1.1.................... moves to amend H.F. No. 2150 as follows:
1.2Delete everything after the enacting clause and insert:

1.3"ARTICLE 1

1.4HEALTH DEPARTMENT

1.5    Section 1. Minnesota Statutes 2012, section 144.551, subdivision 1, is amended to read:
1.6    Subdivision 1. Restricted construction or modification. (a) The following
1.7construction or modification may not be commenced:
1.8(1) any erection, building, alteration, reconstruction, modernization, improvement,
1.9extension, lease, or other acquisition by or on behalf of a hospital that increases the bed
1.10capacity of a hospital, relocates hospital beds from one physical facility, complex, or site
1.11to another, or otherwise results in an increase or redistribution of hospital beds within
1.12the state; and
1.13(2) the establishment of a new hospital.
1.14(b) This section does not apply to:
1.15(1) construction or relocation within a county by a hospital, clinic, or other health
1.16care facility that is a national referral center engaged in substantial programs of patient
1.17care, medical research, and medical education meeting state and national needs that
1.18receives more than 40 percent of its patients from outside the state of Minnesota;
1.19(2) a project for construction or modification for which a health care facility held
1.20an approved certificate of need on May 1, 1984, regardless of the date of expiration of
1.21the certificate;
1.22(3) a project for which a certificate of need was denied before July 1, 1990, if a
1.23timely appeal results in an order reversing the denial;
1.24(4) a project exempted from certificate of need requirements by Laws 1981, chapter
1.25200, section 2;
2.1(5) a project involving consolidation of pediatric specialty hospital services within
2.2the Minneapolis-St. Paul metropolitan area that would not result in a net increase in the
2.3number of pediatric specialty hospital beds among the hospitals being consolidated;
2.4(6) a project involving the temporary relocation of pediatric-orthopedic hospital beds
2.5to an existing licensed hospital that will allow for the reconstruction of a new philanthropic,
2.6pediatric-orthopedic hospital on an existing site and that will not result in a net increase in
2.7the number of hospital beds. Upon completion of the reconstruction, the licenses of both
2.8hospitals must be reinstated at the capacity that existed on each site before the relocation;
2.9(7) the relocation or redistribution of hospital beds within a hospital building or
2.10identifiable complex of buildings provided the relocation or redistribution does not result
2.11in: (i) an increase in the overall bed capacity at that site; (ii) relocation of hospital beds
2.12from one physical site or complex to another; or (iii) redistribution of hospital beds within
2.13the state or a region of the state;
2.14(8) relocation or redistribution of hospital beds within a hospital corporate system
2.15that involves the transfer of beds from a closed facility site or complex to an existing site
2.16or complex provided that: (i) no more than 50 percent of the capacity of the closed facility
2.17is transferred; (ii) the capacity of the site or complex to which the beds are transferred
2.18does not increase by more than 50 percent; (iii) the beds are not transferred outside of a
2.19federal health systems agency boundary in place on July 1, 1983; and (iv) the relocation or
2.20redistribution does not involve the construction of a new hospital building;
2.21(9) a construction project involving up to 35 new beds in a psychiatric hospital in
2.22Rice County that primarily serves adolescents and that receives more than 70 percent of its
2.23patients from outside the state of Minnesota;
2.24(10) a project to replace a hospital or hospitals with a combined licensed capacity
2.25of 130 beds or less if: (i) the new hospital site is located within five miles of the current
2.26site; and (ii) the total licensed capacity of the replacement hospital, either at the time of
2.27construction of the initial building or as the result of future expansion, will not exceed 70
2.28licensed hospital beds, or the combined licensed capacity of the hospitals, whichever is less;
2.29(11) the relocation of licensed hospital beds from an existing state facility operated
2.30by the commissioner of human services to a new or existing facility, building, or complex
2.31operated by the commissioner of human services; from one regional treatment center
2.32site to another; or from one building or site to a new or existing building or site on the
2.33same campus;
2.34(12) the construction or relocation of hospital beds operated by a hospital having a
2.35statutory obligation to provide hospital and medical services for the indigent that does not
2.36result in a net increase in the number of hospital beds, notwithstanding section 144.552, 27
3.1beds, of which 12 serve mental health needs, may be transferred from Hennepin County
3.2Medical Center to Regions Hospital under this clause;
3.3(13) a construction project involving the addition of up to 31 new beds in an existing
3.4nonfederal hospital in Beltrami County;
3.5(14) a construction project involving the addition of up to eight new beds in an
3.6existing nonfederal hospital in Otter Tail County with 100 licensed acute care beds;
3.7(15) a construction project involving the addition of 20 new hospital beds
3.8used for rehabilitation services in an existing hospital in Carver County serving the
3.9southwest suburban metropolitan area. Beds constructed under this clause shall not be
3.10eligible for reimbursement under medical assistance, general assistance medical care,
3.11or MinnesotaCare;
3.12(16) a project for the construction or relocation of up to 20 hospital beds for the
3.13operation of up to two psychiatric facilities or units for children provided that the operation
3.14of the facilities or units have received the approval of the commissioner of human services;
3.15(17) a project involving the addition of 14 new hospital beds to be used for
3.16rehabilitation services in an existing hospital in Itasca County;
3.17(18) a project to add 20 licensed beds in existing space at a hospital in Hennepin
3.18County that closed 20 rehabilitation beds in 2002, provided that the beds are used only
3.19for rehabilitation in the hospital's current rehabilitation building. If the beds are used for
3.20another purpose or moved to another location, the hospital's licensed capacity is reduced
3.21by 20 beds;
3.22(19) a critical access hospital established under section 144.1483, clause (9), and
3.23section 1820 of the federal Social Security Act, United States Code, title 42, section
3.241395i-4, that delicensed beds since enactment of the Balanced Budget Act of 1997, Public
3.25Law 105-33, to the extent that the critical access hospital does not seek to exceed the
3.26maximum number of beds permitted such hospital under federal law;
3.27(20) notwithstanding section 144.552, a project for the construction of a new hospital
3.28in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:
3.29(i) the project, including each hospital or health system that will own or control the
3.30entity that will hold the new hospital license, is approved by a resolution of the Maple
3.31Grove City Council as of March 1, 2006;
3.32(ii) the entity that will hold the new hospital license will be owned or controlled by
3.33one or more not-for-profit hospitals or health systems that have previously submitted a
3.34plan or plans for a project in Maple Grove as required under section 144.552, and the
3.35plan or plans have been found to be in the public interest by the commissioner of health
3.36as of April 1, 2005;
4.1(iii) the new hospital's initial inpatient services must include, but are not limited
4.2to, medical and surgical services, obstetrical and gynecological services, intensive
4.3care services, orthopedic services, pediatric services, noninvasive cardiac diagnostics,
4.4behavioral health services, and emergency room services;
4.5(iv) the new hospital:
4.6(A) will have the ability to provide and staff sufficient new beds to meet the growing
4.7needs of the Maple Grove service area and the surrounding communities currently being
4.8served by the hospital or health system that will own or control the entity that will hold
4.9the new hospital license;
4.10(B) will provide uncompensated care;
4.11(C) will provide mental health services, including inpatient beds;
4.12(D) will be a site for workforce development for a broad spectrum of
4.13health-care-related occupations and have a commitment to providing clinical training
4.14programs for physicians and other health care providers;
4.15(E) will demonstrate a commitment to quality care and patient safety;
4.16(F) will have an electronic medical records system, including physician order entry;
4.17(G) will provide a broad range of senior services;
4.18(H) will provide emergency medical services that will coordinate care with regional
4.19providers of trauma services and licensed emergency ambulance services in order to
4.20enhance the continuity of care for emergency medical patients; and
4.21(I) will be completed by December 31, 2009, unless delayed by circumstances
4.22beyond the control of the entity holding the new hospital license; and
4.23(v) as of 30 days following submission of a written plan, the commissioner of health
4.24has not determined that the hospitals or health systems that will own or control the entity
4.25that will hold the new hospital license are unable to meet the criteria of this clause;
4.26(21) a project approved under section 144.553;
4.27(22) a project for the construction of a hospital with up to 25 beds in Cass County
4.28within a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's
4.29license holder is approved by the Cass County Board;
4.30(23) a project for an acute care hospital in Fergus Falls that will increase the bed
4.31capacity from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16
4.32and closing a separately licensed 13-bed skilled nursing facility; or
4.33(24) notwithstanding section 144.552, a project for the construction and expansion
4.34of a specialty psychiatric hospital in Hennepin County for up to 50 beds, exclusively for
4.35patients who are under 21 years of age on the date of admission. The commissioner
4.36conducted a public interest review of the mental health needs of Minnesota and the Twin
5.1Cities metropolitan area in 2008. No further public interest review shall be conducted for
5.2the construction or expansion project under this clause; or
5.3(25) notwithstanding section 144.552, a project for a 25-bed psychiatric hospital
5.4in the city of Thief River Falls.

5.5    Sec. 2. [144.9513] HEALTHY HOUSING GRANTS.
5.6    Subdivision 1. Definitions. For purposes of this section and sections 144.9501 to
5.7144.9512, the following terms have the meanings given.
5.8(a) "Housing" means a room or group of rooms located within a dwelling forming
5.9a single habitable unit with facilities used or intended to be used for living, sleeping,
5.10cooking, and eating.
5.11(b) "Healthy housing" means housing that is sited, designed, built, renovated, and
5.12maintained in ways that supports the health of residents.
5.13(c) "Housing-based health threat" means a chemical, biologic, or physical agent in
5.14the immediate housing environment which constitutes a potential or actual hazard to
5.15human health at acute or chronic exposure levels.
5.16(d) "Primary prevention" means preventing exposure to housing-based health threats
5.17before seeing clinical symptoms or a diagnosis.
5.18    Subd. 2. Grants; administration. Grant applicants shall submit applications to
5.19the commissioner as directed by a request for proposals. Grants must be competitively
5.20awarded and recipients of a grant under this section must prepare and submit a quarterly
5.21progress report to the commissioner beginning three months after receipt of the grant. The
5.22commissioner shall provide technical assistance and program support as needed to ensure
5.23that housing-based health threats are effectively identified, mitigated, and evaluated by
5.24grantees.
5.25    Subd. 3. Education and training grant; eligible activities. (a) Within the limits of
5.26available appropriations, the commissioner shall make grants to nonprofit organizations
5.27with expertise in providing outreach, education, and training on healthy homes subjects
5.28and in providing comprehensive healthy homes assessments and interventions to provide
5.29healthy housing education, training, and technical assistance services for persons
5.30engaged in addressing housing-based health threats and other individuals impacted by
5.31housing-based health threats.
5.32(b) The grantee may conduct the following activities:
5.33(1) implement and maintain primary prevention programs to reduce housing-based
5.34health threats that include the following:
6.1(i) providing education materials to the general public and to property owners,
6.2contractors, code officials, health care providers, public health professionals, health
6.3educators, nonprofit organizations, and other persons and organizations engaged in
6.4housing and health issues;
6.5(ii) promoting awareness of community, legal, and housing resources; and
6.6(iii) promoting the use of hazard reduction measures in new housing construction
6.7and housing rehabilitation programs;
6.8(2) provide training on identifying and addressing housing-based health threats;
6.9(3) provide technical assistance on the implementation of mitigation measures;
6.10(4) promote adoption of evidence-based best practices for mitigation of
6.11housing-based health threats; or
6.12(5) develop work practices for addressing specific housing-based health threats.

