of the following behaviors:
52.10    (1) physical aggression towards self or others, or destruction of property that requires
52.11the immediate response of another person;
52.12    (2) increased vulnerability due to cognitive deficits or socially inappropriate
52.13behavior; or
52.14    (3) increased need for assistance for recipients who are verbally aggressive and or
52.15 resistive to care so that the time needed to perform activities of daily living is increased.

52.16    Sec. 6. Minnesota Statutes 2010, section 256B.0911, subdivision 1, is amended to read:
52.17    Subdivision 1. Purpose and goal. (a) The purpose of long-term care consultation
52.18services is to assist persons with long-term or chronic care needs in making long-term care
52.19decisions and selecting support and service options that meet their needs and reflect their
52.20preferences. The availability of, and access to, information and other types of assistance,
52.21including assessment and support planning, is also intended to prevent or delay certified
52.22nursing facility institutional placements and to provide access to transition assistance
52.23after admission. Further, the goal of these services is to contain costs associated with
52.24unnecessary certified nursing facility institutional admissions. Long-term consultation
52.25services must be available to any person regardless of public program eligibility. The
52.26commissioner of human services shall seek to maximize use of available federal and state
52.27funds and establish the broadest program possible within the funding available.
52.28(b) These services must be coordinated with long-term care options counseling
52.29provided under section 256.975, subdivision 7, and section 256.01, subdivision 24, for
52.30telephone assistance and follow up and to offer a variety of cost-effective alternatives
52.31to persons with disabilities and elderly persons. The county or tribal lead agency or
52.32managed care plan providing long-term care consultation services shall encourage the use
52.33of volunteers from families, religious organizations, social clubs, and similar civic and
52.34service organizations to provide community-based services.

53.1    Sec. 7. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 1a,
53.2is amended to read:
53.3    Subd. 1a. Definitions. For purposes of this section, the following definitions apply:
53.4    (a) Until additional requirements apply under paragraph (b), "long-term care
53.5consultation services" means:
53.6    (1) intake for and access to assistance in identifying services needed to maintain an
53.7individual in the most inclusive environment;
53.8    (2) providing recommendations on for and referrals to cost-effective community
53.9services that are available to the individual;
53.10    (3) development of an individual's person-centered community support plan;
53.11    (4) providing information regarding eligibility for Minnesota health care programs;
53.12    (5) face-to-face long-term care consultation assessments, which may be completed
53.13in a hospital, nursing facility, intermediate care facility for persons with developmental
53.14disabilities (ICF/DDs), regional treatment centers, or the person's current or planned
53.15residence;
53.16    (6) federally mandated preadmission screening to determine the need for an
53.17institutional level of care under subdivision 4a activities described under subdivisions
53.184a and 4b;
53.19    (7) determination of home and community-based waiver and other service eligibility
53.20as required under sections 256B.0913, 256B.0915, and 256B.49, including level of
53.21care determination for individuals who need an institutional level of care as determined
53.22under section 256B.0911, subdivision 4a, paragraph (d), or 256B.092, service eligibility
53.23including state plan home care services identified in sections 256B.0625, subdivisions 6,
53.247, and 19, paragraphs (a) and (c), and 256B.0657, based on assessment and community
53.25support plan development with, appropriate referrals to obtain necessary diagnostic
53.26information, and including the option an eligibility determination for consumer-directed
53.27community supports;
53.28    (8) providing recommendations for nursing facility institutional placement when
53.29there are no cost-effective community services available; and
53.30    (9) providing access to assistance to transition people back to community settings
53.31after facility institutional admission.; and
53.32(10) providing information about competitive employment, with or without supports,
53.33for school-age youth and working-age adults and referrals to the Disability Linkage
53.34Line and Disability Benefits 101 to ensure that an informed choice about competitive
53.35employment can be made. For the purposes of this subdivision, "competitive employment"
53.36means work in the competitive labor market that is performed on a full-time or part-time
54.1basis in an integrated setting, and for which an individual is compensated at or above the
54.2minimum wage, but not less than the customary wage and level of benefits paid by the
54.3employer for the same or similar work performed by individuals without disabilities.
54.4(b) Upon statewide implementation of lead agency requirements in subdivisions 2b,
54.52c, and 3a, "long-term care consultation services" also means:
54.6(1) service eligibility determination for state plan home care services identified in:
54.7(i) section 256B.0625, subdivisions 7, 19a, and 19c;
54.8(ii) section 256B.0657; or
54.9(iii) consumer support grants under section 256.476;
54.10(2) notwithstanding provisions in Minnesota Rules, parts 9525.0004 to 9525.0024,
54.11determination of eligibility for case management services available under sections
54.12256B.0621, subdivision 2, paragraph (4), and 256B.0924 and Minnesota Rules, part
54.139525.0016;
54.14(3) determination of institutional level of care, home and community-based service
54.15waiver, and other service eligibility as required under section 256B.092, determination
54.16of eligibility for family support grants under section 252.32, semi-independent living
54.17services under section 252.275, and day training and habilitation services under section
54.18256B.092; and
54.19(4) obtaining necessary diagnostic information to determine eligibility under clauses
54.20(2) and (3).
54.21    (b) (c) "Long-term care options counseling" means the services provided by the
54.22linkage lines as mandated by sections 256.01 and 256.975, subdivision 7, and also
54.23includes telephone assistance and follow up once a long-term care consultation assessment
54.24has been completed.
54.25    (c) (d) "Minnesota health care programs" means the medical assistance program
54.26under chapter 256B and the alternative care program under section 256B.0913.
54.27    (d) (e) "Lead agencies" means counties administering or a collaboration of counties,
54.28tribes, and health plans administering under contract with the commissioner to administer
54.29long-term care consultation assessment and support planning services.

54.30    Sec. 8. Minnesota Statutes 2010, section 256B.0911, subdivision 2b, is amended to
54.31read:
54.32    Subd. 2b. Certified assessors. (a) Beginning January 1, 2011, Each lead agency
54.33shall use certified assessors who have completed training and the certification processes
54.34determined by the commissioner in subdivision 2c. Certified assessors shall demonstrate
54.35best practices in assessment and support planning including person-centered planning
55.1principals and have a common set of skills that must ensure consistency and equitable
55.2access to services statewide. Assessors must be part of a multidisciplinary team of
55.3professionals that includes public health nurses, social workers, and other professionals
55.4as defined in paragraph (b). For persons with complex health care needs, a public health
55.5nurse or registered nurse from a multidisciplinary team must be consulted. A lead agency
55.6may choose, according to departmental policies, to contract with a qualified, certified
55.7assessor to conduct assessments and reassessments on behalf of the lead agency.
55.8    (b) Certified assessors are persons with a minimum of a bachelor's degree in social
55.9work, nursing with a public health nursing certificate, or other closely related field with at
55.10least one year of home and community-based experience, or a two-year registered nursing
55.11degree nurse without public health certification with at least three two years of home and
55.12community-based experience that have has received training and certification specific to
55.13assessment and consultation for long-term care services in the state.

55.14    Sec. 9. Minnesota Statutes 2010, section 256B.0911, subdivision 2c, is amended to
55.15read:
55.16    Subd. 2c. Assessor training and certification. The commissioner shall develop
55.17and implement a curriculum and an assessor certification process to begin no later than
55.18January 1, 2010. All existing lead agency staff designated to provide the services defined
55.19in subdivision 1a must be certified by December 30, 2010. within timelines specified by
55.20the commissioner, but no sooner than six months after statewide availability of the training
55.21and certification process. The commissioner must establish the timelines for training and
55.22certification in a manner that allows lead agencies to most efficiently adopt the automated
55.23process established in subdivision 5. Each lead agency is required to ensure that they have
55.24sufficient numbers of certified assessors to provide long-term consultation assessment and
55.25support planning within the timelines and parameters of the service by January 1, 2011.
55.26Certified assessors are required to be recertified every three years.

55.27    Sec. 10. Minnesota Statutes 2010, section 256B.0911, subdivision 3, is amended to
55.28read:
55.29    Subd. 3. Long-term care consultation team. (a) Until January 1, 2011, A long-term
55.30care consultation team shall be established by the county board of commissioners. Each
55.31local consultation team shall consist of at least one social worker and at least one public
55.32health nurse from their respective county agencies. The board may designate public
55.33health or social services as the lead agency for long-term care consultation services. If a
55.34county does not have a public health nurse available, it may request approval from the
56.1commissioner to assign a county registered nurse with at least one year experience in
56.2home care to participate on the team. Two or more counties may collaborate to establish
56.3a joint local consultation team or teams.
56.4(b) Certified assessors must be part of a multidisciplinary long-term care consultation
56.5team of professionals that includes public health nurses, social workers, and other
56.6professionals as defined in subdivision 2b, paragraph (b). The team is responsible for
56.7providing long-term care consultation services to all persons located in the county who
56.8request the services, regardless of eligibility for Minnesota health care programs.
56.9(c) The commissioner shall allow arrangements and make recommendations that
56.10encourage counties and tribes to collaborate to establish joint local long-term care
56.11consultation teams to ensure that long-term care consultations are done within the
56.12timelines and parameters of the service. This includes integrated service models as
56.13required in subdivision 1, paragraph (b).
56.14(d) Tribes and health plans under contract with the commissioner must provide
56.15long-term care consultation services as specified in the contract.
56.16(e) The lead agency must provide the commissioner with an administrative contact
56.17for communication purposes.

56.18    Sec. 11. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 3a,
56.19is amended to read:
56.20    Subd. 3a. Assessment and support planning. (a) Persons requesting assessment,
56.21services planning, or other assistance intended to support community-based living,
56.22including persons who need assessment in order to determine waiver or alternative care
56.23program eligibility, must be visited by a long-term care consultation team within 15 20
56.24calendar days after the date on which an assessment was requested or recommended.
56.25After January 1, 2011, these requirements also apply to Upon statewide implementation
56.26of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
56.27requesting personal care assistance services, and private duty nursing, and home health
56.28agency services, on timelines established in subdivision 5. The commissioner shall provide
56.29at least a 90-day notice to lead agencies prior to the effective date of this requirement.
56.30Face-to-face assessments must be conducted according to paragraphs (b) to (i).
56.31    (b) The county lead agency may utilize a team of either the social worker or public
56.32health nurse, or both. After January 1, 2011 Upon implementation of subdivisions 2b, 2c,
56.33and 5, lead agencies shall use certified assessors to conduct the assessment in a face-to-face
56.34interview assessment. The consultation team members must confer regarding the most
57.1appropriate care for each individual screened or assessed. For a person with complex
57.2health care needs, a public health or registered nurse from the team must be consulted.
57.3    (c) The assessment must be comprehensive and include a person-centered assessment
57.4of the health, psychological, functional, environmental, and social needs of referred
57.5individuals and provide information necessary to develop a community support plan that
57.6meets the consumers needs, using an assessment form provided by the commissioner.
57.7    (d) The assessment must be conducted in a face-to-face interview with the person
57.8being assessed and the person's legal representative, as required by legally executed
57.9documents, and other individuals as requested by the person, who can provide information
57.10on the needs, strengths, and preferences of the person necessary to develop a community
57.11support plan that ensures the person's health and safety, but who is not a provider of
57.12service or has any financial interest in the provision of services.
57.13    (e) The person, or the person's legal representative, must be provided with written
57.14recommendations for community-based services, including consumer-directed options,
57.15or institutional care that include documentation that the most cost-effective alternatives
57.16available were offered to the individual, and alternatives to residential settings, including,
57.17but not limited to, foster care settings that are not the primary residence of the license
57.18holder. For purposes of this requirement, "cost-effective alternatives" means community
57.19services and living arrangements that cost the same as or less than institutional care.
57.20    (f) (e) If the person chooses to use community-based services, the person or the
57.21person's legal representative must be provided with a written community support plan
57.22within 40 calendar days of the assessment visit, regardless of whether the individual
57.23is eligible for Minnesota health care programs. The written community support plan
57.24must include:
57.25(1) a summary of assessed needs as defined in paragraphs (c) and (d);
57.26(2) the individual's options and choices to meet identified needs, including all
57.27available options for case management services and providers;
57.28(3) identification of health and safety risks and how those risks will be addressed,
57.29including personal risk management strategies;
57.30(4) referral information; and
57.31(5) informal caregiver supports, if applicable.
57.32For a person determined eligible for state plan home care under subdivision 1a,
57.33paragraph (b), clause (1), the person or person's representative must also receive a copy of
57.34the home care service plan developed by the certified assessor.
57.35(f) A person may request assistance in identifying community supports without
57.36participating in a complete assessment. Upon a request for assistance identifying
58.1community support, the person must be transferred or referred to the long-term care
58.2options counseling services available under sections 256.975, subdivision 7, and 256.01,
58.3subdivision 24, for telephone assistance and follow up.
58.4    (g) The person has the right to make the final decision between institutional
58.5placement and community placement after the recommendations have been provided,
58.6except as provided in subdivision 4a, paragraph (c).
58.7    (h) The team lead agency must give the person receiving assessment or support
58.8planning, or the person's legal representative, materials, and forms supplied by the
58.9commissioner containing the following information:
58.10    (1) written recommendations for community-based services and consumer-directed
58.11options;
58.12(2) documentation that the most cost-effective alternatives available were offered to
58.13the individual. For purposes of this clause, "cost-effective" means community services and
58.14living arrangements that cost the same as or less than institutional care. For an individual
58.15found to meet eligibility criteria for home and community-based service programs under
58.16section 256B.0915 or 256B.49, "cost effectiveness" has the meaning found in the federally
58.17approved waiver plan for each program;
58.18(3) the need for and purpose of preadmission screening if the person selects nursing
58.19facility placement;
58.20    (2) (4) the role of the long-term care consultation assessment and support planning
58.21in waiver and alternative care program eligibility determination for waiver and alternative
58.22care programs, and state plan home care, case management, and other services as defined
58.23in subdivision 1a, paragraphs (a), clause (7), and (b);
58.24    (3) (5) information about Minnesota health care programs;
58.25    (4) (6) the person's freedom to accept or reject the recommendations of the team;
58.26    (5) (7) the person's right to confidentiality under the Minnesota Government Data
58.27Practices Act, chapter 13;
58.28    (6) (8) the long-term care consultant's certified assessor's decision regarding the
58.29person's need for institutional level of care as determined under criteria established in
58.30section 144.0724, subdivision 11, or 256B.092 256B.0911, subdivision 4a, paragraph (d),
58.31and the certified assessor's decision regarding eligibility for all services and programs as
58.32defined in subdivision 1a, paragraphs (a), clause (7), and (b); and
58.33    (7) (9) the person's right to appeal the certified assessor's decision regarding
58.34eligibility for all services and programs as defined in subdivision 1a, paragraphs (a),
58.35clause (7), and (b), and incorporating the decision regarding the need for nursing facility
59.1institutional level of care or the county's lead agency's final decisions regarding public
59.2programs eligibility according to section 256.045, subdivision 3.
59.3    (i) Face-to-face assessment completed as part of eligibility determination for
59.4the alternative care, elderly waiver, community alternatives for disabled individuals,
59.5community alternative care, and traumatic brain injury waiver programs under sections
59.6256B.0913, 256B.0915, 256B.0917, and 256B.49 is valid to establish service eligibility
59.7for no more than 60 calendar days after the date of assessment.
59.8(j) The effective eligibility start date for these programs in paragraph (i) can never
59.9be prior to the date of assessment. If an assessment was completed more than 60 days
59.10before the effective waiver or alternative care program eligibility start date, assessment
59.11and support plan information must be updated in a face-to-face visit and documented in
59.12the department's Medicaid Management Information System (MMIS). Notwithstanding
59.13retroactive medical assistance coverage of state plan services, the effective date of
59.14program eligibility in this case for programs included in paragraph (i) cannot be prior to
59.15the date the most recent updated assessment is completed.

59.16    Sec. 12. Minnesota Statutes 2010, section 256B.0911, subdivision 3b, is amended to
59.17read:
59.18    Subd. 3b. Transition assistance. (a) A long-term care consultation team Lead
59.19agency certified assessors shall provide assistance to persons residing in a nursing
59.20facility, hospital, regional treatment center, or intermediate care facility for persons with
59.21developmental disabilities who request or are referred for assistance. Transition assistance
59.22must include assessment, community support plan development, referrals to long-term
59.23care options counseling under section 256B.975 256.975, subdivision 10 7, for community
59.24support plan implementation and to Minnesota health care programs, including home and
59.25community-based waiver services and consumer-directed options through the waivers,
59.26and referrals to programs that provide assistance with housing. Transition assistance
59.27must also include information about the Centers for Independent Living and the Senior
59.28LinkAge Line, Disability Linkage Line, and about other organizations that can provide
59.29assistance with relocation efforts, and information about contacting these organizations to
59.30obtain their assistance and support.
59.31    (b) The county lead agency shall develop transition processes with institutional
59.32social workers and discharge planners to ensure that:
59.33    (1) referrals for in-person assessments are taken from long-term care options
59.34counselors as provided for in section 256.975, subdivision 7, paragraph (b), clause (11);
60.1(2) persons admitted to facilities assessed in institutions receive information about
60.2transition assistance that is available;
60.3    (2) (3) the assessment is completed for persons within ten working 20 calendar days
60.4of the date of request or recommendation for assessment; and
60.5    (3) (4) there is a plan for transition and follow-up for the individual's return to the
60.6community. The plan must require, including notification of other local agencies when a
60.7person who may require assistance is screened by one county for admission to a facility
60.8from agencies located in another county.; and
60.9(5) relocation targeted case management as defined in section 256B.0621,
60.10subdivision 2, clause (4), is authorized for an eligible medical assistance recipient.
60.11    (c) If a person who is eligible for a Minnesota health care program is admitted to a
60.12nursing facility, the nursing facility must include a consultation team member or the case
60.13manager in the discharge planning process.

60.14    Sec. 13. Minnesota Statutes 2011 Supplement, section 256B.0911, subdivision 4a,
60.15is amended to read:
60.16    Subd. 4a. Preadmission screening activities related to nursing facility
60.17admissions. (a) All applicants to Medicaid certified nursing facilities, including certified
60.18boarding care facilities, must be screened prior to admission regardless of income, assets,
60.19or funding sources for nursing facility care, except as described in subdivision 4b. The
60.20purpose of the screening is to determine the need for nursing facility level of care as
60.21described in paragraph (d) and to complete activities required under federal law related to
60.22mental illness and developmental disability as outlined in paragraph (b).
60.23(b) A person who has a diagnosis or possible diagnosis of mental illness or
60.24developmental disability must receive a preadmission screening before admission
60.25regardless of the exemptions outlined in subdivision 4b, paragraph (b), to identify the need
60.26for further evaluation and specialized services, unless the admission prior to screening is
60.27authorized by the local mental health authority or the local developmental disabilities case
60.28manager, or unless authorized by the county agency according to Public Law 101-508.
60.29The following criteria apply to the preadmission screening:
60.30(1) the county lead agency must use forms and criteria developed by the
60.31commissioner to identify persons who require referral for further evaluation and
60.32determination of the need for specialized services; and
60.33(2) the evaluation and determination of the need for specialized services must be
60.34done by:
61.1(i) a qualified independent mental health professional, for persons with a primary or
61.2secondary diagnosis of a serious mental illness; or
61.3(ii) a qualified developmental disability professional, for persons with a primary or
61.4secondary diagnosis of developmental disability. For purposes of this requirement, a
61.5qualified developmental disability professional must meet the standards for a qualified
61.6developmental disability professional under Code of Federal Regulations, title 42, section
61.7483.430.
61.8(c) The local county mental health authority or the state developmental disability
61.9authority under Public Law Numbers 100-203 and 101-508 may prohibit admission to a
61.10nursing facility if the individual does not meet the nursing facility level of care criteria or
61.11needs specialized services as defined in Public Law Numbers 100-203 and 101-508. For
61.12purposes of this section, "specialized services" for a person with developmental disability
61.13means active treatment as that term is defined under Code of Federal Regulations, title
61.1442, section 483.440 (a)(1).
61.15(d) The determination of the need for nursing facility level of care must be made
61.16according to criteria developed by the commissioner, and in section 256B.092, using
61.17forms developed by the commissioner. Effective no sooner than on or after July 1, 2012,
61.18for individuals age 21 and older, and on or after October 1, 2019, for individuals under
61.19age 21, the determination of need for nursing facility level of care shall be based on
61.20criteria in section 144.0724, subdivision 11. In assessing a person's needs, consultation
61.21team members shall have a physician available for consultation and shall consider the
61.22assessment of the individual's attending physician, if any. The individual's physician must
61.23be included if the physician chooses to participate. Other personnel may be included on
61.24the team as deemed appropriate by the county lead agency.

61.25    Sec. 14. Minnesota Statutes 2010, section 256B.0911, subdivision 4c, is amended to
61.26read:
61.27    Subd. 4c. Screening requirements. (a) A person may be screened for nursing
61.28facility admission by telephone or in a face-to-face screening interview. Consultation team
61.29members Certified assessors shall identify each individual's needs using the following
61.30categories:
61.31    (1) the person needs no face-to-face screening interview to determine the need
61.32for nursing facility level of care based on information obtained from other health care
61.33professionals;
62.1    (2) the person needs an immediate face-to-face screening interview to determine the
62.2need for nursing facility level of care and complete activities required under subdivision
62.34a; or
62.4    (3) the person may be exempt from screening requirements as outlined in subdivision
62.54b, but will need transitional assistance after admission or in-person follow-along after
62.6a return home.
62.7    (b) Persons admitted on a nonemergency basis to a Medicaid-certified nursing
62.8facility must be screened prior to admission.
62.9    (c) The county lead agency screening or intake activity must include processes to
62.10identify persons who may require transition assistance as described in subdivision 3b.

62.11    Sec. 15. Minnesota Statutes 2010, section 256B.0911, subdivision 6, is amended to
62.12read:
62.13    Subd. 6. Payment for long-term care consultation services. (a) The total payment
62.14for each county must be paid monthly by certified nursing facilities in the county. The
62.15monthly amount to be paid by each nursing facility for each fiscal year must be determined
62.16by dividing the county's annual allocation for long-term care consultation services by 12
62.17to determine the monthly payment and allocating the monthly payment to each nursing
62.18facility based on the number of licensed beds in the nursing facility. Payments to counties
62.19in which there is no certified nursing facility must be made by increasing the payment
62.20rate of the two facilities located nearest to the county seat.
62.21    (b) The commissioner shall include the total annual payment determined under
62.22paragraph (a) for each nursing facility reimbursed under section 256B.431 or, 256B.434
62.23according to section 256B.431, subdivision 2b, paragraph (g), or 256B.441.
62.24    (c) In the event of the layaway, delicensure and decertification, or removal from
62.25layaway of 25 percent or more of the beds in a facility, the commissioner may adjust
62.26the per diem payment amount in paragraph (b) and may adjust the monthly payment
62.27amount in paragraph (a). The effective date of an adjustment made under this paragraph
62.28shall be on or after the first day of the month following the effective date of the layaway,
62.29delicensure and decertification, or removal from layaway.
62.30    (d) Payments for long-term care consultation services are available to the county
62.31or counties to cover staff salaries and expenses to provide the services described in
62.32subdivision 1a. The county shall employ, or contract with other agencies to employ, within
62.33the limits of available funding, sufficient personnel to provide long-term care consultation
62.34services while meeting the state's long-term care outcomes and objectives as defined in
62.35section 256B.0917, subdivision 1. The county shall be accountable for meeting local
63.1objectives as approved by the commissioner in the biennial home and community-based
63.2services quality assurance plan on a form provided by the commissioner.
63.3    (e) Notwithstanding section 256B.0641, overpayments attributable to payment of the
63.4screening costs under the medical assistance program may not be recovered from a facility.
63.5    (f) The commissioner of human services shall amend the Minnesota medical
63.6assistance plan to include reimbursement for the local consultation teams.
63.7    (g) Until the alternative payment methodology in paragraph (h) is implemented,
63.8the county may bill, as case management services, assessments, support planning, and
63.9follow-along provided to persons determined to be eligible for case management under
63.10Minnesota health care programs. No individual or family member shall be charged for an
63.11initial assessment or initial support plan development provided under subdivision 3a or 3b.
63.12(h) The commissioner shall develop an alternative payment methodology for
63.13long-term care consultation services that includes the funding available under this
63.14subdivision, and sections 256B.092 and 256B.0659. In developing the new payment
63.15methodology, the commissioner shall consider the maximization of other funding sources,
63.16including federal funding, for this all long-term care consultation and preadmission
63.17screening activity.

63.18    Sec. 16. Minnesota Statutes 2010, section 256B.0913, subdivision 7, is amended to
63.19read:
63.20    Subd. 7. Case management. (a) The provision of case management under the
63.21alternative care program is governed by requirements in section 256B.0915, subdivisions
63.221a and 1b.
63.23(b) The case manager must not approve alternative care funding for a client in any
63.24setting in which the case manager cannot reasonably ensure the client's health and safety.
63.25(c) The case manager is responsible for the cost-effectiveness of the alternative care
63.26individual care coordinated service and support plan and must not approve any care plan
63.27in which the cost of services funded by alternative care and client contributions exceeds
63.28the limit specified in section 256B.0915, subdivision 3 3a, paragraph (b).
63.29(d) Case manager responsibilities include those in section 256B.0915, subdivision
63.301a, paragraph (g).

63.31    Sec. 17. Minnesota Statutes 2010, section 256B.0913, subdivision 8, is amended to
63.32read:
63.33    Subd. 8. Requirements for individual care coordinated service and support
63.34plan. (a) The case manager shall implement the coordinated service and support plan of
64.1care for each alternative care client and ensure that a client's service needs and eligibility
64.2are reassessed at least every 12 months. The coordinated service and support plan must
64.3meet the requirements in section 256B.0915, subdivision 6. The plan shall include any
64.4services prescribed by the individual's attending physician as necessary to allow the
64.5individual to remain in a community setting. In developing the individual's care plan, the
64.6case manager should include the use of volunteers from families and neighbors, religious
64.7organizations, social clubs, and civic and service organizations to support the formal home
64.8care services. The lead agency shall be held harmless for damages or injuries sustained
64.9through the use of volunteers under this subdivision including workers' compensation
64.10liability. The case manager shall provide documentation in each individual's plan of care
64.11and, if requested, to the commissioner that the most cost-effective alternatives available
64.12have been offered to the individual and that the individual was free to choose among
64.13available qualified providers, both public and private, including qualified case management
64.14or service coordination providers other than those employed by any county; however, the
64.15county or tribe maintains responsibility for prior authorizing services in accordance with
64.16statutory and administrative requirements. The case manager must give the individual a
64.17ten-day written notice of any denial, termination, or reduction of alternative care services.
64.18    (b) The county of service or tribe must provide access to and arrange for case
64.19management services, including assuring implementation of the coordinated service
64.20and support plan. "County of service" has the meaning given it in Minnesota Rules,
64.21part 9505.0015, subpart 11. The county of service must notify the county of financial
64.22responsibility of the approved care plan and the amount of encumbered funds.

64.23    Sec. 18. Minnesota Statutes 2010, section 256B.0915, subdivision 1a, is amended to
64.24read:
64.25    Subd. 1a. Elderly waiver case management services. (a) Elderly Except
64.26as provided to individuals under prepaid medical assistance programs as described
64.27in paragraph (h), case management services under the home and community-based
64.28services waiver for elderly individuals are available from providers meeting qualification
64.29requirements and the standards specified in subdivision 1b. Eligible recipients may choose
64.30any qualified provider of elderly case management services.
64.31    (b) Case management services assist individuals who receive waiver services in
64.32gaining access to needed waiver and other state plan services, and assist individuals in
64.33appeals under section 256.045, as well as needed medical, social, educational, and other
64.34services regardless of the funding source for the services to which access is gained. Case
64.35managers shall collaborate with consumers, families, legal representatives, and relevant
65.1medical experts and service providers in the development and periodic review of the
65.2coordinated service and support plan.
65.3    (c) A case aide shall provide assistance to the case manager in carrying out
65.4administrative activities of the case management function. The case aide may not assume
65.5responsibilities that require professional judgment including assessments, reassessments,
65.6and care plan development. The case manager is responsible for providing oversight of
65.7the case aide.
65.8    (d) Case managers shall be responsible for ongoing monitoring of the provision
65.9of services included in the individual's plan of care. Case managers shall initiate and
65.10oversee the process of assessment and reassessment of the individual's care coordinated
65.11service and support plan and review the plan of care at intervals specified in the federally
65.12approved waiver plan.
65.13    (e) The county of service or tribe must provide access to and arrange for case
65.14management services. County of service has the meaning given it in Minnesota Rules,
65.15part 9505.0015, subpart 11.
65.16(f) Except as described in paragraph (h), case management services must be provided
65.17by a public or private agency that is enrolled as a medical assistance provider determined
65.18by the commissioner to meet all of the requirements in subdivision 1b. Case management
65.19services must not be provided to a recipient by a private agency that has a financial interest
65.20in the provision of any other services included in the recipient's coordinated service and
65.21support plan. For purposes of this section, "private agency" means any agency that is not
65.22identified as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
65.23(g) Case management service activities provided to or arranged for a person include:
65.24(1) development of the coordinated service and support plan under subdivision 6;
65.25(2) informing the individual or the individual's legal guardian or conservator of
65.26service options, and options for case management services and providers;
65.27(3) consulting with relevant medical experts or service providers;
65.28(4) assisting the person in the identification of potential providers;
65.29(5) assisting the person to access services;
65.30(6) coordination of services; and
65.31(7) evaluation and monitoring of the services identified in the plan, which must
65.32incorporate at least one annual face-to-face visit by the case manager with each person.
65.33(h) Notwithstanding any requirements in this section, for individuals enrolled in
65.34prepaid medical assistance programs under section 256B.69, subdivisions 6b and 23, the
65.35health plan shall provide or arrange to provide elderly waiver case management services in
65.36paragraph (g), in accordance with contract requirements established by the commissioner.

66.1    Sec. 19. Minnesota Statutes 2010, section 256B.0915, subdivision 1b, is amended to
66.2read:
66.3    Subd. 1b. Provider qualifications and standards. (a) The commissioner must
66.4enroll qualified providers of elderly case management services under the home and
66.5community-based waiver for the elderly under section 1915(c) of the Social Security
66.6Act. The enrollment process shall ensure the provider's ability to meet the qualification
66.7requirements and standards in this subdivision and other federal and state requirements
66.8of this service. An elderly A case management provider is an enrolled medical
66.9assistance provider who is determined by the commissioner to have all of the following
66.10characteristics:
66.11    (1) the demonstrated capacity and experience to provide the components of
66.12case management to coordinate and link community resources needed by the eligible
66.13population;
66.14    (2) administrative capacity and experience in serving the target population for
66.15whom it will provide services and in ensuring quality of services under state and federal
66.16requirements;
66.17    (3) a financial management system that provides accurate documentation of services
66.18and costs under state and federal requirements;
66.19    (4) the capacity to document and maintain individual case records under state and
66.20federal requirements; and
66.21    (5) the lead agency may allow a case manager employed by the lead agency to
66.22delegate certain aspects of the case management activity to another individual employed
66.23by the lead agency provided there is oversight of the individual by the case manager.
66.24The case manager may not delegate those aspects which require professional judgment
66.25including assessments, reassessments, and care coordinated service and support plan
66.26development. Lead agencies include counties, health plans, and federally recognized
66.27tribes who authorize services under this section.
66.28(b) A health plan shall provide or arrange to provide elderly waiver case management
66.29services in subdivision 1a, paragraph (g), in accordance with contract requirements
66.30established by the commissioner related to provider standards and qualifications.

66.31    Sec. 20. Minnesota Statutes 2010, section 256B.0915, subdivision 3c, is amended to
66.32read:
66.33    Subd. 3c. Service approval and contracting provisions. (a) Medical assistance
66.34funding for skilled nursing services, private duty nursing, home health aide, and personal
67.1care services for waiver recipients must be approved by the case manager and included in
67.2the individual care coordinated service and support plan.
67.3    (b) A lead agency is not required to contract with a provider of supplies and
67.4equipment if the monthly cost of the supplies and equipment is less than $250.

67.5    Sec. 21. Minnesota Statutes 2010, section 256B.0915, subdivision 6, is amended to
67.6read:
67.7    Subd. 6. Implementation of care coordinated service and support plan. (a) Each
67.8elderly waiver client shall be provided a copy of a written care coordinated service and
67.9support plan that meets the requirements outlined in section 256B.0913, subdivision 8.
67.10The care plan must be implemented by the county of service when it is different than the
67.11county of financial responsibility. The county of service administering waivered services
67.12must notify the county of financial responsibility of the approved care plan. which:
67.13(1) is developed and signed by the recipient within ten working days after the case
67.14manager receives the assessment information and written community support plan as
67.15described in section 256B.0911, subdivision 3a, from the certified assessor;
67.16(2) includes the person's need for service and identification of service needs that will
67.17be or that are met by the person's relatives, friends, and others, as well as community
67.18services used by the general public;
67.19(3) reasonably ensures the health and safety of the recipient;
67.20(4) identifies the person's preferences for services as stated by the person or the
67.21person's legal guardian or conservator;
67.22(5) reflects the person's informed choice between institutional and community-based
67.23services, as well as choice of services, supports, and providers, including available case
67.24manager providers;
67.25(6) identifies long and short-range goals for the person;
67.26(7) identifies specific services and the amount, frequency, duration, and cost of the
67.27services to be provided to the person based on assessed needs, preferences, and available
67.28resources;
67.29(8) includes information about the right to appeal decisions under section 256.045;
67.30and
67.31(9) includes the authorized annual and monthly amounts for the services.
67.32(b) In developing the coordinated service and support plan, the case manager should
67.33also include the use of volunteers, religious organizations, social clubs, and civic and
67.34service organizations to support the individual in the community. The lead agency must be
68.1held harmless for damages or injuries sustained through the use of volunteers and agencies
68.2under this paragraph, including workers' compensation liability.

68.3    Sec. 22. Minnesota Statutes 2011 Supplement, section 256B.0915, subdivision 10,
68.4is amended to read:
68.5    Subd. 10. Waiver payment rates; managed care organizations. The
68.6commissioner shall adjust the elderly waiver capitation payment rates for managed
68.7care organizations paid under section 256B.69, subdivisions 6a 6b and 23, to reflect the
68.8maximum service rate limits for customized living services and 24-hour customized
68.9living services under subdivisions 3e and 3h. Medical assistance rates paid to customized
68.10living providers by managed care organizations under this section shall not exceed the
68.11maximum service rate limits and component rates as determined by the commissioner
68.12under subdivisions 3e and 3h.

68.13    Sec. 23. Minnesota Statutes 2010, section 256B.092, subdivision 1, is amended to read:
68.14    Subdivision 1. County of financial responsibility; duties. Before any services
68.15shall be rendered to persons with developmental disabilities who are in need of social
68.16service and medical assistance, the county of financial responsibility shall conduct or
68.17arrange for a diagnostic evaluation in order to determine whether the person has or may
68.18have a developmental disability or has or may have a related condition. If the county
68.19of financial responsibility determines that the person has a developmental disability,
68.20the county shall inform the person of case management services available under this
68.21section. Except as provided in subdivision 1g or 4b, if a person is diagnosed as having a
68.22developmental disability, the county of financial responsibility shall conduct or arrange for
68.23a needs assessment by a certified assessor, and develop or arrange for an individual service
68.24a community support plan according to section 256B.0911, provide or arrange for ongoing
68.25case management services at the level identified in the individual service plan, provide
68.26or arrange for case management administration, and authorize services identified in the
68.27person's individual service coordinated service and support plan developed according to
68.28subdivision 1b. Diagnostic information, obtained by other providers or agencies, may be
68.29used by the county agency in determining eligibility for case management. Nothing in this
68.30section shall be construed as requiring: (1) assessment in areas agreed to as unnecessary
68.31by the case manager a certified assessor and the person, or the person's legal guardian or
68.32conservator, or the parent if the person is a minor, or (2) assessments in areas where there
68.33has been a functional assessment completed in the previous 12 months for which the
68.34case manager certified assessor and the person or person's guardian or conservator, or the
69.1parent if the person is a minor, agree that further assessment is not necessary. For persons
69.2under state guardianship, the case manager certified assessor shall seek authorization from
69.3the public guardianship office for waiving any assessment requirements. Assessments
69.4related to health, safety, and protection of the person for the purpose of identifying service
69.5type, amount, and frequency or assessments required to authorize services may not be
69.6waived. To the extent possible, for wards of the commissioner the county shall consider
69.7the opinions of the parent of the person with a developmental disability when developing
69.8the person's individual service community support plan and coordinated service and
69.9support plan.

69.10    Sec. 24. Minnesota Statutes 2010, section 256B.092, subdivision 1a, is amended to
69.11read:
69.12    Subd. 1a. Case management administration and services. (a) The administrative
69.13functions of case management provided to or arranged for a person include: Each recipient
69.14of a home and community-based waiver shall be provided case management services by
69.15qualified vendors as described in the federally approved waiver application.
69.16(1) review of eligibility for services;
69.17(2) screening;
69.18(3) intake;
69.19(4) diagnosis;
69.20(5) the review and authorization of services based upon an individualized service
69.21plan; and
69.22(6) responding to requests for conciliation conferences and appeals according to
69.23section 256.045 made by the person, the person's legal guardian or conservator, or the
69.24parent if the person is a minor.
69.25(b) Case management service activities provided to or arranged for a person include:
69.26(1) development of the individual service coordinated service and support plan
69.27under subdivision 1b;
69.28(2) informing the individual or the individual's legal guardian or conservator, or
69.29parent if the person is a minor, of service options;
69.30(3) consulting with relevant medical experts or service providers;
69.31(4) assisting the person in the identification of potential providers;
69.32(5) assisting the person to access services and assisting in appeals under section
69.33256.045;
69.34(6) coordination of services, if coordination is not provided by another service
69.35provider;
70.1(7) evaluation and monitoring of the services identified in the coordinated service
70.2and support plan, which must incorporate at least one annual face-to-face visit by the case
70.3manager with each person; and
70.4(8) annual reviews of service plans and services provided reviewing coordinated
70.5service and support plans and providing the lead agency with recommendations for service
70.6authorization based upon the individual's needs identified in the coordinated service and
70.7support plan.
70.8(c) Case management administration and service activities that are provided to the
70.9person with a developmental disability shall be provided directly by county agencies or
70.10under contract. Case management services must be provided by a public or private agency
70.11that is enrolled as a medical assistance provider determined by the commissioner to meet
70.12all of the requirements in the approved federal waiver plans. Case management services
70.13must not be provided to a recipient by a private agency that has a financial interest in the
70.14provision of any other services included in the recipient's coordinated service and support
70.15plan. For purposes of this section, "private agency" means any agency that is not identified
70.16as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).
70.17(d) Case managers are responsible for the administrative duties and service
70.18provisions listed in paragraphs (a) and (b). Case managers shall collaborate with
70.19consumers, families, legal representatives, and relevant medical experts and service
70.20providers in the development and annual review of the individualized service coordinated
70.21service and support plan and habilitation plans plan.
70.22(e) The Department of Human Services shall offer ongoing education in case
70.23management to case managers. Case managers shall receive no less than ten hours of case
70.24management education and disability-related training each year.