6.13    Sec. 3. [144A.484] INTEGRATED LICENSURE; HOME AND
6.14COMMUNITY-BASED SERVICES DESIGNATION.
6.15    Subdivision 1. Integrated licensing established. (a) From January 1, 2014, to
6.16June 30, 2015, the commissioner of health shall enforce the home and community-based
6.17services standards under chapter 245D for those providers who also have a home care
6.18license pursuant to chapter 144A as required under Laws 2013, chapter 108, article 11,
6.19section 31, and article 8, section 60.
6.20(b) Beginning July 1, 2015, a home care provider applicant or license holder may
6.21apply to the commissioner of health for a home and community-based services designation
6.22for the provision of basic home and community-based services identified under section
6.23245D.03, subdivision 1, paragraph (b). The designation allows the license holder to
6.24provide basic home and community-based services that would otherwise require licensure
6.25under chapter 245D, under the license holder's home care license governed by sections
6.26144A.43 to 144A.481.
6.27    Subd. 2. Application for home and community-based services designation. An
6.28application for a home and community-based services designation must be made on the
6.29forms and in the manner prescribed by the commissioner. The commissioner shall provide
6.30the applicant with instruction for completing the application and provide information
6.31about the requirements of other state agencies that affect the applicant. Application for
6.32the home and community-based services designation is subject to the requirements under
6.33section 144A.473.
6.34    Subd. 3. Home and community-based services designation fees. A home care
6.35provider applicant or licensee applying for the home and community-based services
7.1designation or renewal of a home and community-based services designation must submit
7.2a fee in the amount specified in subdivision 8.
7.3    Subd. 4. Applicability of home and community-based services requirements. A
7.4home care provider with a home and community-based services designation must comply
7.5with the requirements for home care services governed by this chapter. For the provision
7.6of basic home and community-based services, the home care provider must also comply
7.7with the following home and community-based services licensing requirements:
7.8(1) person-centered planning requirements in section 245D.07;
7.9(2) protection standards in section 245D.06;
7.10(3) emergency use of manual restraints in section 245D.061; and
7.11(4) service recipient rights in section 245D.04, subdivision 3, paragraph (a), clauses
7.12(5), (7), (8), (12), and (13), and paragraph (b).
7.13A home care provider with the integrated license-HCBS designation may utilize a bill of
7.14rights which incorporates the service recipient rights in section 245D.04, subdivision 3,
7.15paragraph (a), clauses (5), (7), (8), (12), and (13), and paragraph (b) with the home care
7.16bill of rights in section 144A.44.
7.17    Subd. 5. Monitoring and enforcement. (a) The commissioner shall monitor for
7.18compliance with the home and community-based services requirements identified in
7.19subdivision 5, in accordance with this section and any agreements by the commissioners
7.20of health and human services.
7.21(b) The commissioner shall enforce compliance with applicable home and
7.22community-based services licensing requirements as follows:
7.23(1) the commissioner may deny a home and community-based services designation
7.24in accordance with section 144A.473 or 144A.475; and
7.25(2) if the commissioner finds that the applicant or license holder has failed to comply
7.26with the applicable home and community-based services designation requirements the
7.27commissioner may issue:
7.28(i) a correction order in accordance with section 144A.474;
7.29(ii) an order of conditional license in accordance with section 144A.475;
7.30(iii) a sanction in accordance with section 144A.475; or
7.31(iv) any combination of clauses (i) to (iii).
7.32    Subd. 6. Appeals. A home care provider applicant that has been denied a temporary
7.33license will also be denied their application for the home and community-based services
7.34designation. The applicant may request reconsideration in accordance with section
7.35144A.473, subdivision 3. A licensed home care provider whose application for a home
7.36and community-based services designation has been denied or whose designation has been
8.1suspended or revoked may appeal the denial, suspension, revocation, or refusal to renew a
8.2home and community-based services designation in accordance with section 144A.475.
8.3A license holder may request reconsideration of a correction order in accordance with
8.4section 144A.474, subdivision 12.
8.5    Subd. 7. Agreements. The commissioners of health and human services shall enter
8.6into any agreements necessary to implement this section.
8.7    Subd. 8. Fees; home and community-based services designation. (a) The initial
8.8fee for a basic home and community-based services designation is $155. A home care
8.9provider who is seeking to renew the provider's home and community-based services
8.10designation must pay an annual nonrefundable fee with the annual home care license
8.11fee according to the following schedule and based on revenues from the home and
8.12community-based services:

`8.13` `8.14`	Provider Annual Revenue from HCBS	HCBS Designation

`8.15`	greater than $1,500,000	$320
`8.16`	greater than $1,275,000 and no more than $1,500,000	$300
`8.17`	greater than $1,100,000 and no more than $1,275,000	$280
`8.18`	greater than $950,000 and no more than $1,100,000	$260
`8.19`	greater than $850,000 and no more than $950,000	$240
`8.20`	greater than $750,000 and no more than $850,000	$220
`8.21`	greater than $650,000 and no more than $750,000	$200
`8.22`	greater than $550,000 and no more than $650,000	$180
`8.23`	greater than $450,000 and no more than $550,000	$160
`8.24`	greater than $350,000 and no more than $450,000	$140
`8.25`	greater than $250,000 and no more than $350,000	$120
`8.26`	greater than $100,000 and no more than $250,000	$100
`8.27`	greater than $50,000 and no more than $100,000	$80
`8.28`	greater than $25,000 and no more than $50,000	$60
`8.29`	no more than $25,000	$40

8.30(b) Fees and penalties collected under this section shall be deposited in the state
8.31treasury and credited to the state government special revenue fund.
8.32EFFECTIVE DATE.Minnesota Statutes, section 144A.484, subdivisions 2 to 8,
8.33are effective July 1, 2015.

8.34    Sec. 4. Minnesota Statutes 2013 Supplement, section 145.4716, subdivision 2, is
8.35amended to read:
8.36    Subd. 2. Duties of director. The director of child sex trafficking prevention is
8.37responsible for the following:
9.1    (1) developing and providing comprehensive training on sexual exploitation of
9.2youth for social service professionals, medical professionals, public health workers, and
9.3criminal justice professionals;
9.4    (2) collecting, organizing, maintaining, and disseminating information on sexual
9.5exploitation and services across the state, including maintaining a list of resources on the
9.6Department of Health Web site;
9.7    (3) monitoring and applying for federal funding for antitrafficking efforts that may
9.8benefit victims in the state;
9.9    (4) managing grant programs established under sections 145.4716 to 145.4718;
9.10    (5) managing the request for proposals for grants for comprehensive services,
9.11including trauma-informed, culturally specific services;
9.12    (6) identifying best practices in serving sexually exploited youth, as defined in
9.13section 260C.007, subdivision 31;
9.14    ~~(6)~~ (7) providing oversight of and technical support to regional navigators pursuant
9.15to section 145.4717;
9.16    ~~(7)~~ (8) conducting a comprehensive evaluation of the statewide program for safe
9.17harbor of sexually exploited youth; and
9.18    ~~(8)~~ (9) developing a policy consistent with the requirements of chapter 13 for sharing
9.19data related to sexually exploited youth, as defined in section 260C.007, subdivision 31,
9.20among regional navigators and community-based advocates.

9.21    Sec. 5. Minnesota Statutes 2013 Supplement, section 256B.04, subdivision 21, is
9.22amended to read:
9.23    Subd. 21. Provider enrollment. (a) If the commissioner or the Centers for
9.24Medicare and Medicaid Services determines that a provider is designated "high-risk," the
9.25commissioner may withhold payment from providers within that category upon initial
9.26enrollment for a 90-day period. The withholding for each provider must begin on the date
9.27of the first submission of a claim.
9.28(b) An enrolled provider that is also licensed by the commissioner under chapter
9.29245A or that is licensed by the Department of Health under chapter 144A and has a
9.30HCBS designation on the home care license must designate an individual as the entity's
9.31compliance officer. The compliance officer must:
9.32(1) develop policies and procedures to assure adherence to medical assistance laws
9.33and regulations and to prevent inappropriate claims submissions;
9.34(2) train the employees of the provider entity, and any agents or subcontractors of
9.35the provider entity including billers, on the policies and procedures under clause (1);
10.1(3) respond to allegations of improper conduct related to the provision or billing of
10.2medical assistance services, and implement action to remediate any resulting problems;
10.3(4) use evaluation techniques to monitor compliance with medical assistance laws
10.4and regulations;
10.5(5) promptly report to the commissioner any identified violations of medical
10.6assistance laws or regulations; and
10.7    (6) within 60 days of discovery by the provider of a medical assistance
10.8reimbursement overpayment, report the overpayment to the commissioner and make
10.9arrangements with the commissioner for the commissioner's recovery of the overpayment.
10.10The commissioner may require, as a condition of enrollment in medical assistance, that a
10.11provider within a particular industry sector or category establish a compliance program that
10.12contains the core elements established by the Centers for Medicare and Medicaid Services.
10.13(c) The commissioner may revoke the enrollment of an ordering or rendering
10.14provider for a period of not more than one year, if the provider fails to maintain and, upon
10.15request from the commissioner, provide access to documentation relating to written orders
10.16or requests for payment for durable medical equipment, certifications for home health
10.17services, or referrals for other items or services written or ordered by such provider, when
10.18the commissioner has identified a pattern of a lack of documentation. A pattern means a
10.19failure to maintain documentation or provide access to documentation on more than one
10.20occasion. Nothing in this paragraph limits the authority of the commissioner to sanction a
10.21provider under the provisions of section 256B.064.
10.22(d) The commissioner shall terminate or deny the enrollment of any individual or
10.23entity if the individual or entity has been terminated from participation in Medicare or
10.24under the Medicaid program or Children's Health Insurance Program of any other state.
10.25(e) As a condition of enrollment in medical assistance, the commissioner shall
10.26require that a provider designated "moderate" or "high-risk" by the Centers for Medicare
10.27and Medicaid Services or the commissioner permit the Centers for Medicare and Medicaid
10.28Services, its agents, or its designated contractors and the state agency, its agents, or its
10.29designated contractors to conduct unannounced on-site inspections of any provider location.
10.30The commissioner shall publish in the Minnesota Health Care Program Provider Manual a
10.31list of provider types designated "limited," "moderate," or "high-risk," based on the criteria
10.32and standards used to designate Medicare providers in Code of Federal Regulations, title
10.3342, section 424.518. The list and criteria are not subject to the requirements of chapter 14.
10.34The commissioner's designations are not subject to administrative appeal.
10.35(f) As a condition of enrollment in medical assistance, the commissioner shall
10.36require that a high-risk provider, or a person with a direct or indirect ownership interest in
11.1the provider of five percent or higher, consent to criminal background checks, including
11.2fingerprinting, when required to do so under state law or by a determination by the
11.3commissioner or the Centers for Medicare and Medicaid Services that a provider is
11.4designated high-risk for fraud, waste, or abuse.
11.5(g)(1) Upon initial enrollment, reenrollment, and revalidation, all durable medical
11.6equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers operating in
11.7Minnesota and receiving Medicaid funds must purchase a surety bond that is annually
11.8renewed and designates the Minnesota Department of Human Services as the obligee, and
11.9must be submitted in a form approved by the commissioner.
11.10(2) At the time of initial enrollment or reenrollment, the provider agency must
11.11purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
11.12in the previous calendar year is up to and including $300,000, the provider agency must
11.13purchase a performance bond of $50,000. If a revalidating provider's Medicaid revenue
11.14in the previous calendar year is over $300,000, the provider agency must purchase a
11.15performance bond of $100,000. The performance bond must allow for recovery of costs
11.16and fees in pursuing a claim on the bond.
11.17(h) The Department of Human Services may require a provider to purchase a
11.18performance surety bond as a condition of initial enrollment, reenrollment, reinstatement,
11.19or continued enrollment if: (1) the provider fails to demonstrate financial viability, (2) the
11.20department determines there is significant evidence of or potential for fraud and abuse by
11.21the provider, or (3) the provider or category of providers is designated high-risk pursuant
11.22to paragraph (a) and as per Code of Federal Regulations, title 42, section 455.450. The
11.23performance bond must be in an amount of $100,000 or ten percent of the provider's
11.24payments from Medicaid during the immediately preceding 12 months, whichever is
11.25greater. The performance bond must name the Department of Human Services as an
11.26obligee and must allow for recovery of costs and fees in pursuing a claim on the bond.