70.25    Sec. 25. Minnesota Statutes 2010, section 256B.092, subdivision 1b, is amended to
70.26read:
70.27    Subd. 1b. Individual Coordinated service and support plan. The individual
70.28service plan must (a) Each recipient of home and community-based waivered services
70.29shall be provided a copy of the written coordinated service and support plan which:
70.30(1) is developed and signed by the recipient within ten working days after the case
70.31manager receives the assessment information and written community support plan as
70.32described in section 256B.0911, subdivision 3a, from the certified assessor;
70.33(1) include the results of the assessment information on (2) includes the person's
70.34need for service, including identification of service needs that will be or that are met
71.1by the person's relatives, friends, and others, as well as community services used by
71.2the general public;
71.3(3) reasonably ensures the health and safety of the recipient;
71.4(2) identify (4) identifies the person's preferences for services as stated by the
71.5person, the person's legal guardian or conservator, or the parent if the person is a minor,
71.6including the person's choices made on self-directed options and on services and supports
71.7to achieve employment goals;
71.8(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
71.9paragraph (o), of service and support providers, and identifies all available options for
71.10case management services and providers;
71.11(3) identify (6) identifies long- and short-range goals for the person;
71.12(4) identify (7) identifies specific services and the amount and frequency of the
71.13services to be provided to the person based on assessed needs, preferences, and available
71.14resources. The individual service coordinated service and support plan shall also specify
71.15other services the person needs that are not available;
71.16(5) identify (8) identifies the need for an individual program plan to be developed
71.17by the provider according to the respective state and federal licensing and certification
71.18standards, and additional assessments to be completed or arranged by the provider after
71.19service initiation;
71.20(6) identify (9) identifies provider responsibilities to implement and make
71.21recommendations for modification to the individual service coordinated service and
71.22support plan;
71.23(7) include (10) includes notice of the right to request a conciliation conference or a
71.24hearing under section 256.045;
71.25(8) be (11) is agreed upon and signed by the person, the person's legal guardian
71.26or conservator, or the parent if the person is a minor, and the authorized county
71.27representative; and
71.28(9) be (12) is reviewed by a health professional if the person has overriding medical
71.29needs that impact the delivery of services.; and
71.30(13) includes the authorized annual and monthly amounts for the services.
71.31Service planning formats developed for interagency planning such as transition,
71.32vocational, and individual family service plans may be substituted for service planning
71.33formats developed by county agencies.
71.34(b) In developing the coordinated service and support plan, the case manager is
71.35encouraged to include the use of volunteers, religious organizations, social clubs, and civic
71.36and service organizations to support the individual in the community. The lead agency
72.1must be held harmless for damages or injuries sustained through the use of volunteers and
72.2agencies under this paragraph, including workers' compensation liability.

72.3    Sec. 26. Minnesota Statutes 2010, section 256B.092, subdivision 1e, is amended to
72.4read:
72.5    Subd. 1e. Coordination, evaluation, and monitoring of services. (a) If the
72.6individual service coordinated service and support plan identifies the need for individual
72.7program plans for authorized services, the case manager shall assure that individual
72.8program plans are developed by the providers according to clauses (2) to (5). The
72.9providers shall assure that the individual program plans:
72.10(1) are developed according to the respective state and federal licensing and
72.11certification requirements;
72.12(2) are designed to achieve the goals of the individual service coordinated service
72.13and support plan;
72.14(3) are consistent with other aspects of the individual service coordinated service
72.15and support plan;
72.16(4) assure the health and safety of the person; and
72.17(5) are developed with consistent and coordinated approaches to services among the
72.18various service providers.
72.19(b) The case manager shall monitor the provision of services:
72.20(1) to assure that the individual service coordinated service and support plan is
72.21being followed according to paragraph (a);
72.22(2) to identify any changes or modifications that might be needed in the individual
72.23service coordinated service and support plan, including changes resulting from
72.24recommendations of current service providers;
72.25(3) to determine if the person's legal rights are protected, and if not, notify the
72.26person's legal guardian or conservator, or the parent if the person is a minor, protection
72.27services, or licensing agencies as appropriate; and
72.28(4) to determine if the person, the person's legal guardian or conservator, or the
72.29parent if the person is a minor, is satisfied with the services provided.
72.30(c) If the provider fails to develop or carry out the individual program plan according
72.31to paragraph (a), the case manager shall notify the person's legal guardian or conservator,
72.32or the parent if the person is a minor, the provider, the respective licensing and certification
72.33agencies, and the county board where the services are being provided. In addition, the
72.34case manager shall identify other steps needed to assure the person receives the services
72.35identified in the individual service coordinated service and support plan.

73.1    Sec. 27. Minnesota Statutes 2010, section 256B.092, subdivision 1g, is amended to
73.2read:
73.3    Subd. 1g. Conditions not requiring development of individual service
73.4coordinated service and support plan. Unless otherwise required by federal law, the
73.5county agency is not required to complete an individual service a coordinated service and
73.6support plan as defined in subdivision 1b for:
73.7(1) persons whose families are requesting respite care for their family member who
73.8resides with them, or whose families are requesting a family support grant and are not
73.9requesting purchase or arrangement of habilitative services; and
73.10(2) persons with developmental disabilities, living independently without authorized
73.11services or receiving funding for services at a rehabilitation facility as defined in section
73.12268A.01, subdivision 6 , and not in need of or requesting additional services.

73.13    Sec. 28. Minnesota Statutes 2010, section 256B.092, subdivision 2, is amended to read:
73.14    Subd. 2. Medical assistance. To assure quality case management to those persons
73.15who are eligible for medical assistance, the commissioner shall, upon request:
73.16(1) provide consultation on the case management process;
73.17(2) assist county agencies in the screening and annual reviews of clients review
73.18process to assure that appropriate levels of service are provided to persons;
73.19(3) provide consultation on service planning and development of services with
73.20appropriate options;
73.21(4) provide training and technical assistance to county case managers; and
73.22(5) authorize payment for medical assistance services according to this chapter
73.23and rules implementing it.

73.24    Sec. 29. Minnesota Statutes 2010, section 256B.092, subdivision 3, is amended to read:
73.25    Subd. 3. Authorization and termination of services. County agency case
73.26managers, under rules of the commissioner, shall authorize and terminate services of
73.27community and regional treatment center providers according to individual service
73.28support plans. Services provided to persons with developmental disabilities may only be
73.29authorized and terminated by case managers or certified assessors according to (1) rules of
73.30the commissioner and (2) the individual service coordinated service and support plan as
73.31defined in subdivision 1b. Medical assistance services not needed shall not be authorized
73.32by county agencies or funded by the commissioner. When purchasing or arranging for
73.33unlicensed respite care services for persons with overriding health needs, the county
74.1agency shall seek the advice of a health care professional in assessing provider staff
74.2training needs and skills necessary to meet the medical needs of the person.

74.3    Sec. 30. Minnesota Statutes 2010, section 256B.092, subdivision 5, is amended to read:
74.4    Subd. 5. Federal waivers. (a) The commissioner shall apply for any federal
74.5waivers necessary to secure, to the extent allowed by law, federal financial participation
74.6under United States Code, title 42, sections 1396 et seq., as amended, for the provision
74.7of services to persons who, in the absence of the services, would need the level of care
74.8provided in a regional treatment center or a community intermediate care facility for
74.9persons with developmental disabilities. The commissioner may seek amendments to the
74.10waivers or apply for additional waivers under United States Code, title 42, sections 1396
74.11et seq., as amended, to contain costs. The commissioner shall ensure that payment for
74.12the cost of providing home and community-based alternative services under the federal
74.13waiver plan shall not exceed the cost of intermediate care services including day training
74.14and habilitation services that would have been provided without the waivered services.
74.15The commissioner shall seek an amendment to the 1915c home and
74.16community-based waiver to allow properly licensed adult foster care homes to provide
74.17residential services to up to five individuals with developmental disabilities. If the
74.18amendment to the waiver is approved, adult foster care providers that can accommodate
74.19five individuals shall increase their capacity to five beds, provided the providers continue
74.20to meet all applicable licensing requirements.
74.21(b) The commissioner, in administering home and community-based waivers for
74.22persons with developmental disabilities, shall ensure that day services for eligible persons
74.23are not provided by the person's residential service provider, unless the person or the
74.24person's legal representative is offered a choice of providers and agrees in writing to
74.25provision of day services by the residential service provider. The individual service
74.26coordinated service and support plan for individuals who choose to have their residential
74.27service provider provide their day services must describe how health, safety, protection,
74.28and habilitation needs will be met, including how frequent and regular contact with
74.29persons other than the residential service provider will occur. The individualized service
74.30coordinated service and support plan must address the provision of services during the
74.31day outside the residence on weekdays.
74.32(c) When a county lead agency is evaluating denials, reductions, or terminations
74.33of home and community-based services under section 256B.0916 for an individual, the
74.34case manager lead agency shall offer to meet with the individual or the individual's
74.35guardian in order to discuss the prioritization of service needs within the individualized
75.1service coordinated service and support plan. The reduction in the authorized services
75.2for an individual due to changes in funding for waivered services may not exceed the
75.3amount needed to ensure medically necessary services to meet the individual's health,
75.4safety, and welfare.

75.5    Sec. 31. Minnesota Statutes 2010, section 256B.092, subdivision 7, is amended to read:
75.6    Subd. 7. Screening teams Assessments. (a) Assessments and reassessments shall
75.7be conducted by certified assessors according to section 256B.0911, and must incorporate
75.8appropriate referrals to determine eligibility for case management under subdivision 1a.
75.9(b) For persons with developmental disabilities, screening teams shall be established
75.10which a certified assessor shall evaluate the need for the an institutional level of care.
75.11provided by residential-based habilitation services, residential services, training and
75.12habilitation services, and nursing facility services. The evaluation assessment shall
75.13address whether home and community-based services are appropriate for persons who
75.14are at risk of placement in an intermediate care facility for persons with developmental
75.15disabilities, or for whom there is reasonable indication that they might require this level of
75.16care. The screening team certified assessor shall make an evaluation of need within 60
75.17working days of a request for service by a person with a developmental disability, and
75.18within five working days of an emergency admission of a person to an intermediate care
75.19facility for persons with developmental disabilities. The screening team shall consist of
75.20the case manager for persons with developmental disabilities, the person, the person's
75.21legal guardian or conservator, or the parent if the person is a minor, and a qualified
75.22developmental disability professional, as defined in the Code of Federal Regulations,
75.23title 42, section 483.430, as amended through June 3, 1988. The case manager may also
75.24act as the qualified developmental disability professional if the case manager meets
75.25the federal definition. County social service agencies may contract with a public or
75.26private agency or individual who is not a service provider for the person for the public
75.27guardianship representation required by the screening or individual service planning
75.28process. The contract shall be limited to public guardianship representation for the
75.29screening and individual service planning activities. The contract shall require compliance
75.30with the commissioner's instructions and may be for paid or voluntary services. For
75.31persons determined to have overriding health care needs and are seeking admission to a
75.32nursing facility or an ICF/MR, or seeking access to home and community-based waivered
75.33services, a registered nurse must be designated as either the case manager or the qualified
75.34developmental disability professional. For persons under the jurisdiction of a correctional
75.35agency, the case manager must consult with the corrections administrator regarding
76.1additional health, safety, and supervision needs. The case manager, with the concurrence
76.2of the person, the person's legal guardian or conservator, or the parent if the person is a
76.3minor, may invite other individuals to attend meetings of the screening team. No member
76.4of the screening team shall have any direct or indirect service provider interest in the case.
76.5Nothing in this section shall be construed as requiring the screening team meeting to be
76.6separate from the service planning meeting.

76.7    Sec. 32. Minnesota Statutes 2010, section 256B.092, subdivision 8, is amended to read:
76.8    Subd. 8. Screening team Additional certified assessor duties. In addition to the
76.9responsibilities of certified assessors described in section 256B.0911, for persons with
76.10developmental disabilities, the screening team certified assessor shall:
76.11(1) review diagnostic data;
76.12(2) review health, social, and developmental assessment data using a uniform
76.13screening tool specified by the commissioner;
76.14(3) identify the level of services appropriate to maintain the person in the most
76.15normal and least restrictive setting that is consistent with the person's treatment needs;
76.16(4) (1) identify other noninstitutional public assistance or social service that may
76.17prevent or delay long-term residential placement;
76.18(5) (2) assess whether a person is in need of long-term residential care;
76.19(6) (3) make recommendations regarding placement and payment for:
76.20(i) social service or public assistance support, or both, to maintain a person in the
76.21person's own home or other place of residence;
76.22(ii) training and habilitation service, vocational rehabilitation, and employment
76.23training activities;
76.24(iii) community residential service placement;
76.25(iv) regional treatment center placement; or
76.26(v) a home and community-based service alternative to community residential
76.27placement service or regional treatment center placement including self-directed service
76.28options;
76.29(7) (4) evaluate the availability, location, and quality of the services listed in clause
76.30(6) (3), including the impact of placement alternatives on the person's ability to maintain
76.31or improve existing patterns of contact and involvement with parents and other family
76.32members;
76.33(8) (5) identify the cost implications of recommendations in clause (6) (3); and
76.34(9) (6) make recommendations to a court as may be needed to assist the court in
76.35making decisions regarding commitment of persons with developmental disabilities; and.
77.1(10) inform the person and the person's legal guardian or conservator, or the parent if
77.2the person is a minor, that appeal may be made to the commissioner pursuant to section
77.3256.045.

77.4    Sec. 33. Minnesota Statutes 2010, section 256B.092, subdivision 8a, is amended to
77.5read:
77.6    Subd. 8a. County concurrence notification. (a) If the county of financial
77.7responsibility wishes to place a person in another county for services, the county of
77.8financial responsibility shall seek concurrence from notify the proposed county of service
77.9and the placement shall be made cooperatively between the two counties. Arrangements
77.10shall be made between the two counties for ongoing social service, including annual
77.11reviews of the person's individual service coordinated service and support plan. The county
77.12where services are provided may not make changes in the person's service coordinated
77.13service and support plan without approval by the county of financial responsibility.
77.14(b) When a person has been screened and authorized for services in an intermediate
77.15care facility for persons with developmental disabilities or for home and community-based
77.16services for persons with developmental disabilities, the case manager shall assist that
77.17person in identifying a service provider who is able to meet the needs of the person
77.18according to the person's individual service plan. If the identified service is to be provided
77.19in a county other than the county of financial responsibility, the county of financial
77.20responsibility shall request concurrence of the county where the person is requesting to
77.21receive the identified services. The county of service may refuse to concur shall notify
77.22the county of financial responsibility if:
77.23(1) it can demonstrate that the provider is unable to provide the services identified in
77.24the person's individual service plan as services that are needed and are to be provided; or
77.25(2), in the case of an intermediate care facility for persons with developmental
77.26disabilities, there has been no authorization for admission by the admission review team
77.27as required in section 256B.0926.
77.28(c) The county of service shall notify the county of financial responsibility of
77.29concurrence or refusal to concur any concerns about the chosen provider's capacity to
77.30meet the needs of the person seeking to move to residential services in another county no
77.31later than 20 working days following receipt of the written request notification. Unless
77.32other mutually acceptable arrangements are made by the involved county agencies, the
77.33county of financial responsibility is responsible for costs of social services and the costs
77.34associated with the development and maintenance of the placement. The county of
77.35service may request that the county of financial responsibility purchase case management
78.1services from the county of service or from a contracted provider of case management
78.2when the county of financial responsibility is not providing case management as defined
78.3in this section and rules adopted under this section, unless other mutually acceptable
78.4arrangements are made by the involved county agencies. Standards for payment limits
78.5under this section may be established by the commissioner. Financial disputes between
78.6counties shall be resolved as provided in section 256G.09. This subdivision also applies to
78.7home and community-based waiver services provided under section 256B.49.

78.8    Sec. 34. Minnesota Statutes 2010, section 256B.092, subdivision 9, is amended to read:
78.9    Subd. 9. Reimbursement. Payment for services shall not be provided to a
78.10service provider for any person placed in an intermediate care facility for persons with
78.11developmental disabilities prior to the person being screened by the screening team
78.12receiving an assessment by a certified assessor. The commissioner shall not deny
78.13reimbursement for: (1) a person admitted to an intermediate care facility for persons
78.14with developmental disabilities who is assessed to need long-term supportive services,
78.15if long-term supportive services other than intermediate care are not available in that
78.16community; (2) any person admitted to an intermediate care facility for persons with
78.17developmental disabilities under emergency circumstances; (3) any eligible person placed
78.18in the intermediate care facility for persons with developmental disabilities pending an
78.19appeal of the screening team's certified assessor's decision; or (4) any medical assistance
78.20recipient when, after full discussion of all appropriate alternatives including those that
78.21are expected to be less costly than intermediate care for persons with developmental
78.22disabilities, the person or the person's legal guardian or conservator, or the parent if the
78.23person is a minor, insists on intermediate care placement. The screening team certified
78.24assessor shall provide documentation that the most cost-effective alternatives available
78.25were offered to this individual or the individual's legal guardian or conservator.

78.26    Sec. 35. Minnesota Statutes 2010, section 256B.092, subdivision 11, is amended to
78.27read:
78.28    Subd. 11. Residential support services. (a) Upon federal approval, there is
78.29established a new service called residential support that is available on the community
78.30alternative care, community alternatives for disabled individuals, developmental
78.31disabilities, and traumatic brain injury waivers. Existing waiver service descriptions
78.32must be modified to the extent necessary to ensure there is no duplication between
78.33other services. Residential support services must be provided by vendors licensed as a
78.34community residential setting as defined in section 245A.11, subdivision 8.
79.1(b) Residential support services must meet the following criteria:
79.2(1) providers of residential support services must own or control the residential site;
79.3(2) the residential site must not be the primary residence of the license holder;
79.4(3) the residential site must have a designated program supervisor responsible for
79.5program oversight, development, and implementation of policies and procedures;
79.6(4) the provider of residential support services must provide supervision, training,
79.7and assistance as described in the person's community coordinated service and support
79.8plan; and
79.9(5) the provider of residential support services must meet the requirements of
79.10licensure and additional requirements of the person's community coordinated service and
79.11support plan.
79.12(c) Providers of residential support services that meet the definition in paragraph
79.13(a) must be registered using a process determined by the commissioner beginning July
79.141, 2009.

79.15    Sec. 36. Minnesota Statutes 2010, section 256B.15, subdivision 1c, is amended to read:
79.16    Subd. 1c. Notice of potential claim. (a) A state agency with a claim or potential
79.17claim under this section may file a notice of potential claim under this subdivision anytime
79.18before or within one year after a medical assistance recipient dies. The claimant shall be
79.19the state agency. A notice filed prior to the recipient's death shall not take effect and shall
79.20not be effective as notice until the recipient dies. A notice filed after a recipient dies
79.21shall be effective from the time of filing.
79.22    (b) The notice of claim shall be filed or recorded in the real estate records in the
79.23office of the county recorder or registrar of titles for each county in which any part of
79.24the property is located. The recorder shall accept the notice for recording or filing. The
79.25registrar of titles shall accept the notice for filing if the recipient has a recorded interest in
79.26the property. The registrar of titles shall not carry forward to a new certificate of title any
79.27notice filed more than one year from the date of the recipient's death.
79.28    (c) The notice must be dated, state the name of the claimant, the medical assistance
79.29recipient's name and last four digits of the Social Security number if filed before their
79.30death and their date of death if filed after they die, the name and date of death of any
79.31predeceased spouse of the medical assistance recipient for whom a claim may exist, a
79.32statement that the claimant may have a claim arising under this section, generally identify
79.33the recipient's interest in the property, contain a legal description for the property and
79.34whether it is abstract or registered property, a statement of when the notice becomes
80.1effective and the effect of the notice, be signed by an authorized representative of the state
80.2agency, and may include such other contents as the state agency may deem appropriate.

80.3    Sec. 37. Minnesota Statutes 2010, section 256B.15, subdivision 1f, is amended to read:
80.4    Subd. 1f. Agency lien. (a) The notice shall constitute a lien in favor of the
80.5Department of Human Services against the recipient's interests in the real estate it
80.6describes for a period of 20 years from the date of filing or the date of the recipient's death,
80.7whichever is later. Notwithstanding any law or rule to the contrary, a recipient's life estate
80.8and joint tenancy interests shall not end upon the recipient's death but shall continue
80.9according to subdivisions 1h, 1i, and 1j. The amount of the lien shall be equal to the total
80.10amount of the claims that could be presented in the recipient's estate under this section.
80.11    (b) If no estate has been opened for the deceased recipient, any holder of an interest
80.12in the property may apply to the lienholder for a statement of the amount of the lien or
80.13for a full or partial release of the lien. The application shall include the applicant's name,
80.14current mailing address, current home and work telephone numbers, and a description of
80.15their interest in the property, a legal description of the recipient's interest in the property,
80.16and the deceased recipient's name, date of birth, and last four digits of the Social Security
80.17number. The lienholder shall send the applicant by certified mail, return receipt requested,
80.18a written statement showing the amount of the lien, whether the lienholder is willing to
80.19release the lien and under what conditions, and inform them of the right to a hearing under
80.20section 256.045. The lienholder shall have the discretion to compromise and settle the lien
80.21upon any terms and conditions the lienholder deems appropriate.
80.22    (c) Any holder of an interest in property subject to the lien has a right to request
80.23a hearing under section 256.045 to determine the validity, extent, or amount of the lien.
80.24The request must be in writing, and must include the names, current addresses, and home
80.25and business telephone numbers for all other parties holding an interest in the property. A
80.26request for a hearing by any holder of an interest in the property shall be deemed to be a
80.27request for a hearing by all parties owning interests in the property. Notice of the hearing
80.28shall be given to the lienholder, the party filing the appeal, and all of the other holders of
80.29interests in the property at the addresses listed in the appeal by certified mail, return receipt
80.30requested, or by ordinary mail. Any owner of an interest in the property to whom notice of
80.31the hearing is mailed shall be deemed to have waived any and all claims or defenses in
80.32respect to the lien unless they appear and assert any claims or defenses at the hearing.
80.33    (d) If the claim the lien secures could be filed under subdivision 1h, the lienholder
80.34may collect, compromise, settle, or release the lien upon any terms and conditions it deems
80.35appropriate. If the claim the lien secures could be filed under subdivision 1i or 1j, the lien
81.1may be adjusted or enforced to the same extent had it been filed under subdivisions 1i
81.2and 1j, and the provisions of subdivisions 1i, clause (f), and 1j, clause (d), shall apply to
81.3voluntary payment, settlement, or satisfaction of the lien.
81.4    (e) If no probate proceedings have been commenced for the recipient as of the date
81.5the lien holder executes a release of the lien on a recipient's life estate or joint tenancy
81.6interest, created for purposes of this section, the release shall terminate the life estate or
81.7joint tenancy interest created under this section as of the date it is recorded or filed to the
81.8extent of the release. If the claimant executes a release for purposes of extinguishing a
81.9life estate or a joint tenancy interest created under this section to remove a cloud on title
81.10to real property, the release shall have the effect of extinguishing any life estate or joint
81.11tenancy interests in the property it describes which may have been continued by reason
81.12of this section retroactive to the date of death of the deceased life tenant or joint tenant
81.13except as provided for in section 514.981, subdivision 6.
81.14    (f) If the deceased recipient's estate is probated, a claim shall be filed under this
81.15section. The amount of the lien shall be limited to the amount of the claim as finally
81.16allowed. If the claim the lien secures is filed under subdivision 1h, the lien may be released
81.17in full after any allowance of the claim becomes final or according to any agreement to
81.18settle and satisfy the claim. The release shall release the lien but shall not extinguish
81.19or terminate the interest being released. If the claim the lien secures is filed under
81.20subdivision 1i or 1j, the lien shall be released after the lien under subdivision 1i or 1j is
81.21filed or recorded, or settled according to any agreement to settle and satisfy the claim. The
81.22release shall not extinguish or terminate the interest being released. If the claim is finally
81.23disallowed in full, the claimant shall release the claimant's lien at the claimant's expense.

81.24    Sec. 38. Minnesota Statutes 2010, section 256B.49, subdivision 13, is amended to read:
81.25    Subd. 13. Case management. (a) Each recipient of a home and community-based
81.26waiver shall be provided case management services by qualified vendors as described
81.27in the federally approved waiver application. The case management service activities
81.28provided will must include:
81.29    (1) assessing the needs of the individual within 20 working days of a recipient's
81.30request;
81.31    (2) developing (1) finalizing the written individual service coordinated service and
81.32support plan within ten working days after the assessment is completed case manager
81.33receives the plan from the certified assessor;
81.34    (3) (2) informing the recipient or the recipient's legal guardian or conservator
81.35of service options;
82.1    (4) (3) assisting the recipient in the identification of potential service providers and
82.2available options for case management service and providers;
82.3    (5) (4) assisting the recipient to access services and assisting with appeals under
82.4section 256.045; and
82.5    (6) (5) coordinating, evaluating, and monitoring of the services identified in the
82.6service plan;.
82.7    (7) completing the annual reviews of the service plan; and
82.8    (8) informing the recipient or legal representative of the right to have assessments
82.9completed and service plans developed within specified time periods, and to appeal county
82.10action or inaction under section 256.045, subdivision 3, including the determination of
82.11nursing facility level of care.
82.12    (b) The case manager may delegate certain aspects of the case management service
82.13activities to another individual provided there is oversight by the case manager. The case
82.14manager may not delegate those aspects which require professional judgment including
82.15assessments, reassessments, and care plan development.:
82.16(1) finalizing the coordinated service and support plan;
82.17(2) ongoing assessment and monitoring of the person's needs and adequacy of the
82.18approved coordinated service and support plan; and
82.19(3) adjustments to the coordinated service and support plan.
82.20(c) Case management services must be provided by a public or private agency that is
82.21enrolled as a medical assistance provider determined by the commissioner to meet all of
82.22the requirements in the approved federal waiver plans. Case management services must
82.23not be provided to a recipient by a private agency that has any financial interest in the
82.24provision of any other services included in the recipient's coordinated service and support
82.25plan. For purposes of this section, "private agency" means any agency that is not identified
82.26as a lead agency under section 256B.0911, subdivision 1a, paragraph (e).

82.27    Sec. 39. Minnesota Statutes 2011 Supplement, section 256B.49, subdivision 14,
82.28is amended to read:
82.29    Subd. 14. Assessment and reassessment. (a) Assessments of each recipient's
82.30strengths, informal support systems, and need for services shall be completed within 20
82.31working days of the recipient's request as provided in section 256B.0911. Reassessment
82.32of each recipient's strengths, support systems, and need for services shall be conducted
82.33at least every 12 months and at other times when there has been a significant change in
82.34the recipient's functioning and reassessments shall be conducted by certified assessors
82.35according to section 256B.0911, subdivision 2b.
83.1(b) There must be a determination that the client requires a hospital level of care or a
83.2nursing facility level of care as defined in section 256B.0911, subdivision 4a, paragraph
83.3(d), at initial and subsequent assessments to initiate and maintain participation in the
83.4waiver program.
83.5(c) Regardless of other assessments identified in section 144.0724, subdivision 4, as
83.6appropriate to determine nursing facility level of care for purposes of medical assistance
83.7payment for nursing facility services, only face-to-face assessments conducted according
83.8to section 256B.0911, subdivisions 3a, 3b, and 4d, that result in a hospital level of care
83.9determination or a nursing facility level of care determination must be accepted for
83.10purposes of initial and ongoing access to waiver services payment.
83.11(d) Persons with developmental disabilities who apply for services under the nursing
83.12facility level waiver programs shall be screened for the appropriate level of care according
83.13to section 256B.092.
83.14(e) (d) Recipients who are found eligible for home and community-based services
83.15under this section before their 65th birthday may remain eligible for these services after
83.16their 65th birthday if they continue to meet all other eligibility factors.
83.17(f) (e) The commissioner shall develop criteria to identify recipients whose level of
83.18functioning is reasonably expected to improve and reassess these recipients to establish
83.19a baseline assessment. Recipients who meet these criteria must have a comprehensive
83.20transitional service plan developed under subdivision 15, paragraphs (b) and (c), and be
83.21reassessed every six months until there has been no significant change in the recipient's
83.22functioning for at least 12 months. After there has been no significant change in the
83.23recipient's functioning for at least 12 months, reassessments of the recipient's strengths,
83.24informal support systems, and need for services shall be conducted at least every 12
83.25months and at other times when there has been a significant change in the recipient's
83.26functioning. Counties, case managers, and service providers are responsible for
83.27conducting these reassessments and shall complete the reassessments out of existing funds.

83.28    Sec. 40. Minnesota Statutes 2011 Supplement, section 256B.49, subdivision 15,
83.29is amended to read:
83.30    Subd. 15. Individualized service Coordinated service and support plan;
83.31comprehensive transitional service plan; maintenance service plan. (a) Each recipient
83.32of home and community-based waivered services shall be provided a copy of the written
83.33coordinated service and support plan which: meets the requirements in section 256B.092,
83.34subdivision 1b.
84.1(1) is developed and signed by the recipient within ten working days of the
84.2completion of the assessment;
84.3(2) meets the assessed needs of the recipient;
84.4(3) reasonably ensures the health and safety of the recipient;
84.5(4) promotes independence;
84.6(5) allows for services to be provided in the most integrated settings; and
84.7(6) provides for an informed choice, as defined in section 256B.77, subdivision 2,
84.8paragraph (p), of service and support providers.
84.9(b) In developing the comprehensive transitional service plan, the individual
84.10receiving services, the case manager, and the guardian, if applicable, will identify
84.11the transitional service plan fundamental service outcome and anticipated timeline to
84.12achieve this outcome. Within the first 20 days following a recipient's request for an
84.13assessment or reassessment, the transitional service planning team must be identified. A
84.14team leader must be identified who will be responsible for assigning responsibility and
84.15communicating with team members to ensure implementation of the transition plan and
84.16ongoing assessment and communication process. The team leader should be an individual,
84.17such as the case manager or guardian, who has the opportunity to follow the recipient to
84.18the next level of service.
84.19Within ten days following an assessment, a comprehensive transitional service plan
84.20must be developed incorporating elements of a comprehensive functional assessment and
84.21including short-term measurable outcomes and timelines for achievement of and reporting
84.22on these outcomes. Functional milestones must also be identified and reported according
84.23to the timelines agreed upon by the transitional service planning team. In addition, the
84.24comprehensive transitional service plan must identify additional supports that may assist
84.25in the achievement of the fundamental service outcome such as the development of greater
84.26natural community support, increased collaboration among agencies, and technological
84.27supports.
84.28The timelines for reporting on functional milestones will prompt a reassessment of
84.29services provided, the units of services, rates, and appropriate service providers. It is
84.30the responsibility of the transitional service planning team leader to review functional
84.31milestone reporting to determine if the milestones are consistent with observable skills
84.32and that milestone achievement prompts any needed changes to the comprehensive
84.33transitional service plan.
84.34For those whose fundamental transitional service outcome involves the need to
84.35procure housing, a plan for the recipient to seek the resources necessary to secure the least
85.1restrictive housing possible should be incorporated into the plan, including employment
85.2and public supports such as housing access and shelter needy funding.
85.3(c) Counties and other agencies responsible for funding community placement and
85.4ongoing community supportive services are responsible for the implementation of the
85.5comprehensive transitional service plans. Oversight responsibilities include both ensuring
85.6effective transitional service delivery and efficient utilization of funding resources.
85.7(d) Following one year of transitional services, the transitional services planning
85.8team will make a determination as to whether or not the individual receiving services
85.9requires the current level of continuous and consistent support in order to maintain the
85.10recipient's current level of functioning. Recipients who are determined to have not had
85.11a significant change in functioning for 12 months must move from a transitional to a
85.12maintenance service plan. Recipients on a maintenance service plan must be reassessed
85.13to determine if the recipient would benefit from a transitional service plan at least every
85.1412 months and at other times when there has been a significant change in the recipient's
85.15functioning. This assessment should consider any changes to technological or natural
85.16community supports.
85.17(e) When a county is evaluating denials, reductions, or terminations of home and
85.18community-based services under section 256B.49 for an individual, the case manager
85.19shall offer to meet with the individual or the individual's guardian in order to discuss the
85.20prioritization of service needs within the individualized coordinated service and support
85.21plan, comprehensive transitional service plan, or maintenance service plan. The reduction
85.22in the authorized services for an individual due to changes in funding for waivered
85.23services may not exceed the amount needed to ensure medically necessary services to
85.24meet the individual's health, safety, and welfare.
85.25(f) At the time of reassessment, local agency case managers shall assess each
85.26recipient of community alternatives for disabled individuals or traumatic brain injury
85.27waivered services currently residing in a licensed adult foster home that is not the primary
85.28residence of the license holder, or in which the license holder is not the primary caregiver,
85.29to determine if that recipient could appropriately be served in a community-living setting.
85.30If appropriate for the recipient, the case manager shall offer the recipient, through a
85.31person-centered planning process, the option to receive alternative housing and service
85.32options. In the event that the recipient chooses to transfer from the adult foster home,
85.33the vacated bed shall not be filled with another recipient of waiver services and group
85.34residential housing, unless provided under section 245A.03, subdivision 7, paragraph (a),
85.35clauses (3) and (4), and the licensed capacity shall be reduced accordingly. If the adult
85.36foster home becomes no longer viable due to these transfers, the county agency, with the
86.1assistance of the department, shall facilitate a consolidation of settings or closure. This
86.2reassessment process shall be completed by June 30, 2012.

86.3    Sec. 41. Minnesota Statutes 2010, section 256G.02, subdivision 6, is amended to read:
86.4    Subd. 6. Excluded time. "Excluded time" means:
86.5(a) (1) any period an applicant spends in a hospital, sanitarium, nursing home,
86.6shelter other than an emergency shelter, halfway house, foster home, semi-independent
86.7living domicile or services program, residential facility offering care, board and lodging
86.8facility or other institution for the hospitalization or care of human beings, as defined in
86.9section 144.50, 144A.01, or 245A.02, subdivision 14; maternity home, battered women's
86.10shelter, or correctional facility; or any facility based on an emergency hold under sections
86.11253B.05, subdivisions 1 and 2 , and 253B.07, subdivision 6;
86.12(b) (2) any period an applicant spends on a placement basis in a training and
86.13habilitation program, including: a rehabilitation facility or work or employment program
86.14as defined in section 268A.01; or receiving personal care assistance services pursuant to
86.15section 256B.0659; semi-independent living services provided under section 252.275, and
86.16Minnesota Rules, parts 9525.0500 to 9525.0660; or day training and habilitation programs
86.17and assisted living services; and
86.18(c) (3) any placement for a person with an indeterminate commitment, including
86.19independent living.

86.20    Sec. 42. RECOMMENDATIONS FOR FURTHER CASE MANAGEMENT
86.21REDESIGN AND STUDY OF COUNTY AND TRIBAL ADMINISTRATIVE
86.22FUNCTIONS.
86.23(a) By February 1, 2013, the commissioner of human services shall develop a
86.24legislative report with specific recommendations and language for proposed legislation
86.25for the following:
86.26(1) definitions of service and consolidation of standards and rates to the extent
86.27appropriate for all types of medical assistance case management service services, including
86.28targeted case management under Minnesota Statutes, sections 256B.0621, 256B.0924, and
86.29256B.094, and all types of home and community-based waiver case management and case
86.30management under Minnesota Rules, parts 9525.0004 to 9525.0036. This work must be
86.31completed in collaboration with efforts under Minnesota Statutes, section 256B.4912;
86.32(2) recommendations on county of financial responsibility requirements and quality
86.33assurance measures for case management; and
87.1(3) identification of county administrative functions that may remain entwined in
87.2case management service delivery models.
87.3    (b) The commissioner of human services shall evaluate county and tribal
87.4administrative functions, processes, and reimbursement methodologies for the purposes
87.5of administration of home and community-based services, and compliance and
87.6oversight functions. The commissioner shall work with county, tribal, and stakeholder
87.7representatives in the evaluation process and develop a plan for the delegation of
87.8commissioner duties to county and tribal entities after the elimination of county contracts
87.9under Minnesota Statutes, section 256B.4912, for waiver service provision and the
87.10creation of quality outcome standards under Laws 2009, chapter 79, article 8, section
87.1181, and residential support services under Minnesota Statutes, sections 256B.092,
87.12subdivision 11, and 245A.11, subdivision 8. The commissioner shall present findings
87.13and recommendations to the chairs and ranking minority members of the legislative
87.14committees with jurisdiction over health and human services finance and policy by
87.15February 1, 2013, with any specific recommendations and language for proposed
87.16legislation to be effective July 1, 2013.


87.19    Section 1. Minnesota Statutes 2010, section 245.461, is amended by adding a
87.20subdivision to read:
87.21    Subd. 6. Diagnostic codes list. By July 1, 2013, the commissioner of human
87.22services shall develop a list of diagnostic codes to define the range of child and adult
87.23mental illnesses for the statewide mental health system. The commissioner may use the
87.24International Classification of Diseases (ICD); the American Psychiatric Association's
87.25Diagnostic and Statistical Manual (DSM); or a combination of both to develop the list.
87.26The commissioner shall establish an advisory committee, comprising mental health
87.27professional associations, counties, tribes, managed care organizations, state agencies,
87.28and consumer organizations that shall advise the commissioner regarding development of
87.29the diagnostic codes list. The commissioner shall annually notify providers of changes
87.30to the list.

87.31    Sec. 2. Minnesota Statutes 2010, section 245.462, subdivision 20, is amended to read:
87.32    Subd. 20. Mental illness. (a) "Mental illness" means an organic disorder of the
87.33brain or a clinically significant disorder of thought, mood, perception, orientation,
87.34memory, or behavior that is listed in the clinical manual of the International Classification
88.1of Diseases (ICD-9-CM), current edition, code range 290.0 to 302.99 or 306.0 to 316.0
88.2or the corresponding code in the American Psychiatric Association's Diagnostic and
88.3Statistical Manual of Mental Disorders (DSM-MD), current edition, Axes I, II, or III
88.4detailed in a diagnostic codes list published by the commissioner, and that seriously limits
88.5a person's capacity to function in primary aspects of daily living such as personal relations,
88.6living arrangements, work, and recreation.
88.7    (b) An "adult with acute mental illness" means an adult who has a mental illness that
88.8is serious enough to require prompt intervention.
88.9    (c) For purposes of case management and community support services, a "person
88.10with serious and persistent mental illness" means an adult who has a mental illness and
88.11meets at least one of the following criteria:
88.12    (1) the adult has undergone two or more episodes of inpatient care for a mental
88.13illness within the preceding 24 months;
88.14    (2) the adult has experienced a continuous psychiatric hospitalization or residential
88.15treatment exceeding six months' duration within the preceding 12 months;
88.16    (3) the adult has been treated by a crisis team two or more times within the preceding
88.1724 months;
88.18    (4) the adult:
88.19    (i) has a diagnosis of schizophrenia, bipolar disorder, major depression, or borderline
88.20personality disorder;
88.21    (ii) indicates a significant impairment in functioning; and
88.22    (iii) has a written opinion from a mental health professional, in the last three years,
88.23stating that the adult is reasonably likely to have future episodes requiring inpatient or
88.24residential treatment, of a frequency described in clause (1) or (2), unless ongoing case
88.25management or community support services are provided;
88.26    (5) the adult has, in the last three years, been committed by a court as a person
88.27who is mentally ill under chapter 253B, or the adult's commitment has been stayed or
88.28continued; or
88.29    (6) the adult (i) was eligible under clauses (1) to (5), but the specified time period
88.30has expired or the adult was eligible as a child under section 245.4871, subdivision 6; and
88.31(ii) has a written opinion from a mental health professional, in the last three years, stating
88.32that the adult is reasonably likely to have future episodes requiring inpatient or residential
88.33treatment, of a frequency described in clause (1) or (2), unless ongoing case management
88.34or community support services are provided.