11.27    Sec. 6. POISON INFORMATION CENTERS STUDY.
11.28The commissioner of health shall review the duties of poison information centers
11.29under Minnesota Statutes, section 145.93, and make recommendations for the appropriate
11.30level of funding necessary for the continued operation of a single integrated poison control
11.31system, and to determine the financial and public health benefits provided by the state's
11.32poison control system to the state's health care system, including payers, providers, and
11.33medical education institutions.

11.34    Sec. 7. LEGISLATIVE HEALTH CARE WORKFORCE COMMISSION.
12.1    Subdivision 1. Legislative oversight. The Legislative Health Care Workforce
12.2Commission is created to study and make recommendations to the legislature on how to
12.3achieve the goal of strengthening the workforce in healthcare.
12.4    Subd. 2. Membership. The Legislative Health Care Workforce Commission
12.5consists of five members of the senate appointed by the Subcommittee on Committees
12.6of the Committee on Rules and Administration and five members of the house of
12.7representatives appointed by the speaker of the house. The Legislative Health Care
12.8Workforce Commission must include three members of the majority party and two
12.9members of the minority party in each house.
12.10    Subd. 3. Report to the legislature. The Legislative Health Care Workforce
12.11Commission must provide a report making recommendations to the legislature by
12.12December 31, 2014. The report must:
12.13(1) identify current and anticipated health care workforce shortages, by both
12.14provider type and geography;
12.15(2) evaluate the effectiveness of incentives currently available to develop, attract,
12.16and retain a highly skilled health care workforce;
12.17(3) study alternative incentives to develop, attract, and retain a highly skilled health
12.18care workforce; and
12.19(4) identify current causes and potential solutions to barriers related to the primary
12.20care workforce, including, but not limited to:
12.21(i) training and residency shortages;
12.22(ii) disparities in income between primary care and other providers; and
12.23(iii) negative perceptions of primary care among students.
12.24    Subd. 4. Assistance to the commission. The commissioners of health, human
12.25services, commerce, and other state agencies shall provide assistance and technical
12.26support to the commission at the request of the commission. The commission may
12.27convene subcommittees to provide additional assistance and advice to the commission.
12.28    Subd. 5. Expiration. The Legislative Health Care Workforce Commission expires
12.29on January 1, 2015.
12.30EFFECTIVE DATE.This section is effective the day following final enactment.

12.31    Sec. 8. PILOT GRANT PROGRAM FOR OUTREACH AND EDUCATION ON
12.32DEMENTIA; MINORITY GROUPS.
13.1    Subdivision 1. Definitions. (a) For purposes of this section, the following terms
13.2have the meanings given.
13.3(b) "Dementia" means a condition ascribed within the brain that leads to confusion,
13.4lack of focus, and decreased memory.
13.5(c) "Education activities" means providing materials related to dementia in ethnic
13.6specific languages through materials including, but not limited to, Web sites, brochures,
13.7flyers, and other similar vehicles.
13.8(d) "Minority populations" means racial and ethnic groups including, but not limited
13.9to, African Americans, Native Americans, Hmong, Asians, and other similar groups.
13.10(e) "Outreach" means the active pursuit of people within the minority groups
13.11through specific and targeted activities to contact individuals who may not regularly
13.12be contacted by health care professionals.
13.13    Subd. 2. Grants; administration. Grant applicants shall submit applications
13.14to the commissioner of health as directed by a request for proposals. Grants must be
13.15competitively awarded and recipients of a grant under this section must prepare and
13.16submit a quarterly progress report to the commissioner beginning three months after
13.17receipt of the grant. The commissioner shall provide technical assistance and program
13.18support as needed to ensure that minority individuals with dementia are effectively
13.19identified, mitigated, and evaluated by grantees.
13.20    Subd. 3. Education and training grant; eligible activities. (a) Within the limits of
13.21available appropriations, the commissioner shall make a grant to a nonprofit organization
13.22with expertise in providing outreach, education, and training on dementia, Alzheimers,
13.23and other related disabilities within specific minority and under-represented groups.
13.24(b) The grantee must conduct the following activities:
13.25(1) providing and making available educational materials to the general public
13.26as well as specific minority populations;
13.27(2) promoting awareness of dementia related resources and educational materials; and
13.28(3) promoting the use of materials within health care organizations.

13.29    Sec. 9. FULL-TIME EMPLOYEE RESTRICTION.
13.30No more than one full-time employee may be hired by the Department of Health to
13.31administer the grants under Minnesota Statutes, section 144.9513.

14.1ARTICLE 2

14.2HEALTH CARE

14.3    Section 1. Minnesota Statutes 2012, section 256.01, is amended by adding a
14.4subdivision to read:
14.5    Subd. 38. Contract to match recipient third-party liability information. The
14.6commissioner may enter into a contract with a national organization to match recipient
14.7third-party liability information and provide coverage and insurance primacy information
14.8to the department at no charge to providers and the clearinghouses.

14.9    Sec. 2. Minnesota Statutes 2012, section 256.9685, subdivision 1, is amended to read:
14.10    Subdivision 1. Authority. (a) The commissioner shall establish procedures for
14.11determining medical assistance ~~and general assistance medical care~~ payment rates under
14.12a prospective payment system for inpatient hospital services in hospitals that qualify as
14.13vendors of medical assistance. The commissioner shall establish, by rule, procedures for
14.14implementing this section and sections 256.9686, 256.969, and 256.9695. Services must
14.15meet the requirements of section 256B.04, subdivision 15, or ~~256D.03, subdivision 7~~,
14.16~~paragraph (b),~~ to be eligible for payment.
14.17(b) The commissioner may reduce the types of inpatient hospital admissions that
14.18are required to be certified as medically necessary after notice in the State Register and a
14.1930-day comment period.

14.20    Sec. 3. Minnesota Statutes 2012, section 256.9685, subdivision 1a, is amended to read:
14.21    Subd. 1a. Administrative reconsideration. Notwithstanding ~~sections~~ section
14.22 256B.04, subdivision 15, ~~and~~ ~~256D.03, subdivision 7~~, the commissioner shall establish
14.23an administrative reconsideration process for appeals of inpatient hospital services
14.24determined to be medically unnecessary. A physician or hospital may request a
14.25reconsideration of the decision that inpatient hospital services are not medically necessary
14.26by submitting a written request for review to the commissioner within 30 days after
14.27receiving notice of the decision. The reconsideration process shall take place prior to the
14.28procedures of subdivision 1b and shall be conducted by physicians that are independent
14.29of the case under reconsideration. A majority decision by the physicians is necessary to
14.30make a determination that the services were not medically necessary.

14.31    Sec. 4. Minnesota Statutes 2012, section 256.9686, subdivision 2, is amended to read:
14.32    Subd. 2. Base year. "Base year" means a hospital's fiscal year or years that
14.33is recognized by the Medicare program or a hospital's fiscal year specified by the
15.1commissioner if a hospital is not required to file information by the Medicare program
15.2from which cost and statistical data are used to establish medical assistance ~~and general~~
15.3~~assistance medical care~~ payment rates.

15.4    Sec. 5. Minnesota Statutes 2012, section 256.969, subdivision 1, is amended to read:
15.5    Subdivision 1. Hospital cost index. (a) The hospital cost index shall be the change
15.6in the Consumer Price Index-All Items (United States city average) (CPI-U) forecasted
15.7by Data Resources, Inc. The commissioner shall use the indices as forecasted in the
15.8third quarter of the calendar year prior to the rate year. The hospital cost index may be
15.9used to adjust the base year operating payment rate through the rate year on an annually
15.10compounded basis.
15.11(b) ~~For fiscal years beginning on or after July 1, 1993, the commissioner of human~~
15.12~~services shall not provide automatic annual inflation adjustments for hospital payment~~
15.13~~rates under medical assistance, nor under general assistance medical care, except that~~
15.14~~the inflation adjustments under paragraph (a) for medical assistance, excluding general~~
15.15~~assistance medical care, shall apply through calendar year 2001. The index for calendar~~
15.16~~year 2000 shall be reduced 2.5 percentage points to recover overprojections of the index~~
15.17~~from 1994 to 1996.~~ The commissioner of management and budget shall include as a
15.18budget change request in each biennial detailed expenditure budget submitted to the
15.19legislature under section 16A.11 annual adjustments in hospital payment rates under
15.20medical assistance ~~and general assistance medical care,~~ based upon the hospital cost index.

15.21    Sec. 6. Minnesota Statutes 2012, section 256.969, subdivision 2, is amended to read:
15.22    Subd. 2. Diagnostic categories. The commissioner shall use to the extent possible
15.23existing diagnostic classification systems, including the system ~~used by the Medicare~~
15.24~~program~~ created by 3M for all patient refined diagnosis-related groups (APR-DRGs) to
15.25determine the relative values of inpatient services and case mix indices. The commissioner
15.26may combine diagnostic classifications into diagnostic categories and may establish
15.27separate categories and numbers of categories based on ~~program eligibility or~~ hospital
15.28peer group. Relative values shall be recalculated when the base year is changed. Relative
15.29value determinations shall include paid claims for admissions during each hospital's base
15.30year. The commissioner may ~~extend the time period forward to obtain sufficiently valid~~
15.31~~information to establish relative values~~ supplement the APR-DRG data with national
15.32averages. Relative value determinations shall not include property cost data, Medicare
15.33crossover data, and data on admissions that are paid a per day transfer rate under
15.34subdivision 14. The computation of the base year cost per admission must include identified
16.1outlier cases and their weighted costs up to the point that they become outlier cases, but
16.2must exclude costs recognized in outlier payments beyond that point. The commissioner
16.3may recategorize the diagnostic classifications and recalculate relative values and case mix
16.4indices to reflect actual hospital practices, the specific character of specialty hospitals, or
16.5to reduce variances within the diagnostic categories after notice in the State Register ~~and a~~
16.6~~30-day comment period. The commissioner shall recategorize the diagnostic classifications~~
16.7~~and recalculate relative values and case mix indices based on the two-year schedule in~~
16.8~~effect prior to January 1, 2013, reflected in subdivision 2b. The first recategorization shall~~
16.9~~occur January 1, 2013, and shall occur every two years after. When rates are not rebased~~
16.10~~under subdivision 2b, the commissioner may establish relative values and case mix indices~~
16.11~~based on charge data and may update the base year to the most recent data available~~.