89.1    Sec. 3. Minnesota Statutes 2010, section 245.487, is amended by adding a subdivision
89.2to read:
89.3    Subd. 7. Diagnostic codes list. By July 1, 2013, the commissioner of human
89.4services shall develop a list of diagnostic codes to define the range of child and adult
89.5mental illnesses for the statewide mental health system. The commissioner may use the
89.6International Classification of Diseases (ICD); the American Psychiatric Association's
89.7Diagnostic and Statistical Manual (DSM); or a combination of both to develop the list.
89.8The commissioner shall establish an advisory committee, comprising mental health
89.9professional associations, counties, tribes, managed care organizations, state agencies,
89.10and consumer organizations that shall advise the commissioner regarding development of
89.11the diagnostic codes list. The commissioner shall annually notify providers of changes
89.12to the list.

89.13    Sec. 4. Minnesota Statutes 2010, section 245.4871, subdivision 15, is amended to read:
89.14    Subd. 15. Emotional disturbance. "Emotional disturbance" means an organic
89.15disorder of the brain or a clinically significant disorder of thought, mood, perception,
89.16orientation, memory, or behavior that:
89.17(1) is listed in the clinical manual of the International Classification of Diseases
89.18(ICD-9-CM), current edition, code range 290.0 to 302.99 or 306.0 to 316.0 or the
89.19corresponding code in the American Psychiatric Association's Diagnostic and Statistical
89.20Manual of Mental Disorders (DSM-MD), current edition, Axes I, II, or III detailed in a
89.21diagnostic codes list published by the commissioner; and
89.22(2) seriously limits a child's capacity to function in primary aspects of daily living
89.23such as personal relations, living arrangements, work, school, and recreation.
89.24"Emotional disturbance" is a generic term and is intended to reflect all categories
89.25of disorder described in DSM-MD, current edition the clinical code list published by the
89.26commissioner as "usually first evident in childhood or adolescence."

89.27    Sec. 5. Minnesota Statutes 2010, section 245.4932, subdivision 1, is amended to read:
89.28    Subdivision 1. Collaborative responsibilities. The children's mental health
89.29collaborative shall have the following authority and responsibilities regarding federal
89.30revenue enhancement:
89.31(1) the collaborative must establish an integrated fund;
89.32(2) the collaborative shall designate a lead county or other qualified entity as the
89.33fiscal agency for reporting, claiming, and receiving payments;
90.1(3) the collaborative or lead county may enter into subcontracts with other counties,
90.2school districts, special education cooperatives, municipalities, and other public and
90.3nonprofit entities for purposes of identifying and claiming eligible expenditures to enhance
90.4federal reimbursement;
90.5(4) the collaborative shall use any enhanced revenue attributable to the activities of
90.6the collaborative, including administrative and service revenue, solely to provide mental
90.7health services or to expand the operational target population. The lead county or other
90.8qualified entity may not use enhanced federal revenue for any other purpose;
90.9(5) the members of the collaborative must continue the base level of expenditures,
90.10as defined in section 245.492, subdivision 2, for services for children with emotional or
90.11behavioral disturbances and their families from any state, county, federal, or other public
90.12or private funding source which, in the absence of the new federal reimbursement earned
90.13under sections 245.491 to 245.495, would have been available for those services. The
90.14base year for purposes of this subdivision shall be the accounting period closest to state
90.15fiscal year 1993;
90.16(6) (5) the collaborative or lead county must develop and maintain an accounting and
90.17financial management system adequate to support all claims for federal reimbursement,
90.18including a clear audit trail and any provisions specified in the contract with the
90.19commissioner of human services;
90.20(7) (6) the collaborative or its members may elect to pay the nonfederal share of the
90.21medical assistance costs for services designated by the collaborative; and
90.22(8) (7) the lead county or other qualified entity may not use federal funds or local
90.23funds designated as matching for other federal funds to provide the nonfederal share of
90.24medical assistance.

90.25    Sec. 6. Minnesota Statutes 2010, section 246.53, is amended by adding a subdivision
90.26to read:
90.27    Subd. 4. Exception from statute of limitations. Any statute of limitations that
90.28limits the commissioner in recovering the cost of care obligation incurred by a client or
90.29former client shall not apply to any claim against an estate made under this section to
90.30recover the cost of care.

90.31    Sec. 7. Minnesota Statutes 2011 Supplement, section 254B.04, subdivision 2a, is
90.32amended to read:
90.33    Subd. 2a. Eligibility for treatment in residential settings. Notwithstanding
90.34provisions of Minnesota Rules, part 9530.6622, subparts 5 and 6, related to an assessor's
91.1discretion in making placements to residential treatment settings, a person eligible for
91.2services under this section must score at level 4 on assessment dimensions related to
91.3relapse, continued use, and or recovery environment in order to be assigned to services
91.4with a room and board component reimbursed under this section.

91.5    Sec. 8. Minnesota Statutes 2010, section 256B.0625, subdivision 42, is amended to
91.6read:
91.7    Subd. 42. Mental health professional. Notwithstanding Minnesota Rules, part
91.89505.0175, subpart 28, the definition of a mental health professional shall include a person
91.9who is qualified as specified in section 245.462, subdivision 18, clauses (5) and (1) to (6);
91.10or 245.4871, subdivision 27, clauses (5) and (1) to (6), for the purpose of this section and
91.11Minnesota Rules, parts 9505.0170 to 9505.0475.

91.12    Sec. 9. Minnesota Statutes 2010, section 256F.13, subdivision 1, is amended to read:
91.13    Subdivision 1. Federal revenue enhancement. (a) The commissioner of human
91.14services may enter into an agreement with one or more family services collaboratives
91.15to enhance federal reimbursement under title IV-E of the Social Security Act and
91.16federal administrative reimbursement under title XIX of the Social Security Act. The
91.17commissioner may contract with the Department of Education for purposes of transferring
91.18the federal reimbursement to the commissioner of education to be distributed to the
91.19collaboratives according to clause (2). The commissioner shall have the following
91.20authority and responsibilities regarding family services collaboratives:
91.21(1) the commissioner shall submit amendments to state plans and seek waivers as
91.22necessary to implement the provisions of this section;
91.23(2) the commissioner shall pay the federal reimbursement earned under this
91.24subdivision to each collaborative based on their earnings. Payments to collaboratives for
91.25expenditures under this subdivision will only be made of federal earnings from services
91.26provided by the collaborative;
91.27(3) the commissioner shall review expenditures of family services collaboratives
91.28using reports specified in the agreement with the collaborative to ensure that the base level
91.29of expenditures is continued and new federal reimbursement is used to expand education,
91.30social, health, or health-related services to young children and their families;
91.31(4) the commissioner may reduce, suspend, or eliminate a family services
91.32collaborative's obligations to continue the base level of expenditures or expansion of
91.33services if the commissioner determines that one or more of the following conditions
91.34apply:
92.1(i) imposition of levy limits that significantly reduce available funds for social,
92.2health, or health-related services to families and children;
92.3(ii) reduction in the net tax capacity of the taxable property eligible to be taxed by
92.4the lead county or subcontractor that significantly reduces available funds for education,
92.5social, health, or health-related services to families and children;
92.6(iii) reduction in the number of children under age 19 in the county, collaborative
92.7service delivery area, subcontractor's district, or catchment area when compared to the
92.8number in the base year using the most recent data provided by the State Demographer's
92.9Office; or
92.10(iv) termination of the federal revenue earned under the family services collaborative
92.11agreement;
92.12(5) (4) the commissioner shall not use the federal reimbursement earned under this
92.13subdivision in determining the allocation or distribution of other funds to counties or
92.14collaboratives;
92.15(6) (5) the commissioner may suspend, reduce, or terminate the federal
92.16reimbursement to a provider that does not meet the reporting or other requirements
92.17of this subdivision;
92.18(7) (6) the commissioner shall recover from the family services collaborative any
92.19federal fiscal disallowances or sanctions for audit exceptions directly attributable to the
92.20family services collaborative's actions in the integrated fund, or the proportional share if
92.21federal fiscal disallowances or sanctions are based on a statewide random sample; and
92.22(8) (7) the commissioner shall establish criteria for the family services collaborative
92.23for the accounting and financial management system that will support claims for federal
92.24reimbursement.
92.25(b) The family services collaborative shall have the following authority and
92.26responsibilities regarding federal revenue enhancement:
92.27(1) the family services collaborative shall be the party with which the commissioner
92.28contracts. A lead county shall be designated as the fiscal agency for reporting, claiming,
92.29and receiving payments;
92.30(2) the family services collaboratives may enter into subcontracts with other
92.31counties, school districts, special education cooperatives, municipalities, and other public
92.32and nonprofit entities for purposes of identifying and claiming eligible expenditures to
92.33enhance federal reimbursement, or to expand education, social, health, or health-related
92.34services to families and children;
92.35(3) the family services collaborative must use all new federal reimbursement
92.36resulting from federal revenue enhancement to expand expenditures for education, social,
93.1health, or health-related services to families and children beyond the base level, except
93.2as provided in paragraph (a), clause (4);
93.3(4) the family services collaborative must ensure that expenditures submitted for
93.4federal reimbursement are not made from federal funds or funds used to match other
93.5federal funds. Notwithstanding section 256B.19, subdivision 1, for the purposes of family
93.6services collaborative expenditures under agreement with the department, the nonfederal
93.7share of costs shall be provided by the family services collaborative from sources other
93.8than federal funds or funds used to match other federal funds;
93.9(5) the family services collaborative must develop and maintain an accounting and
93.10financial management system adequate to support all claims for federal reimbursement,
93.11including a clear audit trail and any provisions specified in the agreement; and
93.12(6) the family services collaborative shall submit an annual report to the
93.13commissioner as specified in the agreement.

93.14    Sec. 10. TERMINOLOGY AUDIT.
93.15The commissioner of human services shall collaborate with individuals with
93.16disabilities, families, advocates, and other governmental agencies to solicit feedback and
93.17identify inappropriate and insensitive terminology relating to individuals with disabilities,
93.18conduct a comprehensive audit of the placement of this terminology in Minnesota Statutes
93.19and Minnesota Rules, and make recommendations for changes to the 2013 legislature
93.20on the repeal and replacement of this terminology with more appropriate and sensitive
93.21terminology.


93.24    Section 1. Minnesota Statutes 2011 Supplement, section 125A.21, subdivision 7,
93.25is amended to read:
93.26    Subd. 7. District disclosure of information. A school district may disclose
93.27information contained in a student's individualized education program, consistent with
93.28section 13.32, subdivision 3, paragraph (a), and Code of Federal Regulations, title 34,
93.29parts 99 and 300; including records of the student's diagnosis and treatment, to a health
93.30plan company only with the signed and dated consent of the student's parent, or other
93.31legally authorized individual, including consent that the parent or legal representative gave
93.32as part of the application process for MinnesotaCare or medical assistance under section
93.33256B.08, subdivision 1. The school district shall disclose only that information necessary
93.34for the health plan company to decide matters of coverage and payment. A health plan
94.1company may use the information only for making decisions regarding coverage and
94.2payment, and for any other use permitted by law.

94.3    Sec. 2. Minnesota Statutes 2010, section 256B.04, subdivision 14, is amended to read:
94.4    Subd. 14. Competitive bidding. (a) When determined to be effective, economical,
94.5and feasible, the commissioner may utilize volume purchase through competitive bidding
94.6and negotiation under the provisions of chapter 16C, to provide items under the medical
94.7assistance program including but not limited to the following:
94.8    (1) eyeglasses;
94.9    (2) oxygen. The commissioner shall provide for oxygen needed in an emergency
94.10situation on a short-term basis, until the vendor can obtain the necessary supply from
94.11the contract dealer;
94.12    (3) hearing aids and supplies; and
94.13    (4) durable medical equipment, including but not limited to:
94.14    (i) hospital beds;
94.15    (ii) commodes;
94.16    (iii) glide-about chairs;
94.17    (iv) patient lift apparatus;
94.18    (v) wheelchairs and accessories;
94.19    (vi) oxygen administration equipment;
94.20    (vii) respiratory therapy equipment;
94.21    (viii) electronic diagnostic, therapeutic and life-support systems;
94.22    (5) nonemergency medical transportation level of need determinations, disbursement
94.23of public transportation passes and tokens, and volunteer and recipient mileage and
94.24parking reimbursements; and
94.25    (6) drugs.
94.26    (b) Rate changes and recipient cost-sharing under this chapter and chapters 256D and
94.27256L do not affect contract payments under this subdivision unless specifically identified.
94.28    (c) The commissioner may not utilize volume purchase through competitive bidding
94.29and negotiation for special transportation services under the provisions of chapter 16C.

94.30    Sec. 3. Minnesota Statutes 2011 Supplement, section 256B.056, subdivision 3, is
94.31amended to read:
94.32    Subd. 3. Asset limitations for individuals and families. (a) To be eligible for
94.33medical assistance, a person must not individually own more than $3,000 in assets, or if a
94.34member of a household with two family members, husband and wife, or parent and child,
95.1the household must not own more than $6,000 in assets, plus $200 for each additional
95.2legal dependent. In addition to these maximum amounts, an eligible individual or family
95.3may accrue interest on these amounts, but they must be reduced to the maximum at the
95.4time of an eligibility redetermination. The accumulation of the clothing and personal
95.5needs allowance according to section 256B.35 must also be reduced to the maximum at
95.6the time of the eligibility redetermination. The value of assets that are not considered in
95.7determining eligibility for medical assistance is the value of those assets excluded under
95.8the supplemental security income program for aged, blind, and disabled persons, with
95.9the following exceptions:
95.10(1) household goods and personal effects are not considered;
95.11(2) capital and operating assets of a trade or business that the local agency determines
95.12are necessary to the person's ability to earn an income are not considered;
95.13(3) motor vehicles are excluded to the same extent excluded by the supplemental
95.14security income program;
95.15(4) assets designated as burial expenses are excluded to the same extent excluded by
95.16the supplemental security income program. Burial expenses funded by annuity contracts
95.17or life insurance policies must irrevocably designate the individual's estate as contingent
95.18beneficiary to the extent proceeds are not used for payment of selected burial expenses; and
95.19(5) for a person who no longer qualifies as an employed person with a disability due
95.20to loss of earnings, assets allowed while eligible for medical assistance under section
95.21256B.057, subdivision 9 , are not considered for 12 months, beginning with the first month
95.22of ineligibility as an employed person with a disability, to the extent that the person's total
95.23assets remain within the allowed limits of section 256B.057, subdivision 9, paragraph
95.24(d).; and
95.25(6) effective July 1, 2009, certain assets owned by American Indians are excluded as
95.26required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
95.27Law 111-5. For purposes of this clause, an American Indian is any person who meets the
95.28definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
95.29(b) No asset limit shall apply to persons eligible under section 256B.055, subdivision
95.3015.
95.31EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

95.32    Sec. 4. Minnesota Statutes 2010, section 256B.056, subdivision 3c, is amended to read:
95.33    Subd. 3c. Asset limitations for families and children. A household of two or more
95.34persons must not own more than $20,000 in total net assets, and a household of one
95.35person must not own more than $10,000 in total net assets. In addition to these maximum
96.1amounts, an eligible individual or family may accrue interest on these amounts, but they
96.2must be reduced to the maximum at the time of an eligibility redetermination. The value of
96.3assets that are not considered in determining eligibility for medical assistance for families
96.4and children is the value of those assets excluded under the AFDC state plan as of July 16,
96.51996, as required by the Personal Responsibility and Work Opportunity Reconciliation
96.6Act of 1996 (PRWORA), Public Law 104-193, with the following exceptions:
96.7(1) household goods and personal effects are not considered;
96.8(2) capital and operating assets of a trade or business up to $200,000 are not
96.9considered, except that a bank account that contains personal income or assets, or is used to
96.10pay personal expenses, is not considered a capital or operating asset of a trade or business;
96.11(3) one motor vehicle is excluded for each person of legal driving age who is
96.12employed or seeking employment;
96.13(4) assets designated as burial expenses are excluded to the same extent they are
96.14excluded by the Supplemental Security Income program;
96.15(5) court-ordered settlements up to $10,000 are not considered;
96.16(6) individual retirement accounts and funds are not considered; and
96.17(7) assets owned by children are not considered.; and
96.18(8) effective July 1, 2009, certain assets owned by American Indians are excluded, as
96.19required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
96.20Law 111-5. For purposes of this clause, an American Indian is any person who meets the
96.21definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
96.22The assets specified in clause (2) must be disclosed to the local agency at the time of
96.23application and at the time of an eligibility redetermination, and must be verified upon
96.24request of the local agency.
96.25EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