16.12    Sec. 7. Minnesota Statutes 2012, section 256.969, subdivision 2b, is amended to read:
16.13    Subd. 2b. Operating payment rates. ~~In determining operating payment rates for~~
16.14~~admissions occurring on or after the rate year beginning January 1, 1991, and every two~~
16.15~~years after, or more frequently as determined by the commissioner, the commissioner shall~~
16.16~~obtain operating data from an updated base year and establish operating payment rates~~
16.17~~per admission for each hospital based on the cost-finding methods and allowable costs of~~
16.18~~the Medicare program in effect during the base year. Rates under the general assistance~~
16.19~~medical care, medical assistance, and MinnesotaCare programs shall not be rebased to~~
16.20~~more current data on January 1, 1997, January 1, 2005, for the first 24 months of the~~
16.21~~rebased period beginning January 1, 2009.~~ For the rebased period beginning January 1,
16.222011, rates shall not be rebased, except that a Minnesota long-term hospital shall be
16.23rebased effective January 1, 2011, based on its most recent Medicare cost report ending on
16.24or before September 1, 2008, with the provisions under subdivisions 9 and 23, based on
16.25the rates in effect on December 31, 2010. For subsequent rate setting periods in which the
16.26base years are updated, a Minnesota long-term hospital's base year shall remain within
16.27the same period as other hospitals. ~~Effective January 1, 2013, and after, rates shall not be~~
16.28~~rebased.~~ The base year operating payment rate per admission is standardized by the case
16.29mix index and adjusted by the hospital cost index, relative values, and disproportionate
16.30population adjustment. The cost and charge data used to establish operating rates shall
16.31only reflect inpatient services covered by medical assistance ~~and shall not include property~~
16.32~~cost information and costs recognized in outlier payments~~. In determining operating
16.33payment rates for admissions occurring on or after the rate year beginning January 1,
16.342011, through December 31, 2012, the operating payment rate per admission must be
17.1based on the cost-finding methods and allowable costs of the Medicare program in effect
17.2during the base year or years.

17.3    Sec. 8. Minnesota Statutes 2012, section 256.969, subdivision 2c, is amended to read:
17.4    Subd. 2c. Property payment rates. ~~For each hospital's first two consecutive~~
17.5~~fiscal years beginning on or after July 1, 1988, the commissioner shall limit the annual~~
17.6~~increase in property payment rates for depreciation, rents and leases, and interest expense~~
17.7~~to the annual growth in the hospital cost index derived from the methodology in effect~~
17.8~~on the day before July 1, 1989. When computing budgeted and settlement property~~
17.9~~payment rates, the commissioner shall use the annual increase in the hospital cost index~~
17.10~~forecasted by Data Resources, Inc., consistent with the quarter of the hospital's fiscal year~~
17.11~~end. For admissions occurring on or after the rate year beginning January 1, 1991, the~~
17.12~~commissioner shall obtain property data from an updated base year and establish property~~
17.13~~payment rates per admission for each hospital.~~ Property payment rates shall be derived
17.14from data from the same base year that is used to establish operating payment rates. The
17.15property information shall include cost categories not subject to the hospital cost index
17.16and shall reflect the cost-finding methods and allowable costs of the Medicare program.
17.17~~The base year property payment rates shall be adjusted for increases in the property cost~~
17.18~~by increasing the base year property payment rate 85 percent of the percentage change~~
17.19~~from the base year through the year for which a Medicare cost report has been submitted~~
17.20~~to the Medicare program and filed with the department by the October 1 before the rate~~
17.21~~year.~~ The property rates shall only reflect inpatient services covered by medical assistance.
17.22~~The commissioner shall adjust rates for the rate year beginning January 1, 1991, to ensure~~
17.23~~that all hospitals are subject to the hospital cost index limitation for two complete years.~~

17.24    Sec. 9. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
17.25to read:
17.26    Subd. 2d. Budget neutrality factor. For the rebased period effective September 1,
17.272014, when rebasing rates under subdivisions 2b and 2c, the commissioner must apply a
17.28budget neutrality factor (BNF) to a hospital's conversion factor to ensure that total DRG
17.29payments to hospitals do not exceed total DRG payments that would have been made to
17.30hospitals if the relative rates and weights had not been recalibrated. For the purposes of
17.31this section, BNF equals the percentage change from total aggregate payments calculated
17.32under a new payment system to total aggregate payments calculated under the old system.

17.33    Sec. 10. Minnesota Statutes 2012, section 256.969, subdivision 3a, is amended to read:
18.1    Subd. 3a. Payments. ~~(a)~~ Acute care hospital billings under the medical
18.2assistance program must not be submitted until the recipient is discharged. However,
18.3the commissioner shall establish monthly interim payments for inpatient hospitals that
18.4have individual patient lengths of stay over 30 days regardless of diagnostic category.
18.5Except as provided in section 256.9693, medical assistance reimbursement for treatment
18.6of mental illness shall be reimbursed based on diagnostic classifications. Individual
18.7hospital payments established under this section and sections 256.9685, 256.9686, and
18.8256.9695 , in addition to third-party and recipient liability, for discharges occurring during
18.9the rate year shall not exceed, in aggregate, the charges for the medical assistance covered
18.10inpatient services paid for the same period of time to the hospital. ~~This payment limitation~~
18.11~~shall be calculated separately for medical assistance and general assistance medical~~
18.12~~care services. The limitation on general assistance medical care shall be effective for~~
18.13~~admissions occurring on or after July 1, 1991.~~ Services that have rates established under
18.14subdivision 11 or 12, must be limited separately from other services. After consulting with
18.15the affected hospitals, the commissioner may consider related hospitals one entity and may
18.16merge the payment rates while maintaining separate provider numbers. The operating and
18.17property base rates per admission or per day shall be derived from the best Medicare and
18.18claims data available when rates are established. The commissioner shall determine the
18.19best Medicare and claims data, taking into consideration variables of recency of the data,
18.20audit disposition, settlement status, and the ability to set rates in a timely manner. The
18.21commissioner shall notify hospitals of payment rates ~~by December 1 of the year preceding~~
18.22~~the rate year~~ 30 days prior to implementation. The rate setting data must reflect the
18.23admissions data used to establish relative values. ~~Base year changes from 1981 to the base~~
18.24~~year established for the rate year beginning January 1, 1991, and for subsequent rate years,~~
18.25~~shall not be limited to the limits ending June 30, 1987, on the maximum rate of increase~~
18.26~~under subdivision 1.~~ The commissioner may adjust base year cost, relative value, and case
18.27mix index data to exclude the costs of services that have been discontinued by the October
18.281 of the year preceding the rate year or that are paid separately from inpatient services.
18.29Inpatient stays that encompass portions of two or more rate years shall have payments
18.30established based on payment rates in effect at the time of admission unless the date of
18.31admission preceded the rate year in effect by six months or more. In this case, operating
18.32payment rates for services rendered during the rate year in effect and established based on
18.33the date of admission shall be adjusted to the rate year in effect by the hospital cost index.
18.34    ~~(b) For fee-for-service admissions occurring on or after July 1, 2002, the total~~
18.35~~payment, before third-party liability and spenddown, made to hospitals for inpatient~~
18.36~~services is reduced by .5 percent from the current statutory rates.~~
19.1    ~~(c) In addition to the reduction in paragraph (b), the total payment for fee-for-service~~
19.2~~admissions occurring on or after July 1, 2003, made to hospitals for inpatient services~~
19.3~~before third-party liability and spenddown, is reduced five percent from the current~~
19.4~~statutory rates. Mental health services within diagnosis related groups 424 to 432, and~~
19.5~~facilities defined under subdivision 16 are excluded from this paragraph.~~
19.6    ~~(d) In addition to the reduction in paragraphs (b) and (c), the total payment for~~
19.7~~fee-for-service admissions occurring on or after August 1, 2005, made to hospitals for~~
19.8~~inpatient services before third-party liability and spenddown, is reduced 6.0 percent~~
19.9~~from the current statutory rates. Mental health services within diagnosis related groups~~
19.10~~424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.~~
19.11~~Notwithstanding section~~ ~~256.9686, subdivision 7, for purposes of this paragraph, medical~~
19.12~~assistance does not include general assistance medical care. Payments made to managed~~
19.13~~care plans shall be reduced for services provided on or after January 1, 2006, to reflect~~
19.14~~this reduction.~~
19.15    ~~(e) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for~~
19.16~~fee-for-service admissions occurring on or after July 1, 2008, through June 30, 2009, made~~
19.17~~to hospitals for inpatient services before third-party liability and spenddown, is reduced~~
19.18~~3.46 percent from the current statutory rates. Mental health services with diagnosis related~~
19.19~~groups 424 to 432 and facilities defined under subdivision 16 are excluded from this~~
19.20~~paragraph. Payments made to managed care plans shall be reduced for services provided~~
19.21~~on or after January 1, 2009, through June 30, 2009, to reflect this reduction.~~
19.22    ~~(f) In addition to the reductions in paragraphs (b), (c), and (d), the total payment for~~
19.23~~fee-for-service admissions occurring on or after July 1, 2009, through June 30, 2011, made~~
19.24~~to hospitals for inpatient services before third-party liability and spenddown, is reduced~~
19.25~~1.9 percent from the current statutory rates. Mental health services with diagnosis related~~
19.26~~groups 424 to 432 and facilities defined under subdivision 16 are excluded from this~~
19.27~~paragraph. Payments made to managed care plans shall be reduced for services provided~~
19.28~~on or after July 1, 2009, through June 30, 2011, to reflect this reduction.~~
19.29    ~~(g) In addition to the reductions in paragraphs (b), (c), and (d), the total payment~~
19.30~~for fee-for-service admissions occurring on or after July 1, 2011, made to hospitals for~~
19.31~~inpatient services before third-party liability and spenddown, is reduced 1.79 percent~~
19.32~~from the current statutory rates. Mental health services with diagnosis related groups~~
19.33~~424 to 432 and facilities defined under subdivision 16 are excluded from this paragraph.~~
19.34~~Payments made to managed care plans shall be reduced for services provided on or after~~
19.35~~July 1, 2011, to reflect this reduction.~~
20.1~~(h) In addition to the reductions in paragraphs (b), (c), (d), (f), and (g), the total~~
20.2~~payment for fee-for-service admissions occurring on or after July 1, 2009, made to~~
20.3~~hospitals for inpatient services before third-party liability and spenddown, is reduced~~
20.4~~one percent from the current statutory rates. Facilities defined under subdivision 16 are~~
20.5~~excluded from this paragraph. Payments made to managed care plans shall be reduced for~~
20.6~~services provided on or after October 1, 2009, to reflect this reduction.~~
20.7~~(i) In addition to the reductions in paragraphs (b), (c), (d), (g), and (h), the total~~
20.8~~payment for fee-for-service admissions occurring on or after July 1, 2011, made to~~
20.9~~hospitals for inpatient services before third-party liability and spenddown, is reduced~~
20.10~~1.96 percent from the current statutory rates. Facilities defined under subdivision 16 are~~
20.11~~excluded from this paragraph. Payments made to managed care plans shall be reduced for~~
20.12~~services provided on or after January 1, 2011, to reflect this reduction.~~

20.13    Sec. 11. Minnesota Statutes 2012, section 256.969, subdivision 3b, is amended to read:
20.14    Subd. 3b. Nonpayment for hospital-acquired conditions and for certain
20.15treatments. (a) The commissioner must not make medical assistance payments to a
20.16hospital for any costs of care that result from a condition listed in paragraph (c), if the
20.17condition was hospital acquired.
20.18    (b) For purposes of this subdivision, a condition is hospital acquired if it is not
20.19identified by the hospital as present on admission. For purposes of this subdivision,
20.20medical assistance includes ~~general assistance medical care and~~ MinnesotaCare.
20.21(c) The prohibition in paragraph (a) applies to payment for each hospital-acquired
20.22condition listed in this paragraph that is represented by an ~~ICD-9-CM~~ ICD-10-CM
20.23 diagnosis code ~~and is designated as a complicating condition or a major complicating~~
20.24~~condition:~~. The list of conditions is defined by the Centers for Medicare and Medicaid
20.25Services on an annual basis with the hospital-acquired conditions (HAC) list:
20.26(1) foreign object retained after surgery ~~(ICD-9-CM codes 998.4 or 998.7)~~;
20.27(2) air embolism ~~(ICD-9-CM code 999.1)~~;
20.28(3) blood incompatibility ~~(ICD-9-CM code 999.6)~~;
20.29(4) pressure ulcers stage III or IV ~~(ICD-9-CM codes 707.23 or 707.24)~~;
20.30(5) falls and trauma, including fracture, dislocation, intracranial injury, crushing
20.31injury, burn, and electric shock ~~(ICD-9-CM codes with these ranges on the complicating~~
20.32~~condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929;~~
20.33~~940-949; and 991-994)~~;
20.34(6) catheter-associated urinary tract infection ~~(ICD-9-CM code 996.64)~~;
20.35(7) vascular catheter-associated infection ~~(ICD-9-CM code 999.31)~~;
21.1(8) manifestations of poor glycemic control ~~(ICD-9-CM codes 249.10; 249.11;~~
21.2~~249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and~~
21.3~~251.0)~~;
21.4(9) surgical site infection ~~(ICD-9-CM codes 996.67 or 998.59)~~ following certain
21.5orthopedic procedures ~~(procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07;~~
21.6~~81.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and~~
21.7~~81.85)~~;
21.8(10) surgical site infection ~~(ICD-9-CM code 998.59)~~ following bariatric surgery
21.9~~(procedure codes 44.38; 44.39; or 44.95)~~ for a principal diagnosis of morbid obesity
21.10~~(ICD-9-CM code 278.01)~~;
21.11(11) surgical site infection, mediastinitis ~~(ICD-9-CM code 519.2)~~ following coronary
21.12artery bypass graft ~~(procedure codes 36.10 to 36.19)~~; and
21.13(12) deep vein thrombosis ~~(ICD-9-CM codes 453.40 to 453.42)~~ or pulmonary
21.14embolism ~~(ICD-9-CM codes 415.11 or 415.19)~~ following total knee replacement
21.15~~(procedure code 81.54)~~ or hip replacement ~~(procedure codes 00.85 to 00.87 or 81.51~~
21.16~~to 81.52)~~.
21.17(d) The prohibition in paragraph (a) applies to any additional payments that result
21.18from a hospital-acquired condition listed in paragraph (c), including, but not limited to,
21.19additional treatment or procedures, readmission to the facility after discharge, increased
21.20length of stay, change to a higher diagnostic category, or transfer to another hospital. In
21.21the event of a transfer to another hospital, the hospital where the condition listed under
21.22paragraph (c) was acquired is responsible for any costs incurred at the hospital to which
21.23the patient is transferred.
21.24(e) A hospital shall not bill a recipient of services for any payment disallowed under
21.25this subdivision.

21.26    Sec. 12. Minnesota Statutes 2012, section 256.969, subdivision 3c, is amended to read:
21.27    Subd. 3c. Rateable reduction and readmissions reduction. (a) The total payment
21.28for fee for service admissions occurring on or after September 1, 2011, through June 30,
21.292015, made to hospitals for inpatient services before third-party liability and spenddown,
21.30is reduced ten percent from the current statutory rates. Facilities defined under subdivision
21.3116, long-term hospitals as determined under the Medicare program, children's hospitals
21.32whose inpatients are predominantly under 18 years of age, and payments under managed
21.33care are excluded from this paragraph.
21.34(b) Effective for admissions occurring during calendar year 2010 and each year
21.35after, the commissioner shall calculate a regional readmission rate for admissions to all
22.1hospitals occurring within 30 days of a previous discharge. The commissioner may
22.2adjust the readmission rate taking into account factors such as the medical relationship,
22.3complicating conditions, and sequencing of treatment between the initial admission and
22.4subsequent readmissions.
22.5(c) Effective for payments to all hospitals on or after July 1, 2013, through June 30,
22.62015, the reduction in paragraph (a) is reduced one percentage point for every percentage
22.7point reduction in the overall readmissions rate between the two previous calendar years
22.8to a maximum of five percent.
22.9(d) A university-affiliated children's hospital, with 1,800 licensed beds on January 1,
22.102012, located in a city of the first class, is excluded from the reduction in paragraph (a)
22.11for admissions occurring on or after September 1, 2011, through August 30, 2013, but is
22.12subject to the reduction in paragraph (a) for admissions occurring on or after September
22.131, 2013, through June 30, 2015.
22.14EFFECTIVE DATE.This section is effectively retroactively from September 1,
22.152011.

22.16    Sec. 13. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
22.17to read:
22.18    Subd. 4b. Medical assistance cost reports for services. (a) A hospital that meets
22.19one of the following criteria must annually file medical assistance cost reports within six
22.20months of the end of the hospital's fiscal year:
22.21(1) a hospital designated as a critical access hospital that receives medical assistance
22.22payments; or
22.23(2) a Minnesota hospital or out-of-state hospital located within a Minnesota local
22.24trade area that receives a disproportionate population adjustment under subdivision 9.
22.25For purposes of this subdivision, local trade area has the meaning given in
22.26subdivision 17.
22.27(b) The Department of Human Services must suspend payments to any hospital that
22.28fails to file a report required under this subdivision. Payments must remain suspended
22.29until the report has been filed with and accepted by the Department of Human Services
22.30inpatient rates unit.

22.31    Sec. 14. Minnesota Statutes 2012, section 256.969, subdivision 6a, is amended to read:
22.32    Subd. 6a. Special considerations. In determining the payment rates, the
22.33commissioner shall consider whether the circumstances in subdivisions 7 8 to 14 exist.

23.1    Sec. 15. Minnesota Statutes 2012, section 256.969, is amended by adding a subdivision
23.2to read:
23.3    Subd. 8c. Hospital residents. Payments for hospital residents shall be made
23.4as follows:
23.5(1) payments for the first 180 days of inpatient care shall be the APR-DRG payment
23.6plus any appropriate outliers; and
23.7(2) payment for all medically necessary patient care subsequent to 180 days shall
23.8be reimbursed at a rate computed by multiplying the statewide average cost-to-charge
23.9ratio by the usual and customary charges.

23.10    Sec. 16. Minnesota Statutes 2012, section 256.969, subdivision 9, is amended to read:
23.11    Subd. 9. Disproportionate numbers of low-income patients served. (a) For
23.12admissions occurring on or after October 1, 1992, through December 31, 1992, the
23.13medical assistance disproportionate population adjustment shall comply with federal law
23.14and shall be paid to a hospital, excluding regional treatment centers and facilities of the
23.15federal Indian Health Service, with a medical assistance inpatient utilization rate in excess
23.16of the arithmetic mean. The adjustment must be determined as follows:
23.17    (1) for a hospital with a medical assistance inpatient utilization rate above the
23.18arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
23.19federal Indian Health Service but less than or equal to one standard deviation above the
23.20mean, the adjustment must be determined by multiplying the total of the operating and
23.21property payment rates by the difference between the hospital's actual medical assistance
23.22inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
23.23treatment centers and facilities of the federal Indian Health Service; and
23.24    (2) for a hospital with a medical assistance inpatient utilization rate above one
23.25standard deviation above the mean, the adjustment must be determined by multiplying
23.26the adjustment that would be determined under clause (1) for that hospital by 1.1. If
23.27federal matching funds are not available for all adjustments under this subdivision, the
23.28commissioner shall reduce payments on a pro rata basis so that all adjustments qualify for
23.29federal match. ~~The commissioner may establish a separate disproportionate population~~
23.30~~operating payment rate adjustment under the general assistance medical care program.~~
23.31~~For purposes of this subdivision medical assistance does not include general assistance~~
23.32~~medical care.~~ The commissioner shall report annually on the number of hospitals likely to
23.33receive the adjustment authorized by this paragraph. The commissioner shall specifically
23.34report on the adjustments received by public hospitals and public hospital corporations
23.35located in cities of the first class.
24.1    (b) For admissions occurring on or after July 1, 1993, the medical assistance
24.2disproportionate population adjustment shall comply with federal law and shall be paid to
24.3a hospital, excluding regional treatment centers, critical access hospitals, and facilities of
24.4the federal Indian Health Service, with a medical assistance inpatient utilization rate in
24.5excess of the arithmetic mean. The adjustment must be determined as follows:
24.6    (1) for a hospital with a medical assistance inpatient utilization rate above the
24.7arithmetic mean for all hospitals excluding regional treatment centers, critical access
24.8hospitals, and facilities of the federal Indian Health Service but less than or equal to one
24.9standard deviation above the mean, the adjustment must be determined by multiplying the
24.10total of the operating and property payment rates by the difference between the hospital's
24.11actual medical assistance inpatient utilization rate and the arithmetic mean for all hospitals
24.12excluding regional treatment centers and facilities of the federal Indian Health Service; and
24.13    (2) for a hospital with a medical assistance inpatient utilization rate above one
24.14standard deviation above the mean, the adjustment must be determined by multiplying
24.15the adjustment that would be determined under clause (1) for that hospital by 1.1. ~~The~~
24.16~~commissioner may establish a separate disproportionate population operating payment~~
24.17~~rate adjustment under the general assistance medical care program. For purposes of this~~
24.18~~subdivision, medical assistance does not include general assistance medical care.~~ The
24.19commissioner shall report annually on the number of hospitals likely to receive the
24.20adjustment authorized by this paragraph. The commissioner shall specifically report on
24.21the adjustments received by public hospitals and public hospital corporations located in
24.22cities of the first class;.
24.23    ~~(3) for a hospital that had medical assistance fee-for-service payment volume during~~
24.24~~calendar year 1991 in excess of 13 percent of total medical assistance fee-for-service~~
24.25~~payment volume, a medical assistance disproportionate population adjustment shall be~~
24.26~~paid in addition to any other disproportionate payment due under this subdivision as~~
24.27~~follows: $1,515,000 due on the 15th of each month after noon, beginning July 15, 1995.~~
24.28~~For a hospital that had medical assistance fee-for-service payment volume during calendar~~
24.29~~year 1991 in excess of eight percent of total medical assistance fee-for-service payment~~
24.30~~volume and was the primary hospital affiliated with the University of Minnesota, a~~
24.31~~medical assistance disproportionate population adjustment shall be paid in addition to any~~
24.32~~other disproportionate payment due under this subdivision as follows: $505,000 due on~~
24.33~~the 15th of each month after noon, beginning July 15, 1995; and~~
24.34    ~~(4) effective August 1, 2005, the payments in paragraph (b), clause (3), shall be~~
24.35~~reduced to zero.~~
25.1    ~~(c) The commissioner shall adjust rates paid to a health maintenance organization~~
25.2~~under contract with the commissioner to reflect rate increases provided in paragraph (b),~~
25.3~~clauses (1) and (2), on a nondiscounted hospital-specific basis but shall not adjust those~~
25.4~~rates to reflect payments provided in clause (3).~~
25.5    ~~(d) If federal matching funds are not available for all adjustments under paragraph~~
25.6~~(b), the commissioner shall reduce payments under paragraph (b), clauses (1) and (2), on a~~
25.7~~pro rata basis so that all adjustments under paragraph (b) qualify for federal match.~~
25.8    ~~(e) For purposes of this subdivision, medical assistance does not include general~~
25.9~~assistance medical care.~~
25.10    ~~(f) For hospital services occurring on or after July 1, 2005, to June 30, 2007:~~
25.11    ~~(1) general assistance medical care expenditures for fee-for-service inpatient and~~
25.12~~outpatient hospital payments made by the department shall be considered Medicaid~~
25.13~~disproportionate share hospital payments, except as limited below:~~
25.14     ~~(i) only the portion of Minnesota's disproportionate share hospital allotment under~~
25.15~~section 1923(f) of the Social Security Act that is not spent on the disproportionate~~
25.16~~population adjustments in paragraph (b), clauses (1) and (2), may be used for general~~
25.17~~assistance medical care expenditures;~~
25.18     ~~(ii) only those general assistance medical care expenditures made to hospitals that~~
25.19~~qualify for disproportionate share payments under section 1923 of the Social Security Act~~
25.20~~and the Medicaid state plan may be considered disproportionate share hospital payments;~~
25.21     ~~(iii) only those general assistance medical care expenditures made to an individual~~
25.22~~hospital that would not cause the hospital to exceed its individual hospital limits under~~
25.23~~section 1923 of the Social Security Act may be considered; and~~
25.24     ~~(iv) general assistance medical care expenditures may be considered only to the~~
25.25~~extent of Minnesota's aggregate allotment under section 1923 of the Social Security Act.~~
25.26~~All hospitals and prepaid health plans participating in general assistance medical care~~
25.27~~must provide any necessary expenditure, cost, and revenue information required by the~~
25.28~~commissioner as necessary for purposes of obtaining federal Medicaid matching funds for~~
25.29~~general assistance medical care expenditures; and~~
25.30    ~~(2)~~ (c) Certified public expenditures made by Hennepin County Medical Center shall
25.31be considered Medicaid disproportionate share hospital payments. Hennepin County
25.32and Hennepin County Medical Center shall report by June 15, 2007, on payments made
25.33beginning July 1, 2005, or another date specified by the commissioner, that may qualify
25.34for reimbursement under federal law. Based on these reports, the commissioner shall
25.35apply for federal matching funds.
26.1    ~~(g)~~ (d) Upon federal approval of the related state plan amendment, paragraph ~~(f)~~ (c)
26.2 is effective retroactively from July 1, 2005, or the earliest effective date approved by the
26.3Centers for Medicare and Medicaid Services.