96.26    Sec. 5. Minnesota Statutes 2011 Supplement, section 256B.057, subdivision 9, is
96.27amended to read:
96.28    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid
96.29for a person who is employed and who:
96.30(1) but for excess earnings or assets, meets the definition of disabled under the
96.31Supplemental Security Income program;
96.32(2) is at least 16 but less than 65 years of age;
96.33(3) meets the asset limits in paragraph (d); and
96.34(4) pays a premium and other obligations under paragraph (e).
97.1    (b) For purposes of eligibility, there is a $65 earned income disregard. To be eligible
97.2for medical assistance under this subdivision, a person must have more than $65 of earned
97.3income. Earned income must have Medicare, Social Security, and applicable state and
97.4federal taxes withheld. The person must document earned income tax withholding. Any
97.5spousal income or assets shall be disregarded for purposes of eligibility and premium
97.6determinations.
97.7(c) After the month of enrollment, a person enrolled in medical assistance under
97.8this subdivision who:
97.9(1) is temporarily unable to work and without receipt of earned income due to a
97.10medical condition, as verified by a physician; or
97.11(2) loses employment for reasons not attributable to the enrollee, and is without
97.12receipt of earned income may retain eligibility for up to four consecutive months after the
97.13month of job loss. To receive a four-month extension, enrollees must verify the medical
97.14condition or provide notification of job loss. All other eligibility requirements must be met
97.15and the enrollee must pay all calculated premium costs for continued eligibility.
97.16(d) For purposes of determining eligibility under this subdivision, a person's assets
97.17must not exceed $20,000, excluding:
97.18(1) all assets excluded under section 256B.056;
97.19(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans,
97.20Keogh plans, and pension plans;
97.21(3) medical expense accounts set up through the person's employer; and
97.22(4) spousal assets, including spouse's share of jointly held assets.
97.23(e) All enrollees must pay a premium to be eligible for medical assistance under this
97.24subdivision, except as provided under section 256.01, subdivision 18b clause (5).
97.25(1) An enrollee must pay the greater of a $65 premium or the premium calculated
97.26based on the person's gross earned and unearned income and the applicable family size
97.27using a sliding fee scale established by the commissioner, which begins at one percent of
97.28income at 100 percent of the federal poverty guidelines and increases to 7.5 percent of
97.29income for those with incomes at or above 300 percent of the federal poverty guidelines.
97.30(2) Annual adjustments in the premium schedule based upon changes in the federal
97.31poverty guidelines shall be effective for premiums due in July of each year.
97.32(3) All enrollees who receive unearned income must pay five percent of unearned
97.33income in addition to the premium amount, except as provided under section 256.01,
97.34subdivision 18b clause (5).
97.35(4) Increases in benefits under title II of the Social Security Act shall not be counted
97.36as income for purposes of this subdivision until July 1 of each year.
98.1(5) Effective July 1, 2009, American Indians are exempt from paying premiums as
98.2required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
98.3Law 111-5. For purposes of this clause, an American Indian is any person who meets the
98.4definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
98.5(f) A person's eligibility and premium shall be determined by the local county
98.6agency. Premiums must be paid to the commissioner. All premiums are dedicated to
98.7the commissioner.
98.8(g) Any required premium shall be determined at application and redetermined at
98.9the enrollee's six-month income review or when a change in income or household size is
98.10reported. Enrollees must report any change in income or household size within ten days
98.11of when the change occurs. A decreased premium resulting from a reported change in
98.12income or household size shall be effective the first day of the next available billing month
98.13after the change is reported. Except for changes occurring from annual cost-of-living
98.14increases, a change resulting in an increased premium shall not affect the premium amount
98.15until the next six-month review.
98.16(h) Premium payment is due upon notification from the commissioner of the
98.17premium amount required. Premiums may be paid in installments at the discretion of
98.18the commissioner.
98.19(i) Nonpayment of the premium shall result in denial or termination of medical
98.20assistance unless the person demonstrates good cause for nonpayment. Good cause exists
98.21if the requirements specified in Minnesota Rules, part 9506.0040, subpart 7, items B to
98.22D, are met. Except when an installment agreement is accepted by the commissioner,
98.23all persons disenrolled for nonpayment of a premium must pay any past due premiums
98.24as well as current premiums due prior to being reenrolled. Nonpayment shall include
98.25payment with a returned, refused, or dishonored instrument. The commissioner may
98.26require a guaranteed form of payment as the only means to replace a returned, refused,
98.27or dishonored instrument.
98.28(j) The commissioner shall notify enrollees annually beginning at least 24 months
98.29before the person's 65th birthday of the medical assistance eligibility rules affecting
98.30income, assets, and treatment of a spouse's income and assets that will be applied upon
98.31reaching age 65.
98.32(k) For enrollees whose income does not exceed 200 percent of the federal poverty
98.33guidelines and who are also enrolled in Medicare, the commissioner shall reimburse
98.34the enrollee for Medicare part B premiums under section 256B.0625, subdivision 15,
98.35paragraph (a).
98.36EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

99.1    Sec. 6. Minnesota Statutes 2010, section 256B.0595, subdivision 2, is amended to read:
99.2    Subd. 2. Period of ineligibility for long-term care services. (a) For any
99.3uncompensated transfer occurring on or before August 10, 1993, the number of months
99.4of ineligibility for long-term care services shall be the lesser of 30 months, or the
99.5uncompensated transfer amount divided by the average medical assistance rate for nursing
99.6facility services in the state in effect on the date of application. The amount used to
99.7calculate the average medical assistance payment rate shall be adjusted each July 1 to
99.8reflect payment rates for the previous calendar year. The period of ineligibility begins
99.9with the month in which the assets were transferred. If the transfer was not reported to
99.10the local agency at the time of application, and the applicant received long-term care
99.11services during what would have been the period of ineligibility if the transfer had been
99.12reported, a cause of action exists against the transferee for the cost of long-term care
99.13services provided during the period of ineligibility, or for the uncompensated amount of
99.14the transfer, whichever is less. The uncompensated transfer amount is the fair market
99.15value of the asset at the time it was given away, sold, or disposed of, less the amount of
99.16compensation received.
99.17    (b) For uncompensated transfers made after August 10, 1993, the number of months
99.18of ineligibility for long-term care services shall be the total uncompensated value of the
99.19resources transferred divided by the average medical assistance rate for nursing facility
99.20services in the state in effect on the date of application. The amount used to calculate
99.21the average medical assistance payment rate shall be adjusted each July 1 to reflect
99.22payment rates for the previous calendar year. The period of ineligibility begins with the
99.23first day of the month after the month in which the assets were transferred except that
99.24if one or more uncompensated transfers are made during a period of ineligibility, the
99.25total assets transferred during the ineligibility period shall be combined and a penalty
99.26period calculated to begin on the first day of the month after the month in which the first
99.27uncompensated transfer was made. If the transfer was reported to the local agency after
99.28the date that advance notice of a period of ineligibility that affects the next month could
99.29be provided to the recipient and the recipient received medical assistance services or the
99.30transfer was not reported to the local agency, and the applicant or recipient received
99.31medical assistance services during what would have been the period of ineligibility if
99.32the transfer had been reported, a cause of action exists against the transferee for that
99.33portion of long-term care services provided during the period of ineligibility, or for the
99.34uncompensated amount of the transfer, whichever is less. The uncompensated transfer
99.35amount is the fair market value of the asset at the time it was given away, sold, or disposed
99.36of, less the amount of compensation received. Effective for transfers made on or after
100.1March 1, 1996, involving persons who apply for medical assistance on or after April 13,
100.21996, no cause of action exists for a transfer unless:
100.3    (1) the transferee knew or should have known that the transfer was being made by a
100.4person who was a resident of a long-term care facility or was receiving that level of care in
100.5the community at the time of the transfer;
100.6    (2) the transferee knew or should have known that the transfer was being made to
100.7assist the person to qualify for or retain medical assistance eligibility; or
100.8    (3) the transferee actively solicited the transfer with intent to assist the person to
100.9qualify for or retain eligibility for medical assistance.
100.10    (c) For uncompensated transfers made on or after February 8, 2006, the period
100.11of ineligibility:
100.12    (1) for uncompensated transfers by or on behalf of individuals receiving medical
100.13assistance payment of long-term care services, begins the first day of the month following
100.14advance notice of the period of ineligibility, but no later than the first day of the month
100.15that follows three full calendar months from the date of the report or discovery of the
100.16transfer; or
100.17    (2) for uncompensated transfers by individuals requesting medical assistance
100.18payment of long-term care services, begins the date on which the individual is eligible
100.19for medical assistance under the Medicaid state plan and would otherwise be receiving
100.20long-term care services based on an approved application for such care but for the period
100.21of ineligibility resulting from the uncompensated transfer; and
100.22    (3) cannot begin during any other period of ineligibility.
100.23    (d) If a calculation of a period of ineligibility results in a partial month, payments for
100.24long-term care services shall be reduced in an amount equal to the fraction.
100.25    (e) In the case of multiple fractional transfers of assets in more than one month for
100.26less than fair market value on or after February 8, 2006, the period of ineligibility is
100.27calculated by treating the total, cumulative, uncompensated value of all assets transferred
100.28during all months on or after February 8, 2006, as one transfer.
100.29    (f) A period of ineligibility established under paragraph (c) may be eliminated if
100.30all of the assets transferred for less than fair market value used to calculate the period of
100.31ineligibility, or cash equal to the value of the assets at the time of the transfer, are returned
100.32within 12 months after the date the period of ineligibility began. A period of ineligibility
100.33must not be adjusted if less than the full amount of the transferred assets or the full cash
100.34value of the transferred assets are returned.

101.1    Sec. 7. Minnesota Statutes 2010, section 256B.0625, subdivision 13, is amended to
101.2read:
101.3    Subd. 13. Drugs. (a) Medical assistance covers drugs, except for fertility drugs
101.4when specifically used to enhance fertility, if prescribed by a licensed practitioner and
101.5dispensed by a licensed pharmacist, by a physician enrolled in the medical assistance
101.6program as a dispensing physician, or by a physician, physician assistant, or a nurse
101.7practitioner employed by or under contract with a community health board as defined in
101.8section 145A.02, subdivision 5, for the purposes of communicable disease control.
101.9(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
101.10unless authorized by the commissioner.
101.11(c) For the purpose of this subdivision and subdivision 13d, an "active
101.12pharmaceutical ingredient" is defined as a substance that is represented for use in a drug
101.13and when used in the manufacturing, processing, or packaging of a drug, becomes an
101.14active ingredient of the drug product. An "excipient" is defined as an inert substance
101.15used as a diluent or vehicle for a drug. The commissioner shall establish a list of active
101.16pharmaceutical ingredients and excipients which are included in the medical assistance
101.17formulary. Medical assistance covers selected active pharmaceutical ingredients and
101.18excipients used in compounded prescriptions when the compounded combination is
101.19specifically approved by the commissioner or when a commercially available product:
101.20(1) is not a therapeutic option for the patient;
101.21(2) does not exist in the same combination of active ingredients in the same strengths
101.22as the compounded prescription; and
101.23(3) cannot be used in place of the active pharmaceutical ingredient in the
101.24compounded prescription.
101.25(c) (d) Medical assistance covers the following over-the-counter drugs when
101.26prescribed by a licensed practitioner or by a licensed pharmacist who meets standards
101.27established by the commissioner, in consultation with the board of pharmacy: antacids,
101.28acetaminophen, family planning products, aspirin, insulin, products for the treatment of
101.29lice, vitamins for adults with documented vitamin deficiencies, vitamins for children
101.30under the age of seven and pregnant or nursing women, and any other over-the-counter
101.31drug identified by the commissioner, in consultation with the formulary committee, as
101.32necessary, appropriate, and cost-effective for the treatment of certain specified chronic
101.33diseases, conditions, or disorders, and this determination shall not be subject to the
101.34requirements of chapter 14. A pharmacist may prescribe over-the-counter medications as
101.35provided under this paragraph for purposes of receiving reimbursement under Medicaid.
101.36When prescribing over-the-counter drugs under this paragraph, licensed pharmacists must
102.1consult with the recipient to determine necessity, provide drug counseling, review drug
102.2therapy for potential adverse interactions, and make referrals as needed to other health care
102.3professionals. Over-the-counter medications must be dispensed in a quantity that is the
102.4lower of: (1) the number of dosage units contained in the manufacturer's original package;
102.5and (2) the number of dosage units required to complete the patient's course of therapy.
102.6(d) (e) Effective January 1, 2006, medical assistance shall not cover drugs that
102.7are coverable under Medicare Part D as defined in the Medicare Prescription Drug,
102.8Improvement, and Modernization Act of 2003, Public Law 108-173, section 1860D-2(e),
102.9for individuals eligible for drug coverage as defined in the Medicare Prescription
102.10Drug, Improvement, and Modernization Act of 2003, Public Law 108-173, section
102.111860D-1(a)(3)(A). For these individuals, medical assistance may cover drugs from the
102.12drug classes listed in United States Code, title 42, section 1396r-8(d)(2), subject to this
102.13subdivision and subdivisions 13a to 13g, except that drugs listed in United States Code,
102.14title 42, section 1396r-8(d)(2)(E), shall not be covered.

102.15    Sec. 8. Minnesota Statutes 2010, section 256B.0625, subdivision 13d, is amended to
102.16read:
102.17    Subd. 13d. Drug formulary. (a) The commissioner shall establish a drug
102.18formulary. Its establishment and publication shall not be subject to the requirements of the
102.19Administrative Procedure Act, but the Formulary Committee shall review and comment
102.20on the formulary contents.
102.21    (b) The formulary shall not include:
102.22    (1) drugs, active pharmaceutical ingredients, or products for which there is no
102.23federal funding;
102.24    (2) over-the-counter drugs, except as provided in subdivision 13;
102.25    (3) drugs or active pharmaceutical ingredients used for weight loss, except that
102.26medically necessary lipase inhibitors may be covered for a recipient with type II diabetes;
102.27    (4) drugs or active pharmaceutical ingredients when used for the treatment of
102.28impotence or erectile dysfunction;
102.29    (5) drugs or active pharmaceutical ingredients for which medical value has not
102.30been established; and
102.31    (6) drugs from manufacturers who have not signed a rebate agreement with the
102.32Department of Health and Human Services pursuant to section 1927 of title XIX of the
102.33Social Security Act.
102.34    (c) If a single-source drug used by at least two percent of the fee-for-service
102.35medical assistance recipients is removed from the formulary due to the failure of the
103.1manufacturer to sign a rebate agreement with the Department of Health and Human
103.2Services, the commissioner shall notify prescribing practitioners within 30 days of
103.3receiving notification from the Centers for Medicare and Medicaid Services (CMS) that a
103.4rebate agreement was not signed.

103.5    Sec. 9. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 13e,
103.6is amended to read:
103.7    Subd. 13e. Payment rates. (a) The basis for determining the amount of payment
103.8shall be the lower of the actual acquisition costs of the drugs or the maximum allowable
103.9cost by the commissioner plus the fixed dispensing fee; or the usual and customary price
103.10charged to the public. The amount of payment basis must be reduced to reflect all discount
103.11amounts applied to the charge by any provider/insurer agreement or contract for submitted
103.12charges to medical assistance programs. The net submitted charge may not be greater
103.13than the patient liability for the service. The pharmacy dispensing fee shall be $3.65,
103.14except that the dispensing fee for intravenous solutions which must be compounded by the
103.15pharmacist shall be $8 per bag, $14 per bag for cancer chemotherapy products, and $30
103.16per bag for total parenteral nutritional products dispensed in one liter quantities, or $44 per
103.17bag for total parenteral nutritional products dispensed in quantities greater than one liter.
103.18Actual acquisition cost includes quantity and other special discounts except time and cash
103.19discounts. The actual acquisition cost of a drug shall be estimated by the commissioner at
103.20wholesale acquisition cost plus four percent for independently owned pharmacies located
103.21in a designated rural area within Minnesota, and at wholesale acquisition cost plus two
103.22percent for all other pharmacies. A pharmacy is "independently owned" if it is one
103.23of four or fewer pharmacies under the same ownership nationally. A "designated rural
103.24area" means an area defined as a small rural area or isolated rural area according to the
103.25four-category classification of the Rural Urban Commuting Area system developed for the
103.26United States Health Resources and Services Administration. Wholesale acquisition cost
103.27is defined as the manufacturer's list price for a drug or biological to wholesalers or direct
103.28purchasers in the United States, not including prompt pay or other discounts, rebates, or
103.29reductions in price, for the most recent month for which information is available, as
103.30reported in wholesale price guides or other publications of drug or biological pricing data.
103.31The maximum allowable cost of a multisource drug may be set by the commissioner and it
103.32shall be comparable to, but no higher than, the maximum amount paid by other third-party
103.33payors in this state who have maximum allowable cost programs. Establishment of the
103.34amount of payment for drugs shall not be subject to the requirements of the Administrative
103.35Procedure Act.
104.1    (b) An additional dispensing fee of $.30 may be added to the dispensing fee paid
104.2to pharmacists for legend drug prescriptions dispensed to residents of long-term care
104.3facilities when a unit dose blister card system, approved by the department, is used. Under
104.4this type of dispensing system, the pharmacist must dispense a 30-day supply of drug.
104.5The National Drug Code (NDC) from the drug container used to fill the blister card must
104.6be identified on the claim to the department. The unit dose blister card containing the
104.7drug must meet the packaging standards set forth in Minnesota Rules, part 6800.2700,
104.8that govern the return of unused drugs to the pharmacy for reuse. The pharmacy provider
104.9will be required to credit the department for the actual acquisition cost of all unused
104.10drugs that are eligible for reuse. Over-the-counter medications must be dispensed in the
104.11manufacturer's unopened package. The commissioner may permit the drug clozapine to be
104.12dispensed in a quantity that is less than a 30-day supply.
104.13    (c) Whenever a maximum allowable cost has been set for a multisource drug,
104.14payment shall be the lower of the usual and customary price charged to the public or the
104.15maximum allowable cost established by the commissioner unless prior authorization
104.16for the brand name product has been granted according to the criteria established by
104.17the Drug Formulary Committee as required by subdivision 13f, paragraph (a), and the
104.18prescriber has indicated "dispense as written" on the prescription in a manner consistent
104.19with section 151.21, subdivision 2.
104.20    (d) The basis for determining the amount of payment for drugs administered in an
104.21outpatient setting shall be the lower of the usual and customary cost submitted by the
104.22provider or 106 percent of the average sales price as determined by the United States
104.23Department of Health and Human Services pursuant to title XVIII, section 1847a of the
104.24federal Social Security Act. If average sales price is unavailable, the amount of payment
104.25must be lower of the usual and customary cost submitted by the provider or the wholesale
104.26acquisition cost.
104.27    (e) The commissioner may negotiate lower reimbursement rates for specialty
104.28pharmacy products than the rates specified in paragraph (a). The commissioner may
104.29require individuals enrolled in the health care programs administered by the department
104.30to obtain specialty pharmacy products from providers with whom the commissioner has
104.31negotiated lower reimbursement rates. Specialty pharmacy products are defined as those
104.32used by a small number of recipients or recipients with complex and chronic diseases
104.33that require expensive and challenging drug regimens. Examples of these conditions
104.34include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis
104.35C, growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms
104.36of cancer. Specialty pharmaceutical products include injectable and infusion therapies,
105.1biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies
105.2that require complex care. The commissioner shall consult with the formulary committee
105.3to develop a list of specialty pharmacy products subject to this paragraph. In consulting
105.4with the formulary committee in developing this list, the commissioner shall take into
105.5consideration the population served by specialty pharmacy products, the current delivery
105.6system and standard of care in the state, and access to care issues. The commissioner shall
105.7have the discretion to adjust the reimbursement rate to prevent access to care issues.
105.8(f) Home infusion therapy services provided by home infusion therapy pharmacies
105.9must be paid at rates according to subdivision 8d.

105.10    Sec. 10. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 13h,
105.11is amended to read:
105.12    Subd. 13h. Medication therapy management services. (a) Medical assistance
105.13and general assistance medical care cover medication therapy management services for
105.14a recipient taking three or more prescriptions to treat or prevent one or more chronic
105.15medical conditions; a recipient with a drug therapy problem that is identified by the
105.16commissioner or identified by a pharmacist and approved by the commissioner; or prior
105.17authorized by the commissioner that has resulted or is likely to result in significant
105.18nondrug program costs. The commissioner may cover medical therapy management
105.19services under MinnesotaCare if the commissioner determines this is cost-effective. For
105.20purposes of this subdivision, "medication therapy management" means the provision
105.21of the following pharmaceutical care services by a licensed pharmacist to optimize the
105.22therapeutic outcomes of the patient's medications:
105.23    (1) performing or obtaining necessary assessments of the patient's health status;
105.24    (2) formulating a medication treatment plan;
105.25    (3) monitoring and evaluating the patient's response to therapy, including safety
105.26and effectiveness;
105.27    (4) performing a comprehensive medication review to identify, resolve, and prevent
105.28medication-related problems, including adverse drug events;
105.29    (5) documenting the care delivered and communicating essential information to
105.30the patient's other primary care providers;
105.31    (6) providing verbal education and training designed to enhance patient
105.32understanding and appropriate use of the patient's medications;
105.33    (7) providing information, support services, and resources designed to enhance
105.34patient adherence with the patient's therapeutic regimens; and
106.1    (8) coordinating and integrating medication therapy management services within the
106.2broader health care management services being provided to the patient.
106.3Nothing in this subdivision shall be construed to expand or modify the scope of practice of
106.4the pharmacist as defined in section 151.01, subdivision 27.
106.5    (b) To be eligible for reimbursement for services under this subdivision, a pharmacist
106.6must meet the following requirements:
106.7    (1) have a valid license issued under chapter 151 by the Board of Pharmacy of the
106.8state in which the medication therapy management service is being performed;
106.9    (2) have graduated from an accredited college of pharmacy on or after May 1996, or
106.10completed a structured and comprehensive education program approved by the Board of
106.11Pharmacy and the American Council of Pharmaceutical Education for the provision and
106.12documentation of pharmaceutical care management services that has both clinical and
106.13didactic elements;
106.14    (3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
106.15have developed a structured patient care process that is offered in a private or semiprivate
106.16patient care area that is separate from the commercial business that also occurs in the
106.17setting, or in home settings, including long-term care settings, group homes, and facilities
106.18providing assisted living services, but excluding skilled nursing facilities; and
106.19    (4) make use of an electronic patient record system that meets state standards.
106.20    (c) For purposes of reimbursement for medication therapy management services,
106.21the commissioner may enroll individual pharmacists as medical assistance and general
106.22assistance medical care providers. The commissioner may also establish contact
106.23requirements between the pharmacist and recipient, including limiting the number of
106.24reimbursable consultations per recipient.
106.25(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing
106.26within a reasonable geographic distance of the patient, a pharmacist who meets the
106.27requirements may provide the services via two-way interactive video. Reimbursement
106.28shall be at the same rates and under the same conditions that would otherwise apply to
106.29the services provided. To qualify for reimbursement under this paragraph, the pharmacist
106.30providing the services must meet the requirements of paragraph (b), and must be located
106.31within an ambulatory care setting approved by the commissioner. The patient must also
106.32be located within an ambulatory care setting approved by the commissioner. Services
106.33provided under this paragraph may not be transmitted into the patient's residence.
106.34(e) The commissioner shall establish a pilot project for an intensive medication
106.35therapy management program for patients identified by the commissioner with multiple
106.36chronic conditions and a high number of medications who are at high risk of preventable
107.1hospitalizations, emergency room use, medication complications, and suboptimal
107.2treatment outcomes due to medication-related problems. For purposes of the pilot
107.3project, medication therapy management services may be provided in a patient's home
107.4or community setting, in addition to other authorized settings. The commissioner may
107.5waive existing payment policies and establish special payment rates for the pilot project.
107.6The pilot project must be designed to produce a net savings to the state compared to the
107.7estimated costs that would otherwise be incurred for similar patients without the program.
107.8The pilot project must begin by January 1, 2010, and end June 30, 2012.