26.4    Sec. 17. Minnesota Statutes 2012, section 256.969, subdivision 10, is amended to read:
26.5    Subd. 10. Separate billing by certified registered nurse anesthetists. Hospitals
26.6~~may~~ must exclude certified registered nurse anesthetist costs from the operating payment
26.7rate ~~as allowed by section~~ ~~256B.0625, subdivision 11. To be eligible, a hospital must~~
26.8~~notify the commissioner in writing by October 1 of even-numbered years to exclude~~
26.9~~certified registered nurse anesthetist costs. The hospital must agree that all hospital~~
26.10~~claims for the cost and charges of certified registered nurse anesthetist services will not~~
26.11~~be included as part of the rates for inpatient services provided during the rate year. In~~
26.12~~this case, the operating payment rate shall be adjusted to exclude the cost of certified~~
26.13~~registered nurse anesthetist services~~.
26.14~~For admissions occurring on or after July 1, 1991, and until the expiration date of~~
26.15~~section~~ ~~256.9695, subdivision 3, services of certified registered nurse anesthetists provided~~
26.16~~on an inpatient basis may be paid as allowed by section~~ ~~256B.0625, subdivision 11, when~~
26.17~~the hospital's base year did not include the cost of these services. To be eligible, a hospital~~
26.18~~must notify the commissioner in writing by July 1, 1991, of the request and must comply~~
26.19~~with all other requirements of this subdivision.~~

26.20    Sec. 18. Minnesota Statutes 2012, section 256.969, subdivision 14, is amended to read:
26.21    Subd. 14. Transfers. ~~Except as provided in subdivisions 11 and 13,~~ Operating
26.22and property payment rates for admissions that result in transfers and transfers shall be
26.23established on a per day payment system. The per day payment rate shall be the sum of
26.24the adjusted operating and property payment rates determined under this subdivision and
26.25subdivisions 2, 2b, 2c, 3a, 4a, 5a, and 7 8 to 12, divided by the arithmetic mean length
26.26of stay for the diagnostic category. Each admission that results in a transfer and each
26.27transfer is considered a separate admission to each hospital, and the total of the admission
26.28and transfer payments to each hospital must not exceed the total per admission payment
26.29that would otherwise be made to each hospital under this subdivision and subdivisions
26.302, 2b, 2c, 3a, 4a, 5a, and ~~7 to 13~~ 8 to 12.

26.31    Sec. 19. Minnesota Statutes 2012, section 256.969, subdivision 17, is amended to read:
26.32    Subd. 17. Out-of-state hospitals in local trade areas. Out-of-state hospitals that
26.33are located within a Minnesota local trade area and that have more than 20 admissions in
27.1the base year or years shall have rates established using the same procedures and methods
27.2that apply to Minnesota hospitals. For this subdivision and subdivision 18, local trade area
27.3means a county contiguous to Minnesota and located in a metropolitan statistical area as
27.4determined by Medicare for October 1 prior to the most current rebased rate year. Hospitals
27.5that are not required by law to file information in a format necessary to establish rates shall
27.6have rates established based on the commissioner's estimates of the information. Relative
27.7values of the diagnostic categories shall not be redetermined under this subdivision until
27.8required by ~~rule~~ statute. Hospitals affected by this subdivision shall then be included in
27.9determining relative values. However, hospitals that have rates established based upon
27.10the commissioner's estimates of information shall not be included in determining relative
27.11values. This subdivision is effective for hospital fiscal years beginning on or after July
27.121, 1988. A hospital shall provide the information necessary to establish rates under this
27.13subdivision at least 90 days before the start of the hospital's fiscal year.

27.14    Sec. 20. Minnesota Statutes 2012, section 256.969, subdivision 30, is amended to read:
27.15    Subd. 30. Payment rates for births. (a) For admissions occurring on or after
27.16~~October 1, 2009~~ September 1, 2014, the total operating and property payment rate,
27.17excluding disproportionate population adjustment, for the following diagnosis-related
27.18groups, as they fall within the ~~diagnostic~~ APR-DRG categories: (1) ~~371 cesarean section~~
27.19~~without complicating diagnosis~~ 5601, 5602, 5603, 5604 vaginal delivery; and (2) ~~372~~
27.20~~vaginal delivery with complicating diagnosis; and (3) 373 vaginal delivery without~~
27.21~~complicating diagnosis~~ 5401, 5402, 5403, 5404 cesarean section, shall be no greater
27.22than $3,528.
27.23(b) The rates described in this subdivision do not include newborn care.
27.24(c) Payments to managed care and county-based purchasing plans under section
27.25256B.69 , 256B.692, or 256L.12 shall be reduced for services provided on or after October
27.261, 2009, to reflect the adjustments in paragraph (a).
27.27(d) Prior authorization shall not be required before reimbursement is paid for a
27.28cesarean section delivery.

27.29    Sec. 21. Minnesota Statutes 2012, section 256B.0751, is amended by adding a
27.30subdivision to read:
27.31    Subd. 10. Health care homes advisory committee. (a) The commissioners of
27.32health and human services shall establish a health care homes advisory committee to
27.33advise the commissioners on the ongoing statewide implementation of the health care
27.34homes program authorized in this section.
28.1(b) The commissioners shall establish an advisory committee that includes
28.2representatives of the health care professions such as primary care providers; mental
28.3health providers; nursing and care coordinators; certified health care home clinics with
28.4statewide representation; health plan companies; state agencies; employers; academic
28.5researchers; consumers; and organizations that work to improve health care quality in
28.6Minnesota. At least 25 percent of the committee members must be consumers or patients
28.7in health care homes.
28.8(c) The advisory committee shall advise the commissioners on ongoing
28.9implementation of the health care homes program, including, but not limited to, the
28.10following activities:
28.11(1) implementation of certified health care homes across the state on performance
28.12management and implementation of benchmarking;
28.13(2) implementation of modifications to the health care homes program based on
28.14results of the legislatively mandated health care home evaluation;
28.15(3) statewide solutions for engagement of employers and commercial payers;
28.16(4) potential modifications of the health care home rules or statutes;
28.17(5) consumer engagement, including patient and family-centered care, patient
28.18activation in health care, and shared decision making;
28.19(6) oversight for health care home subject matter task forces or workgroups; and
28.20(7) other related issues as requested by the commissioners.
28.21(d) The advisory committee shall have the ability to establish subcommittees on
28.22specific topics. The advisory committee is governed by section 15.059. Notwithstanding
28.23section 15.059, the advisory committee does not expire.

28.24    Sec. 22. Minnesota Statutes 2012, section 256B.199, is amended to read:
28.25256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
28.26    (a) ~~Effective July 1, 2007,~~ The commissioner shall apply for federal matching
28.27funds for the expenditures in paragraphs (b) and (c). ~~Effective September 1, 2011, the~~
28.28~~commissioner shall apply for matching funds for expenditures in paragraph (e).~~
28.29    (b) The commissioner shall apply for federal matching funds for certified public
28.30expenditures as follows:.
28.31    ~~(1) Hennepin County, Hennepin County Medical Center, Ramsey County, Regions~~
28.32~~Hospital, the University of Minnesota, and Fairview-University Medical Center shall~~
28.33~~report quarterly to the commissioner beginning June 1, 2007, payments made during the~~
28.34~~second previous quarter that may qualify for reimbursement under federal law;~~
29.1     ~~(2) based on these reports, the commissioner shall apply for federal matching~~
29.2~~funds. These funds are appropriated to the commissioner for the payments under section~~
29.3~~256.969, subdivision 27; and~~
29.4    ~~(3)~~ By May 1 of each year, beginning May 1, 2007, the commissioner shall inform
29.5the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
29.6hospital payment money expected to be available in the current federal fiscal year.
29.7    ~~(c) The commissioner shall apply for federal matching funds for general assistance~~
29.8~~medical care expenditures as follows:~~
29.9    ~~(1) for hospital services occurring on or after July 1, 2007, general assistance medical~~
29.10~~care expenditures for fee-for-service inpatient and outpatient hospital payments made by~~
29.11~~the department shall be used to apply for federal matching funds, except as limited below:~~
29.12    ~~(i) only those general assistance medical care expenditures made to an individual~~
29.13~~hospital that would not cause the hospital to exceed its individual hospital limits under~~
29.14~~section 1923 of the Social Security Act may be considered; and~~
29.15    ~~(ii) general assistance medical care expenditures may be considered only to the extent~~
29.16~~of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and~~
29.17    ~~(2) all hospitals must provide any necessary expenditure, cost, and revenue~~
29.18~~information required by the commissioner as necessary for purposes of obtaining federal~~
29.19~~Medicaid matching funds for general assistance medical care expenditures.~~
29.20~~(d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall~~
29.21~~apply for additional federal matching funds available as disproportionate share hospital~~
29.22~~payments under the American Recovery and Reinvestment Act of 2009. These funds shall~~
29.23~~be made available as the state share of payments under section~~ ~~256.969, subdivision 28~~.
29.24~~The entities required to report certified public expenditures under paragraph (b), clause~~
29.25~~(1), shall report additional certified public expenditures as necessary under this paragraph.~~
29.26~~(e)~~ (c) For services provided on or after September 1, 2011, the commissioner shall
29.27apply for additional federal matching funds available as disproportionate share hospital
29.28payments under the MinnesotaCare program ~~according to the requirements and conditions~~
29.29~~of paragraph (c)~~. A hospital may elect on an annual basis to not be a disproportionate
29.30share hospital for purposes of this paragraph, if the hospital does not qualify for a payment
29.31under section 256.969, subdivision 9, paragraph (b).

29.32    Sec. 23. Minnesota Statutes 2012, section 256B.35, subdivision 1, is amended to read:
29.33    Subdivision 1. Personal needs allowance. (a) Notwithstanding any law to the
29.34contrary, welfare allowances for clothing and personal needs for individuals receiving
29.35medical assistance while residing in any skilled nursing home, intermediate care facility,
30.1or medical institution including recipients of Supplemental Security Income, in this state
30.2shall not be less than $45 per month from all sources. When benefit amounts for Social
30.3Security or Supplemental Security Income recipients are increased pursuant to United
30.4States Code, title 42, sections 415(i) and 1382f, the commissioner shall, effective in the
30.5month in which the increase takes effect, increase by the same percentage to the nearest
30.6whole dollar the clothing and personal needs allowance for individuals receiving medical
30.7assistance while residing in any skilled nursing home, medical institution, or intermediate
30.8care facility. The commissioner shall provide timely notice to local agencies, providers,
30.9and recipients of increases under this provision.
30.10(b) The personal needs allowance may be paid as part of the Minnesota supplemental
30.11aid program, and payments to recipients of Minnesota supplemental aid may be made once
30.12each three months covering liabilities that accrued during the preceding three months.
30.13(c) The personal needs allowance shall be increased to include income garnished
30.14for child support under a court order, up to a maximum of $250 per month but only to
30.15the extent that the amount garnished is not deducted as a monthly allowance for children
30.16under section 256B.0575, paragraph (a), clause (5).
30.17(d) Solely for the purpose of section 256B.0575, subdivision 1, paragraph (a), clause
30.18(1), the personal needs allowance shall be increased to include income garnished for
30.19spousal maintenance under a judgment and decree for dissolution of marriage, and any
30.20administrative fees garnished for collection efforts.

30.21    Sec. 24. REPEALER.
30.22Minnesota Statutes 2012, sections 256.969, subdivisions 8b, 9a, 9b, 11, 13, 20, 21,
30.2322, 25, 26, 27, and 28; and 256.9695, subdivisions 3 and 4, are repealed.

30.24ARTICLE 3

30.25NORTHSTAR CARE FOR CHILDREN

30.26    Section 1. Minnesota Statutes 2012, section 245C.05, subdivision 5, is amended to read:
30.27    Subd. 5. Fingerprints. (a) Except as provided in paragraph (c), for any background
30.28study completed under this chapter, when the commissioner has reasonable cause to
30.29believe that further pertinent information may exist on the subject of the background
30.30study, the subject shall provide the commissioner with a set of classifiable fingerprints
30.31obtained from an authorized agency.
30.32    (b) For purposes of requiring fingerprints, the commissioner has reasonable cause
30.33when, but not limited to, the:
31.1    (1) information from the Bureau of Criminal Apprehension indicates that the subject
31.2is a multistate offender;
31.3    (2) information from the Bureau of Criminal Apprehension indicates that multistate
31.4offender status is undetermined; or
31.5    (3) commissioner has received a report from the subject or a third party indicating
31.6that the subject has a criminal history in a jurisdiction other than Minnesota.
31.7    (c) Except as specified under section 245C.04, subdivision 1, paragraph (d), for
31.8background studies conducted by the commissioner for child foster care or, adoptions, or a
31.9transfer of permanent legal and physical custody of a child, the subject of the background
31.10study, who is 18 years of age or older, shall provide the commissioner with a set of
31.11classifiable fingerprints obtained from an authorized agency.

31.12    Sec. 2. Minnesota Statutes 2013 Supplement, section 245C.08, subdivision 1, is
31.13amended to read:
31.14    Subdivision 1. Background studies conducted by Department of Human
31.15Services. (a) For a background study conducted by the Department of Human Services,
31.16the commissioner shall review:
31.17    (1) information related to names of substantiated perpetrators of maltreatment of
31.18vulnerable adults that has been received by the commissioner as required under section
31.19626.557, subdivision 9c , paragraph (j);
31.20    (2) the commissioner's records relating to the maltreatment of minors in licensed
31.21programs, and from findings of maltreatment of minors as indicated through the social
31.22service information system;
31.23    (3) information from juvenile courts as required in subdivision 4 for individuals
31.24listed in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
31.25    (4) information from the Bureau of Criminal Apprehension, including information
31.26regarding a background study subject's registration in Minnesota as a predatory offender
31.27under section 243.166;
31.28    (5) except as provided in clause (6), information from the national crime information
31.29system when the commissioner has reasonable cause as defined under section 245C.05,
31.30subdivision 5; and
31.31    (6) for a background study related to a child foster care application for licensure, a
31.32transfer of permanent legal and physical custody of a child under sections 260C.503 to
31.33260C.515, or adoptions, the commissioner shall also review:
31.34    (i) information from the child abuse and neglect registry for any state in which the
31.35background study subject has resided for the past five years; and
32.1    (ii) information from national crime information databases, when the background
32.2study subject is 18 years of age or older.
32.3    (b) Notwithstanding expungement by a court, the commissioner may consider
32.4information obtained under paragraph (a), clauses (3) and (4), unless the commissioner
32.5received notice of the petition for expungement and the court order for expungement is
32.6directed specifically to the commissioner.
32.7    (c) The commissioner shall also review criminal case information received according
32.8to section 245C.04, subdivision 4a, from the Minnesota court information system that
32.9relates to individuals who have already been studied under this chapter and who remain
32.10affiliated with the agency that initiated the background study.

32.11    Sec. 3. Minnesota Statutes 2012, section 245C.33, subdivision 1, is amended to read:
32.12    Subdivision 1. Background studies conducted by commissioner. (a) Before
32.13placement of a child for purposes of adoption, the commissioner shall conduct a
32.14background study on individuals listed in ~~section~~ sections 259.41, subdivision 3, and
32.15260C.611, for county agencies and private agencies licensed to place children for adoption.
32.16 When a prospective adoptive parent is seeking to adopt a child who is currently placed in
32.17the prospective adoptive parent's home and is under the guardianship of the commissioner
32.18according to section 260C.325, subdivision 1, paragraph (b), and the prospective adoptive
32.19parent holds a child foster care license, a new background study is not required when:
32.20(1) a background study was completed on persons required to be studied under section
32.21245C.03 in connection with the application for child foster care licensure after July 1, 2007;
32.22(2) the background study included a review of the information in section 245C.08,
32.23subdivisions 1, 3, and 4; and
32.24(3) as a result of the background study, the individual was either not disqualified
32.25or, if disqualified, the disqualification was set aside under section 245C.22, or a variance
32.26was issued under section 245C.30.
32.27(b) Before placement of a child for purposes of transferring permanent legal and
32.28physical custody to a relative under sections 260C.503 to 260C.515, the commissioner
32.29shall conduct a background study on each person age 13 or older living in the home.
32.30When a prospective relative custodian has a child foster care license, a new background
32.31study is not required when:
32.32(1) a background study was completed on persons required to be studied under section
32.33245C.03 in connection with the application for child foster care licensure after July 1, 2007;
32.34(2) the background study included a review of the information in section 245C.08,
32.35subdivisions 1, 3, and 4; and
33.1(3) as a result of the background study, the individual was either not disqualified
33.2or, if disqualified, the disqualification was set aside under section 245C.22, or a variance
33.3was issued under section 245C.30.

33.4    Sec. 4. Minnesota Statutes 2012, section 245C.33, subdivision 4, is amended to read:
33.5    Subd. 4. Information commissioner reviews. (a) The commissioner shall review
33.6the following information regarding the background study subject:
33.7    (1) the information under section 245C.08, subdivisions 1, 3, and 4;
33.8    (2) information from the child abuse and neglect registry for any state in which the
33.9subject has resided for the past five years; and
33.10    (3) information from national crime information databases, when required under
33.11section 245C.08.
33.12    (b) The commissioner shall provide any information collected under this subdivision
33.13to the county or private agency that initiated the background study. The commissioner
33.14shall also provide the agency:
33.15(1) notice whether the information collected shows that the subject of the background
33.16study has a conviction listed in United States Code, title 42, section 671(a)(20)(A); and
33.17(2) for background studies conducted under subdivision 1, paragraph (a), the date of
33.18all adoption-related background studies completed on the subject by the commissioner
33.19after June 30, 2007, and the name of the county or private agency that initiated the
33.20adoption-related background study.

33.21    Sec. 5. Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 1, is
33.22amended to read:
33.23    Subdivision 1. General eligibility requirements. (a) To be eligible for guardianship
33.24assistance under this section, there must be a judicial determination under section
33.25260C.515, subdivision 4 , that a transfer of permanent legal and physical custody to a
33.26relative is in the child's best interest. For a child under jurisdiction of a tribal court, a
33.27judicial determination under a similar provision in tribal code indicating that a relative
33.28will assume the duty and authority to provide care, control, and protection of a child who
33.29is residing in foster care, and to make decisions regarding the child's education, health
33.30care, and general welfare until adulthood, and that this is in the child's best interest is
33.31considered equivalent. Additionally, a child must:
33.32(1) have been removed from the child's home pursuant to a voluntary placement
33.33agreement or court order;
34.1(2)(i) have resided in with the prospective relative custodian who has been a
34.2licensed child foster ~~care~~ parent for at least six consecutive months ~~in the home of the~~
34.3~~prospective relative custodian~~; or
34.4(ii) have received from the commissioner an exemption from the requirement in item
34.5(i) ~~from the court~~ that the prospective relative custodian has been a licensed child foster
34.6parent for at least six consecutive months, based on a determination that:
34.7(A) an expedited move to permanency is in the child's best interest;
34.8(B) expedited permanency cannot be completed without provision of guardianship
34.9assistance; ~~and~~
34.10(C) the prospective relative custodian is uniquely qualified to meet the child's needs,
34.11as defined in section 260C.212, subdivision 2, on a permanent basis;
34.12(D) the child and prospective relative custodian meet the eligibility requirements
34.13of this section; and
34.14(E) efforts were made by the legally responsible agency to place the child with the
34.15prospective relative custodian as a licensed child foster parent for six consecutive months
34.16before permanency, or an explanation why these efforts were not in the child's best interests;
34.17(3) meet the agency determinations regarding permanency requirements in
34.18subdivision 2;
34.19(4) meet the applicable citizenship and immigration requirements in subdivision 3;
34.20(5) have been consulted regarding the proposed transfer of permanent legal and
34.21physical custody to a relative, if the child is at least 14 years of age or is expected to attain
34.2214 years of age prior to the transfer of permanent legal and physical custody; and
34.23(6) have a written, binding agreement under section 256N.25 among the caregiver or
34.24caregivers, the financially responsible agency, and the commissioner established prior to
34.25transfer of permanent legal and physical custody.
34.26(b) In addition to the requirements in paragraph (a), the child's prospective relative
34.27custodian or custodians must meet the applicable background study requirements in
34.28subdivision 4.
34.29(c) To be eligible for title IV-E guardianship assistance, a child must also meet any
34.30additional criteria in section 473(d) of the Social Security Act. The sibling of a child
34.31who meets the criteria for title IV-E guardianship assistance in section 473(d) of the
34.32Social Security Act is eligible for title IV-E guardianship assistance if the child and
34.33sibling are placed with the same prospective relative custodian or custodians, and the
34.34legally responsible agency, relatives, and commissioner agree on the appropriateness of
34.35the arrangement for the sibling. A child who meets all eligibility criteria except those
35.1specific to title IV-E guardianship assistance is entitled to guardianship assistance paid
35.2through funds other than title IV-E.