107.9    Sec. 11. Minnesota Statutes 2011 Supplement, section 256B.0625, subdivision 14,
107.10is amended to read:
107.11    Subd. 14. Diagnostic, screening, and preventive services. (a) Medical assistance
107.12covers diagnostic, screening, and preventive services.
107.13(b) "Preventive services" include services related to pregnancy, including:
107.14(1) services for those conditions which may complicate a pregnancy and which may
107.15be available to a pregnant woman determined to be at risk of poor pregnancy outcome;
107.16(2) prenatal HIV risk assessment, education, counseling, and testing; and
107.17(3) alcohol abuse assessment, education, and counseling on the effects of alcohol
107.18usage while pregnant. Preventive services available to a woman at risk of poor pregnancy
107.19outcome may differ in an amount, duration, or scope from those available to other
107.20individuals eligible for medical assistance.
107.21(c) "Screening services" include, but are not limited to, blood lead tests.
107.22(d) The commissioner shall encourage, at the time of the child and teen checkup or
107.23at an episodic care visit, the primary care health care provider to perform primary caries
107.24preventive services. Primary caries preventive services include, at a minimum:
107.25(1) a general visual examination of the child's mouth without using probes or other
107.26dental equipment or taking radiographs;
107.27(2) a risk assessment using the factors established by the American Academies
107.28of Pediatrics and Pediatric Dentistry; and
107.29(3) the application of a fluoride varnish beginning at age one to those children
107.30assessed by the provider as being high risk in accordance with best practices as defined by
107.31the Department of Human Services. The provider must obtain parental or legal guardian
107.32consent before a fluoride treatment varnish is applied to a minor child's teeth.
107.33At each checkup, if primary caries preventive services are provided, the provider must
107.34provide to the child's parent or legal guardian: information on caries etiology and
107.35prevention; and information on the importance of finding a dental home for their child
108.1by the age of one. The provider must also advise the parent or legal guardian to contact
108.2the child's managed care plan or the Department of Human Services in order to secure a
108.3dental appointment with a dentist. The provider must indicate in the child's medical record
108.4that the parent or legal guardian was provided with this information and document any
108.5primary caries prevention services provided to the child.

108.6    Sec. 12. Minnesota Statutes 2011 Supplement, section 256B.0631, subdivision 1,
108.7is amended to read:
108.8    Subdivision 1. Cost-sharing. (a) Except as provided in subdivision 2, the medical
108.9assistance benefit plan shall include the following cost-sharing for all recipients, effective
108.10for services provided on or after September 1, 2011:
108.11    (1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes
108.12of this subdivision, a visit means an episode of service which is required because of
108.13a recipient's symptoms, diagnosis, or established illness, and which is delivered in an
108.14ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse
108.15midwife, advanced practice nurse, audiologist, optician, or optometrist;
108.16    (2) $3 for eyeglasses;
108.17    (3) (2) $3.50 for nonemergency visits to a hospital-based emergency room, except
108.18that this co-payment shall be increased to $20 upon federal approval;
108.19    (4) (3) $3 per brand-name drug prescription and $1 per generic drug prescription,
108.20subject to a $12 per month maximum for prescription drug co-payments. No co-payments
108.21shall apply to antipsychotic drugs when used for the treatment of mental illness;
108.22(5) (4) effective January 1, 2012, a family deductible equal to the maximum amount
108.23allowed under Code of Federal Regulations, title 42, part 447.54; and
108.24    (6) (5) for individuals identified by the commissioner with income at or below 100
108.25percent of the federal poverty guidelines, total monthly cost-sharing must not exceed five
108.26percent of family income. For purposes of this paragraph, family income is the total
108.27earned and unearned income of the individual and the individual's spouse, if the spouse is
108.28enrolled in medical assistance and also subject to the five percent limit on cost-sharing.
108.29    (b) Recipients of medical assistance are responsible for all co-payments and
108.30deductibles in this subdivision.

108.31    Sec. 13. Minnesota Statutes 2011 Supplement, section 256B.0631, subdivision 2,
108.32is amended to read:
108.33    Subd. 2. Exceptions. Co-payments and deductibles shall be subject to the following
108.34exceptions:
109.1(1) children under the age of 21;
109.2(2) pregnant women for services that relate to the pregnancy or any other medical
109.3condition that may complicate the pregnancy;
109.4(3) recipients expected to reside for at least 30 days in a hospital, nursing home, or
109.5intermediate care facility for the developmentally disabled;
109.6(4) recipients receiving hospice care;
109.7(5) 100 percent federally funded services provided by an Indian health service;
109.8(6) emergency services;
109.9(7) family planning services;
109.10(8) services that are paid by Medicare, resulting in the medical assistance program
109.11paying for the coinsurance and deductible; and
109.12(9) co-payments that exceed one per day per provider for nonpreventive visits,
109.13eyeglasses, and nonemergency visits to a hospital-based emergency room.; and
109.14(10) services, fee-for-service payments subject to volume purchase through
109.15competitive bidding.

109.16    Sec. 14. Minnesota Statutes 2010, section 256B.19, subdivision 1c, is amended to read:
109.17    Subd. 1c. Additional portion of nonfederal share. (a) Hennepin County shall
109.18be responsible for a monthly transfer payment of $1,500,000, due before noon on the
109.1915th of each month and the University of Minnesota shall be responsible for a monthly
109.20transfer payment of $500,000 due before noon on the 15th of each month, beginning July
109.2115, 1995. These sums shall be part of the designated governmental unit's portion of the
109.22nonfederal share of medical assistance costs.
109.23(b) Beginning July 1, 2001, Hennepin County's payment under paragraph (a) shall
109.24be $2,066,000 each month.
109.25(c) Beginning July 1, 2001, the commissioner shall increase annual capitation
109.26payments to the metropolitan health plan a demonstration provider serving eligible
109.27individuals in Hennepin County under section 256B.69 for the prepaid medical assistance
109.28program by approximately $6,800,000 to recognize higher than average medical education
109.29costs.
109.30(d) Effective August 1, 2005, Hennepin County's payment under paragraphs (a)
109.31and (b) shall be reduced to $566,000, and the University of Minnesota's payment under
109.32paragraph (a) shall be reduced to zero. Effective October 1, 2008, to December 31, 2010,
109.33Hennepin County's payment under paragraphs (a) and (b) shall be $434,688. Effective
109.34January 1, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be
109.35$566,000.
110.1(e) Notwithstanding paragraph (d), upon federal enactment of an extension to June
110.230, 2011, of the enhanced federal medical assistance percentage (FMAP) originally
110.3provided under Public Law 111-5, for the six-month period from January 1, 2011, to June
110.430, 2011, Hennepin County's payment under paragraphs (a) and (b) shall be $434,688.

110.5    Sec. 15. Minnesota Statutes 2010, section 256B.69, subdivision 5, is amended to read:
110.6    Subd. 5. Prospective per capita payment. The commissioner shall establish the
110.7method and amount of payments for services. The commissioner shall annually contract
110.8with demonstration providers to provide services consistent with these established
110.9methods and amounts for payment.
110.10If allowed by the commissioner, a demonstration provider may contract with
110.11an insurer, health care provider, nonprofit health service plan corporation, or the
110.12commissioner, to provide insurance or similar protection against the cost of care provided
110.13by the demonstration provider or to provide coverage against the risks incurred by
110.14demonstration providers under this section. The recipients enrolled with a demonstration
110.15provider are a permissible group under group insurance laws and chapter 62C, the
110.16Nonprofit Health Service Plan Corporations Act. Under this type of contract, the insurer
110.17or corporation may make benefit payments to a demonstration provider for services
110.18rendered or to be rendered to a recipient. Any insurer or nonprofit health service plan
110.19corporation licensed to do business in this state is authorized to provide this insurance or
110.20similar protection.
110.21Payments to providers participating in the project are exempt from the requirements
110.22of sections 256.966 and 256B.03, subdivision 2. The commissioner shall complete
110.23development of capitation rates for payments before delivery of services under this section
110.24is begun. For payments made during calendar year 1990 and later years, the commissioner
110.25shall contract with an independent actuary to establish prepayment rates.
110.26By January 15, 1996, the commissioner shall report to the legislature on the
110.27methodology used to allocate to participating counties available administrative
110.28reimbursement for advocacy and enrollment costs. The report shall reflect the
110.29commissioner's judgment as to the adequacy of the funds made available and of the
110.30methodology for equitable distribution of the funds. The commissioner must involve
110.31participating counties in the development of the report.
110.32Beginning July 1, 2004, the commissioner may include payments for elderly waiver
110.33services and 180 days of nursing home care in capitation payments for the prepaid medical
110.34assistance program for recipients age 65 and older. Payments for elderly waiver services
111.1shall be made no earlier than the month following the month in which services were
111.2received.

111.3    Sec. 16. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 5a,
111.4is amended to read:
111.5    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
111.6and section 256L.12 shall be entered into or renewed on a calendar year basis beginning
111.7January 1, 1996. Managed care contracts which were in effect on June 30, 1995, and set to
111.8renew on July 1, 1995, shall be renewed for the period July 1, 1995 through December
111.931, 1995 at the same terms that were in effect on June 30, 1995. The commissioner may
111.10issue separate contracts with requirements specific to services to medical assistance
111.11recipients age 65 and older.
111.12    (b) A prepaid health plan providing covered health services for eligible persons
111.13pursuant to chapters 256B and 256L is responsible for complying with the terms of its
111.14contract with the commissioner. Requirements applicable to managed care programs
111.15under chapters 256B and 256L established after the effective date of a contract with the
111.16commissioner take effect when the contract is next issued or renewed.
111.17    (c) Effective for services rendered on or after January 1, 2003, the commissioner
111.18shall withhold five percent of managed care plan payments under this section and
111.19county-based purchasing plan payments under section 256B.692 for the prepaid medical
111.20assistance program pending completion of performance targets. Each performance target
111.21must be quantifiable, objective, measurable, and reasonably attainable, except in the case
111.22of a performance target based on a federal or state law or rule. Criteria for assessment
111.23of each performance target must be outlined in writing prior to the contract effective
111.24date. Clinical or utilization performance targets and their related criteria must consider
111.25evidence-based research and reasonable interventions when available or applicable to
111.26the population served, and must be developed with input from external clinical experts
111.27and stakeholders, including managed care plans and providers. The managed care plan
111.28must demonstrate, to the commissioner's satisfaction, that the data submitted regarding
111.29attainment of the performance target is accurate. The commissioner shall periodically
111.30change the administrative measures used as performance targets in order to improve plan
111.31performance across a broader range of administrative services. The performance targets
111.32must include measurement of plan efforts to contain spending on health care services and
111.33administrative activities. The commissioner may adopt plan-specific performance targets
111.34that take into account factors affecting only one plan, including characteristics of the
111.35plan's enrollee population. The withheld funds must be returned no sooner than July of the
112.1following year if performance targets in the contract are achieved. The commissioner may
112.2exclude special demonstration projects under subdivision 23.
112.3    (d) Effective for services rendered on or after January 1, 2009, through December
112.431, 2009, the commissioner shall withhold three percent of managed care plan payments
112.5under this section and county-based purchasing plan payments under section 256B.692
112.6for the prepaid medical assistance program. The withheld funds must be returned no
112.7sooner than July 1 and no later than July 31 of the following year. The commissioner may
112.8exclude special demonstration projects under subdivision 23.
112.9    (e) Effective for services provided on or after January 1, 2010, the commissioner
112.10shall require that managed care plans use the assessment and authorization processes,
112.11forms, timelines, standards, documentation, and data reporting requirements, protocols,
112.12billing processes, and policies consistent with medical assistance fee-for-service or the
112.13Department of Human Services contract requirements consistent with medical assistance
112.14fee-for-service or the Department of Human Services contract requirements for all
112.15personal care assistance services under section 256B.0659.
112.16    (f) Effective for services rendered on or after January 1, 2010, through December
112.1731, 2010, the commissioner shall withhold 4.5 percent of managed care plan payments
112.18under this section and county-based purchasing plan payments under section 256B.692
112.19for the prepaid medical assistance program. The withheld funds must be returned no
112.20sooner than July 1 and no later than July 31 of the following year. The commissioner may
112.21exclude special demonstration projects under subdivision 23.
112.22    (g) Effective for services rendered on or after January 1, 2011, through December
112.2331, 2011, the commissioner shall include as part of the performance targets described
112.24in paragraph (c) a reduction in the health plan's emergency room utilization rate for
112.25state health care program enrollees by a measurable rate of five percent from the plan's
112.26utilization rate for state health care program enrollees for the previous calendar year.
112.27Effective for services rendered on or after January 1, 2012, the commissioner shall include
112.28as part of the performance targets described in paragraph (c) a reduction in the health plan's
112.29emergency department utilization rate for medical assistance and MinnesotaCare enrollees,
112.30as determined by the commissioner. For 2012, the reduction shall be based on the health
112.31plan's utilization in 2009. To earn the return of the withhold each subsequent year, the
112.32managed care plan or county-based purchasing plan must achieve a qualifying reduction
112.33of no less than ten percent of the plan's emergency department utilization rate for medical
112.34assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs
112.35described in subdivisions 23 and 28, compared to the previous calendar measurement
112.36year, until the final performance target is reached. When measuring performance, the
113.1commissioner must consider the difference in health risk in a plan's membership in the
113.2baseline year compared to the measurement year and work with the managed care or
113.3county-based purchasing plan to account for differences that they agree are significant.
113.4    The withheld funds must be returned no sooner than July 1 and no later than July 31
113.5of the following calendar year if the managed care plan or county-based purchasing plan
113.6demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
113.7was achieved. The commissioner shall structure the withhold so that the commissioner
113.8returns a portion of the withheld funds in amounts commensurate with achieved reductions
113.9in utilization less than the targeted amount.
113.10    The withhold described in this paragraph shall continue for each consecutive
113.11contract period until the plan's emergency room utilization rate for state health care
113.12program enrollees is reduced by 25 percent of the plan's emergency room utilization
113.13rate for medical assistance and MinnesotaCare enrollees for calendar year 2011 2009.
113.14Hospitals shall cooperate with the health plans in meeting this performance target and
113.15shall accept payment withholds that may be returned to the hospitals if the performance
113.16target is achieved.
113.17    (h) Effective for services rendered on or after January 1, 2012, the commissioner
113.18shall include as part of the performance targets described in paragraph (c) a reduction
113.19in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
113.20enrollees, as determined by the commissioner. To earn the return of the withhold each
113.21year, the managed care plan or county-based purchasing plan must achieve a qualifying
113.22reduction of no less than five percent of the plan's hospital admission rate for medical
113.23assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs
113.24described in subdivisions 23 and 28, compared to the previous calendar year until the final
113.25performance target is reached. When measuring performance, the commissioner must
113.26consider the difference in health risk in a plan's membership in the baseline year compared
113.27to the measurement year, and work with the managed care or county-based purchasing
113.28plan to account for differences that they agree are significant.
113.29    The withheld funds must be returned no sooner than July 1 and no later than July
113.3031 of the following calendar year if the managed care plan or county-based purchasing
113.31plan demonstrates to the satisfaction of the commissioner that this reduction in the
113.32hospitalization rate was achieved. The commissioner shall structure the withhold so that
113.33the commissioner returns a portion of the withheld funds in amounts commensurate with
113.34achieved reductions in utilization less than the targeted amount.
113.35    The withhold described in this paragraph shall continue until there is a 25 percent
113.36reduction in the hospital admission rate compared to the hospital admission rates in
114.1calendar year 2011, as determined by the commissioner. The hospital admissions in this
114.2performance target do not include the admissions applicable to the subsequent hospital
114.3admission performance target under paragraph (i). Hospitals shall cooperate with the
114.4plans in meeting this performance target and shall accept payment withholds that may be
114.5returned to the hospitals if the performance target is achieved.
114.6    (i) Effective for services rendered on or after January 1, 2012, the commissioner
114.7shall include as part of the performance targets described in paragraph (c) a reduction in
114.8the plan's hospitalization admission rates for subsequent hospitalizations within 30 days
114.9of a previous hospitalization of a patient regardless of the reason, for medical assistance
114.10and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of
114.11the withhold each year, the managed care plan or county-based purchasing plan must
114.12achieve a qualifying reduction of the subsequent hospitalization rate for medical assistance
114.13and MinnesotaCare enrollees, excluding Medicare enrollees in programs described in
114.14subdivisions 23 and 28, of no less than five percent compared to the previous calendar
114.15year until the final performance target is reached.
114.16    The withheld funds must be returned no sooner than July 1 and no later than July
114.1731 of the following calendar year if the managed care plan or county-based purchasing
114.18plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in
114.19the subsequent hospitalization rate was achieved. The commissioner shall structure the
114.20withhold so that the commissioner returns a portion of the withheld funds in amounts
114.21commensurate with achieved reductions in utilization less than the targeted amount.
114.22    The withhold described in this paragraph must continue for each consecutive
114.23contract period until the plan's subsequent hospitalization rate for medical assistance
114.24and MinnesotaCare enrollees, excluding Medicare enrollees in programs described in
114.25subdivisions 23 and 28, is reduced by 25 percent of the plan's subsequent hospitalization
114.26rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this
114.27performance target and shall accept payment withholds that must be returned to the
114.28hospitals if the performance target is achieved.
114.29    (j) Effective for services rendered on or after January 1, 2011, through December 31,
114.302011, the commissioner shall withhold 4.5 percent of managed care plan payments under
114.31this section and county-based purchasing plan payments under section 256B.692 for the
114.32prepaid medical assistance program. The withheld funds must be returned no sooner than
114.33July 1 and no later than July 31 of the following year. The commissioner may exclude
114.34special demonstration projects under subdivision 23.
114.35    (k) Effective for services rendered on or after January 1, 2012, through December
114.3631, 2012, the commissioner shall withhold 4.5 percent of managed care plan payments
115.1under this section and county-based purchasing plan payments under section 256B.692
115.2for the prepaid medical assistance program. The withheld funds must be returned no
115.3sooner than July 1 and no later than July 31 of the following year. The commissioner may
115.4exclude special demonstration projects under subdivision 23.
115.5    (l) Effective for services rendered on or after January 1, 2013, through December 31,
115.62013, the commissioner shall withhold 4.5 percent of managed care plan payments under
115.7this section and county-based purchasing plan payments under section 256B.692 for the
115.8prepaid medical assistance program. The withheld funds must be returned no sooner than
115.9July 1 and no later than July 31 of the following year. The commissioner may exclude
115.10special demonstration projects under subdivision 23.
115.11    (m) Effective for services rendered on or after January 1, 2014, the commissioner
115.12shall withhold three percent of managed care plan payments under this section and
115.13county-based purchasing plan payments under section 256B.692 for the prepaid medical
115.14assistance program. The withheld funds must be returned no sooner than July 1 and
115.15no later than July 31 of the following year. The commissioner may exclude special
115.16demonstration projects under subdivision 23.
115.17    (n) A managed care plan or a county-based purchasing plan under section 256B.692
115.18may include as admitted assets under section 62D.044 any amount withheld under this
115.19section that is reasonably expected to be returned.
115.20    (o) Contracts between the commissioner and a prepaid health plan are exempt from
115.21the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph
115.22(a), and 7.
115.23    (p) The return of the withhold under paragraphs (d), (f), and (j) to (m) is not subject
115.24to the requirements of paragraph (c).

115.25    Sec. 17. Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 28,
115.26is amended to read:
115.27    Subd. 28. Medicare special needs plans; medical assistance basic health
115.28care. (a) The commissioner may contract with demonstration providers and current or
115.29former sponsors of qualified Medicare-approved special needs plans, to provide medical
115.30assistance basic health care services to persons with disabilities, including those with
115.31developmental disabilities. Basic health care services include:
115.32    (1) those services covered by the medical assistance state plan except for ICF/MR
115.33services, home and community-based waiver services, case management for persons with
115.34developmental disabilities under section 256B.0625, subdivision 20a, and personal care
116.1and certain home care services defined by the commissioner in consultation with the
116.2stakeholder group established under paragraph (d); and
116.3    (2) basic health care services may also include risk for up to 100 days of nursing
116.4facility services for persons who reside in a noninstitutional setting and home health
116.5services related to rehabilitation as defined by the commissioner after consultation with
116.6the stakeholder group.
116.7    The commissioner may exclude other medical assistance services from the basic
116.8health care benefit set. Enrollees in these plans can access any excluded services on the
116.9same basis as other medical assistance recipients who have not enrolled.
116.10    (b) Beginning January 1, 2007, the commissioner may contract with demonstration
116.11providers and current and former sponsors of qualified Medicare special needs plans, to
116.12provide basic health care services under medical assistance to persons who are dually
116.13eligible for both Medicare and Medicaid and those Social Security beneficiaries eligible
116.14for Medicaid but in the waiting period for Medicare. The commissioner shall consult with
116.15the stakeholder group under paragraph (d) in developing program specifications for these
116.16services. The commissioner shall report to the chairs of the house of representatives and
116.17senate committees with jurisdiction over health and human services policy and finance by
116.18February 1, 2007, on implementation of these programs and the need for increased funding
116.19for the ombudsman for managed care and other consumer assistance and protections
116.20needed due to enrollment in managed care of persons with disabilities. Payment for
116.21Medicaid services provided under this subdivision for the months of May and June will
116.22be made no earlier than July 1 of the same calendar year.
116.23    (c) Notwithstanding subdivision 4, beginning January 1, 2012, the commissioner
116.24shall enroll persons with disabilities in managed care under this section, unless the
116.25individual chooses to opt out of enrollment. The commissioner shall establish enrollment
116.26and opt out procedures consistent with applicable enrollment procedures under this
116.27subdivision section.
116.28    (d) The commissioner shall establish a state-level stakeholder group to provide
116.29advice on managed care programs for persons with disabilities, including both MnDHO
116.30and contracts with special needs plans that provide basic health care services as described
116.31in paragraphs (a) and (b). The stakeholder group shall provide advice on program
116.32expansions under this subdivision and subdivision 23, including:
116.33    (1) implementation efforts;
116.34    (2) consumer protections; and
116.35    (3) program specifications such as quality assurance measures, data collection and
116.36reporting, and evaluation of costs, quality, and results.
117.1    (e) Each plan under contract to provide medical assistance basic health care services
117.2shall establish a local or regional stakeholder group, including representatives of the
117.3counties covered by the plan, members, consumer advocates, and providers, for advice on
117.4issues that arise in the local or regional area.
117.5    (f) The commissioner is prohibited from providing the names of potential enrollees
117.6to health plans for marketing purposes. The commissioner shall mail no more than
117.7two sets of marketing materials per contract year to potential enrollees on behalf of
117.8health plans, at the health plan's request. The marketing materials shall be mailed by the
117.9commissioner within 30 days of receipt of these materials from the health plan. The health
117.10plans shall cover any costs incurred by the commissioner for mailing marketing materials.

117.11    Sec. 18. Minnesota Statutes 2010, section 256L.05, subdivision 3, is amended to read:
117.12    Subd. 3. Effective date of coverage. (a) The effective date of coverage is the
117.13first day of the month following the month in which eligibility is approved and the first
117.14premium payment has been received. As provided in section 256B.057, coverage for
117.15newborns is automatic from the date of birth and must be coordinated with other health
117.16coverage. The effective date of coverage for eligible newly adoptive children added to a
117.17family receiving covered health services is the month of placement. The effective date
117.18of coverage for other new members added to the family is the first day of the month
117.19following the month in which the change is reported. All eligibility criteria must be met
117.20by the family at the time the new family member is added. The income of the new family
117.21member is included with the family's gross income and the adjusted premium begins in
117.22the month the new family member is added.
117.23(b) The initial premium must be received by the last working day of the month for
117.24coverage to begin the first day of the following month.
117.25(c) Benefits are not available until the day following discharge if an enrollee is
117.26hospitalized on the first day of coverage.
117.27(d) Notwithstanding any other law to the contrary, benefits under sections 256L.01 to
117.28256L.18 are secondary to a plan of insurance or benefit program under which an eligible
117.29person may have coverage and the commissioner shall use cost avoidance techniques to
117.30ensure coordination of any other health coverage for eligible persons. The commissioner
117.31shall identify eligible persons who may have coverage or benefits under other plans of
117.32insurance or who become eligible for medical assistance.
117.33(e) The effective date of coverage for individuals or families who are exempt from
117.34paying premiums under section 256L.15, subdivision 1, paragraph (d), is the first day of
118.1the month following the month in which verification of American Indian status is received
118.2or eligibility is approved, whichever is later.

118.3    Sec. 19. Minnesota Statutes 2011 Supplement, section 256L.12, subdivision 9, is
118.4amended to read:
118.5    Subd. 9. Rate setting; performance withholds. (a) Rates will be prospective,
118.6per capita, where possible. The commissioner may allow health plans to arrange for
118.7inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
118.8an independent actuary to determine appropriate rates.
118.9    (b) For services rendered on or after January 1, 2004, the commissioner shall
118.10withhold five percent of managed care plan payments and county-based purchasing
118.11plan payments under this section pending completion of performance targets. Each
118.12performance target must be quantifiable, objective, measurable, and reasonably attainable,
118.13except in the case of a performance target based on a federal or state law or rule. Criteria
118.14for assessment of each performance target must be outlined in writing prior to the contract
118.15effective date. Clinical or utilization performance targets and their related criteria must
118.16consider evidence-based research and reasonable interventions, when available or
118.17applicable to the populations served, and must be developed with input from external
118.18clinical experts and stakeholders, including managed care plans and providers. The
118.19managed care plan must demonstrate, to the commissioner's satisfaction, that the data
118.20submitted regarding attainment of the performance target is accurate. The commissioner
118.21shall periodically change the administrative measures used as performance targets in
118.22order to improve plan performance across a broader range of administrative services.
118.23The performance targets must include measurement of plan efforts to contain spending
118.24on health care services and administrative activities. The commissioner may adopt
118.25plan-specific performance targets that take into account factors affecting only one plan,
118.26such as characteristics of the plan's enrollee population. The withheld funds must be
118.27returned no sooner than July 1 and no later than July 31 of the following calendar year if
118.28performance targets in the contract are achieved.
118.29    (c) For services rendered on or after January 1, 2011, the commissioner shall
118.30withhold an additional three percent of managed care plan or county-based purchasing
118.31plan payments under this section. The withheld funds must be returned no sooner than
118.32July 1 and no later than July 31 of the following calendar year. The return of the withhold
118.33under this paragraph is not subject to the requirements of paragraph (b).
118.34    (d) Effective for services rendered on or after January 1, 2011, through December
118.3531, 2011, the commissioner shall include as part of the performance targets described in
119.1paragraph (b) a reduction in the plan's emergency room utilization rate for state health
119.2care program enrollees by a measurable rate of five percent from the plan's utilization
119.3rate for the previous calendar year. Effective for services rendered on or after January
119.41, 2012, the commissioner shall include as part of the performance targets described in
119.5paragraph (b) a reduction in the health plan's emergency department utilization rate for
119.6medical assistance and MinnesotaCare enrollees, as determined by the commissioner.
119.7For 2012, the reduction shall be based on the health plan's utilization in 2009. To earn
119.8the return of the withhold each subsequent year, the managed care plan or county-based
119.9purchasing plan must achieve a qualifying reduction of no less than ten percent of the
119.10plan's utilization rate for medical assistance and MinnesotaCare enrollees, excluding
119.11Medicare enrollees in programs described in section 256B.69, subdivisions 23 and 28,
119.12compared to the previous calendar measurement year, until the final performance target is
119.13reached. When measuring performance, the commissioner must consider the difference
119.14in health risk in a plan's membership in the baseline year compared to the measurement
119.15year, and work with the managed care or county-based purchasing plan to account for
119.16differences that they agree are significant.
119.17    The withheld funds must be returned no sooner than July 1 and no later than July 31
119.18of the following calendar year if the managed care plan or county-based purchasing plan
119.19demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
119.20was achieved. The commissioner shall structure the withhold so that the commissioner
119.21returns a portion of the withheld funds in amounts commensurate with achieved reductions
119.22in utilization less than the targeted amount.
119.23    The withhold described in this paragraph shall continue for each consecutive
119.24contract period until the plan's emergency room utilization rate for state health care
119.25program enrollees is reduced by 25 percent of the plan's emergency room utilization
119.26rate for medical assistance and MinnesotaCare enrollees for calendar year 2011 2009.
119.27Hospitals shall cooperate with the health plans in meeting this performance target and
119.28shall accept payment withholds that may be returned to the hospitals if the performance
119.29target is achieved.
119.30    (e) Effective for services rendered on or after January 1, 2012, the commissioner
119.31shall include as part of the performance targets described in paragraph (b) a reduction
119.32in the plan's hospitalization admission rate for medical assistance and MinnesotaCare
119.33enrollees, as determined by the commissioner. To earn the return of the withhold each
119.34year, the managed care plan or county-based purchasing plan must achieve a qualifying
119.35reduction of no less than five percent of the plan's hospital admission rate for medical
119.36assistance and MinnesotaCare enrollees, excluding Medicare enrollees in programs
120.1described in section 256B.69, subdivisions 23 and 28, compared to the previous calendar
120.2year, until the final performance target is reached. When measuring performance, the
120.3commissioner must consider the difference in health risk in a plan's membership in the
120.4baseline year compared to the measurement year, and work with the managed care or
120.5county-based purchasing plan to account for differences that they agree are significant.
120.6    The withheld funds must be returned no sooner than July 1 and no later than July
120.731 of the following calendar year if the managed care plan or county-based purchasing
120.8plan demonstrates to the satisfaction of the commissioner that this reduction in the
120.9hospitalization rate was achieved. The commissioner shall structure the withhold so that
120.10the commissioner returns a portion of the withheld funds in amounts commensurate with
120.11achieved reductions in utilization less than the targeted amount.
120.12    The withhold described in this paragraph shall continue until there is a 25 percent
120.13reduction in the hospitals admission rate compared to the hospital admission rate for
120.14calendar year 2011 as determined by the commissioner. Hospitals shall cooperate with the
120.15plans in meeting this performance target and shall accept payment withholds that may be
120.16returned to the hospitals if the performance target is achieved. The hospital admissions
120.17in this performance target do not include the admissions applicable to the subsequent
120.18hospital admission performance target under paragraph (f).
120.19    (f) Effective for services provided on or after January 1, 2012, the commissioner
120.20shall include as part of the performance targets described in paragraph (b) a reduction
120.21in the plan's hospitalization rate for a subsequent hospitalization within 30 days of a
120.22previous hospitalization of a patient regardless of the reason, for medical assistance and
120.23MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the
120.24withhold each year, the managed care plan or county-based purchasing plan must achieve
120.25a qualifying reduction of the subsequent hospital admissions rate for medical assistance
120.26and MinnesotaCare enrollees, excluding Medicare enrollees in programs described in
120.27section 256B.69, subdivisions 23 and 28, of no less than five percent compared to the
120.28previous calendar year until the final performance target is reached.
120.29    The withheld funds must be returned no sooner than July 1 and no later than July 31
120.30of the following calendar year if the managed care plan or county-based purchasing plan
120.31demonstrates to the satisfaction of the commissioner that a reduction in the subsequent
120.32hospitalization rate was achieved. The commissioner shall structure the withhold so that
120.33the commissioner returns a portion of the withheld funds in amounts commensurate with
120.34achieved reductions in utilization less than the targeted amount.
120.35    The withhold described in this paragraph must continue for each consecutive
120.36contract period until the plan's subsequent hospitalization rate for medical assistance and
121.1MinnesotaCare enrollees is reduced by 25 percent of the plan's subsequent hospitalization
121.2rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this
121.3performance target and shall accept payment withholds that must be returned to the
121.4hospitals if the performance target is achieved.
121.5    (g) A managed care plan or a county-based purchasing plan under section 256B.692
121.6may include as admitted assets under section 62D.044 any amount withheld under this
121.7section that is reasonably expected to be returned.

121.8    Sec. 20. Minnesota Statutes 2011 Supplement, section 256L.15, subdivision 1, is
121.9amended to read:
121.10    Subdivision 1. Premium determination. (a) Families with children and individuals
121.11shall pay a premium determined according to subdivision 2.
121.12    (b) Pregnant women and children under age two are exempt from the provisions
121.13of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
121.14for failure to pay premiums. For pregnant women, this exemption continues until the
121.15first day of the month following the 60th day postpartum. Women who remain enrolled
121.16during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
121.17disenrolled on the first of the month following the 60th day postpartum for the penalty
121.18period that otherwise applies under section 256L.06, unless they begin paying premiums.
121.19    (c) Members of the military and their families who meet the eligibility criteria
121.20for MinnesotaCare upon eligibility approval made within 24 months following the end
121.21of the member's tour of active duty shall have their premiums paid by the commissioner.
121.22The effective date of coverage for an individual or family who meets the criteria of this
121.23paragraph shall be the first day of the month following the month in which eligibility is
121.24approved. This exemption applies for 12 months.
121.25(d) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and their
121.26families shall have their premiums waived by the commissioner in accordance with
121.27section 5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5.
121.28An individual must document status as an American Indian, as defined under Code of
121.29Federal Regulations, title 42, section 447.50, to qualify for the waiver of premiums.
121.30EFFECTIVE DATE.This section is effective retroactively from July 1, 2009.

121.31    Sec. 21. Minnesota Statutes 2010, section 514.982, subdivision 1, is amended to read:
121.32    Subdivision 1. Contents. A medical assistance lien notice must be dated and
121.33must contain:
122.1(1) the full name, last known address, and last four digits of the Social Security
122.2number of the medical assistance recipient;
122.3(2) a statement that medical assistance payments have been made to or for the
122.4benefit of the medical assistance recipient named in the notice, specifying the first date
122.5of eligibility for benefits;
122.6(3) a statement that all interests in real property owned by the persons named in the
122.7notice may be subject to or affected by the rights of the agency to be reimbursed for
122.8medical assistance benefits; and
122.9(4) the legal description of the real property upon which the lien attaches, and
122.10whether the property is registered property.

122.11    Sec. 22. HEALTH SERVICES ADVISORY COUNCIL.
122.12The Health Services Advisory Council shall review currently available literature
122.13regarding the efficacy of various treatments for autism spectrum disorder, including
122.14an evaluation of age-based variation in the appropriateness of existing medical and
122.15behavioral interventions. The council shall recommend to the commissioner of human
122.16services authorization criteria for services based on existing evidence. The council may
122.17recommend coverage with ongoing collection of outcomes evidence in circumstances
122.18where evidence is currently unavailable, or where the strength of the evidence is low. The
122.19council shall make this recommendation by December 31, 2012.

122.20    Sec. 23. REPEALER.
122.21Minnesota Statutes 2010, section 256.01, subdivision 18b, is repealed.


122.24    Section 1. Minnesota Statutes 2010, section 144A.071, subdivision 5a, is amended to
122.25read:
122.26    Subd. 5a. Cost estimate of a moratorium exception project. (a) For the
122.27purposes of this section and section 144A.073, the cost estimate of a moratorium
122.28exception project shall include the effects of the proposed project on the costs of the state
122.29subsidy for community-based services, nursing services, and housing in institutional
122.30and noninstitutional settings. The commissioner of health, in cooperation with the
122.31commissioner of human services, shall define the method for estimating these costs in the
122.32permanent rule implementing section 144A.073. The commissioner of human services
123.1shall prepare an estimate of the total state annual long-term costs of each moratorium
123.2exception proposal.
123.3    (b) The interest rate to be used for estimating the cost of each moratorium exception
123.4project proposal shall be the lesser of either the prime rate plus two percentage points, or
123.5the posted yield for standard conventional fixed rate mortgages of the Federal Home Loan
123.6Mortgage Corporation plus two percentage points as published in the Wall Street Journal
123.7and in effect 56 days prior to the application deadline. If the applicant's proposal uses this
123.8interest rate, the commissioner of human services, in determining the facility's actual
123.9property-related payment rate to be established upon completion of the project must use
123.10the actual interest rate obtained by the facility for the project's permanent financing up to
123.11the maximum permitted under subdivision 6 Minnesota Rules, part 9549.0060, subpart 6.
123.12    The applicant may choose an alternate interest rate for estimating the project's cost.
123.13If the applicant makes this election, the commissioner of human services, in determining
123.14the facility's actual property-related payment rate to be established upon completion of the
123.15project, must use the lesser of the actual interest rate obtained for the project's permanent
123.16financing or the interest rate which was used to estimate the proposal's project cost. For
123.17succeeding rate years, the applicant is at risk for financing costs in excess of the interest
123.18rate selected.

123.19    Sec. 2. REVISOR'S INSTRUCTION.
123.20    (a) In Minnesota Statutes, sections 256B.038, 256B.0911, 256B.0918, 256B.092,
123.21256B.097, 256B.49, and 256B.765, the revisor of statutes shall delete the word "traumatic"
123.22when it comes before the word "brain."
123.23    (b) In Minnesota Statutes, section 256B.093, subdivision 1, clauses (4) and (5), and
123.24subdivision 3, clause (2), the revisor of statutes shall delete the word "traumatic" when it
123.25comes before the word "brain."
123.26    (c) In Minnesota Statutes, sections 144.0724 and 144G.05, the revisor of statutes
123.27shall delete "TBI" and replace it with "BI.""
123.28Renumber the sections in sequence and correct the internal references
123.29Amend the title accordingly