35.3    Sec. 6. Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 2, is
35.4amended to read:
35.5    Subd. 2. Agency determinations regarding permanency. (a) To be eligible for
35.6guardianship assistance, the legally responsible agency must complete the following
35.7determinations regarding permanency for the child prior to the transfer of permanent
35.8legal and physical custody:
35.9(1) a determination that reunification and adoption are not appropriate permanency
35.10options for the child; and
35.11(2) a determination that the child demonstrates a strong attachment to the prospective
35.12relative custodian and the prospective relative custodian has a strong commitment to
35.13caring permanently for the child.
35.14(b) The legally responsible agency shall document the determinations in paragraph
35.15(a) and ~~the~~ eligibility requirements in this section that comply with United States Code,
35.16title 42, sections 673(d) and 675(1)(F). These determinations must be documented in a
35.17kinship placement agreement, which must be in the format prescribed by the commissioner
35.18and must be signed by the prospective relative custodian and the legally responsible
35.19agency. In the case of a Minnesota tribe, the determinations and eligibility requirements
35.20in this section may be provided in an alternative format approved by the commissioner.
35.21 Supporting information for completing each determination must be documented in the
35.22legally responsible agency's case file and ~~make them~~ available for review as requested
35.23by the financially responsible agency and the commissioner during the guardianship
35.24assistance eligibility determination process.

35.25    Sec. 7. Minnesota Statutes 2013 Supplement, section 256N.22, subdivision 4, is
35.26amended to read:
35.27    Subd. 4. Background study. (a) A background study ~~under section~~ ~~245C.33~~ must be
35.28completed on each prospective relative custodian and any other adult residing in the home
35.29of the prospective relative custodian. The background study must meet the requirements of
35.30United States Code, title 42, section 671(a)(20). A study completed under section 245C.33
35.31meets this requirement. A background study on the prospective relative custodian or adult
35.32residing in the household previously completed under ~~section~~ ~~245C.04~~ chapter 245C for the
35.33purposes of child foster care licensure ~~may~~ under chapter 245A or licensure by a Minnesota
35.34tribe, shall be used for the purposes of this section, provided that the background study is
36.1~~current~~ meets the requirements of this subdivision and the prospective relative custodian is
36.2a licensed child foster parent at the time of the application for guardianship assistance.
36.3(b) If the background study reveals:
36.4(1) a felony conviction at any time for:
36.5(i) child abuse or neglect;
36.6(ii) spousal abuse;
36.7(iii) a crime against a child, including child pornography; or
36.8(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
36.9including other physical assault or battery; or
36.10(2) a felony conviction within the past five years for:
36.11(i) physical assault;
36.12(ii) battery; or
36.13(iii) a drug-related offense;
36.14the prospective relative custodian is prohibited from receiving guardianship assistance
36.15on behalf of an otherwise eligible child.

36.16    Sec. 8. Minnesota Statutes 2013 Supplement, section 256N.23, subdivision 4, is
36.17amended to read:
36.18    Subd. 4. Background study. (a) A background study ~~under section~~ ~~259.41~~ must be
36.19completed on each prospective adoptive parent. and all other adults residing in the home.
36.20A background study must meet the requirements of United States Code, title 42, section
36.21671(a)(20). A study completed under section 245C.33 meets this requirement. If the
36.22prospective adoptive parent is a licensed child foster parent licensed under chapter 245A
36.23or by a Minnesota tribe, the background study previously completed for the purposes of
36.24child foster care licensure shall be used for the purpose of this section, provided that the
36.25background study meets all other requirements of this subdivision and the prospective
36.26adoptive parent is a licensed child foster parent at the time of the application for adoption
36.27assistance.
36.28(b) If the background study reveals:
36.29(1) a felony conviction at any time for:
36.30(i) child abuse or neglect;
36.31(ii) spousal abuse;
36.32(iii) a crime against a child, including child pornography; or
36.33(iv) a crime involving violence, including rape, sexual assault, or homicide, but not
36.34including other physical assault or battery; or
36.35(2) a felony conviction within the past five years for:
37.1(i) physical assault;
37.2(ii) battery; or
37.3(iii) a drug-related offense;
37.4the adoptive parent is prohibited from receiving adoption assistance on behalf of an
37.5otherwise eligible child.

37.6    Sec. 9. Minnesota Statutes 2013 Supplement, section 256N.25, subdivision 2, is
37.7amended to read:
37.8    Subd. 2. Negotiation of agreement. (a) When a child is determined to be eligible
37.9for guardianship assistance or adoption assistance, the financially responsible agency, or,
37.10if there is no financially responsible agency, the agency designated by the commissioner,
37.11must negotiate with the caregiver to develop an agreement under subdivision 1. If and when
37.12the caregiver and agency reach concurrence as to the terms of the agreement, both parties
37.13shall sign the agreement. The agency must submit the agreement, along with the eligibility
37.14determination outlined in sections 256N.22, subdivision 7, and 256N.23, subdivision 7, to
37.15the commissioner for final review, approval, and signature according to subdivision 1.
37.16(b) A monthly payment is provided as part of the adoption assistance or guardianship
37.17assistance agreement to support the care of children unless the child is eligible for adoption
37.18assistance and determined to be an at-risk child, in which case ~~the special at-risk monthly~~
37.19~~payment under section~~ ~~256N.26, subdivision 7, must~~ no payment will be made unless and
37.20until the caregiver obtains written documentation from a qualified expert that the potential
37.21disability upon which eligibility for the agreement was based has manifested itself.
37.22(1) The amount of the payment made on behalf of a child eligible for guardianship
37.23assistance or adoption assistance is determined through agreement between the prospective
37.24relative custodian or the adoptive parent and the financially responsible agency, or, if there
37.25is no financially responsible agency, the agency designated by the commissioner, using
37.26the assessment tool established by the commissioner in section 256N.24, subdivision 2,
37.27and the associated benefit and payments outlined in section 256N.26. Except as provided
37.28under section 256N.24, subdivision 1, paragraph (c), the assessment tool establishes
37.29the monthly benefit level for a child under foster care. The monthly payment under a
37.30guardianship assistance agreement or adoption assistance agreement may be negotiated up
37.31to the monthly benefit level under foster care. In no case may the amount of the payment
37.32under a guardianship assistance agreement or adoption assistance agreement exceed the
37.33foster care maintenance payment which would have been paid during the month if the
37.34child with respect to whom the guardianship assistance or adoption assistance payment is
37.35made had been in a foster family home in the state.
38.1(2) The rate schedule for the agreement is determined based on the age of the
38.2child on the date that the prospective adoptive parent or parents or relative custodian or
38.3custodians sign the agreement.
38.4(3) The income of the relative custodian or custodians or adoptive parent or parents
38.5must not be taken into consideration when determining eligibility for guardianship
38.6assistance or adoption assistance or the amount of the payments under section 256N.26.
38.7(4) With the concurrence of the relative custodian or adoptive parent, the amount of
38.8the payment may be adjusted periodically using the assessment tool established by the
38.9commissioner in section 256N.24, subdivision 2, and the agreement renegotiated under
38.10subdivision 3 when there is a change in the child's needs or the family's circumstances.
38.11(5) ~~The guardianship assistance or adoption assistance agreement of a child who is~~
38.12~~identified as at-risk receives the special at-risk monthly payment under section~~ ~~256N.26~~,
38.13~~subdivision 7, unless and until the potential disability manifests itself, as documented by~~
38.14~~an appropriate professional, and the commissioner authorizes commencement of payment~~
38.15~~by modifying the agreement accordingly. A relative custodian or~~ An adoptive parent
38.16of an at-risk child with ~~a guardianship assistance or~~ an adoption assistance agreement
38.17may request a reassessment of the child under section 256N.24, subdivision 9 10, and
38.18renegotiation of the ~~guardianship assistance or~~ adoption assistance agreement under
38.19subdivision 3 to include a monthly payment, if the caregiver has written documentation
38.20from a qualified expert that the potential disability upon which eligibility for the agreement
38.21was based has manifested itself. Documentation of the disability must be limited to
38.22evidence deemed appropriate by the commissioner.
38.23(c) For guardianship assistance agreements:
38.24(1) the initial amount of the monthly guardianship assistance payment must be
38.25equivalent to the foster care rate in effect at the time that the agreement is signed less any
38.26offsets under section 256N.26, subdivision 11, or a lesser negotiated amount if agreed to
38.27by the prospective relative custodian and specified in that agreement, unless ~~the child is~~
38.28~~identified as at-risk or~~ the guardianship assistance agreement is entered into when a child
38.29is under the age of six; and
38.30~~(2) an at-risk child must be assigned level A as outlined in section~~ ~~256N.26~~ ~~and~~
38.31~~receive the special at-risk monthly payment under section~~ ~~256N.26, subdivision 7, unless~~
38.32~~and until the potential disability manifests itself, as documented by a qualified expert, and~~
38.33~~the commissioner authorizes commencement of payment by modifying the agreement~~
38.34~~accordingly; and~~
39.1~~(3)~~ (2) the amount of the monthly payment for a guardianship assistance agreement
39.2for a child~~, other than an at-risk child,~~ who is under the age of six must be as specified in
39.3section 256N.26, subdivision 5.
39.4(d) For adoption assistance agreements:
39.5(1) for a child in foster care with the prospective adoptive parent immediately prior
39.6to adoptive placement, the initial amount of the monthly adoption assistance payment
39.7must be equivalent to the foster care rate in effect at the time that the agreement is signed
39.8less any offsets in section 256N.26, subdivision 11, or a lesser negotiated amount if agreed
39.9to by the prospective adoptive parents and specified in that agreement, unless the child is
39.10identified as at-risk or the adoption assistance agreement is entered into when a child is
39.11under the age of six;
39.12(2) for an at-risk child who must be assigned level A as outlined in section
39.13256N.26 ~~and receive the special at-risk monthly payment under section 256N.26,~~
39.14~~subdivision 7~~, no payment will be made unless and until the potential disability manifests
39.15itself, as documented by an appropriate professional, and the commissioner authorizes
39.16commencement of payment by modifying the agreement accordingly;
39.17(3) the amount of the monthly payment for an adoption assistance agreement for
39.18a child under the age of six, other than an at-risk child, must be as specified in section
39.19256N.26, subdivision 5 ;
39.20(4) for a child who is in the guardianship assistance program immediately prior
39.21to adoptive placement, the initial amount of the adoption assistance payment must be
39.22equivalent to the guardianship assistance payment in effect at the time that the adoption
39.23assistance agreement is signed or a lesser amount if agreed to by the prospective adoptive
39.24parent and specified in that agreement, unless the child is identified as an at-risk child; and
39.25(5) for a child who is not in foster care placement or the guardianship assistance
39.26program immediately prior to adoptive placement or negotiation of the adoption assistance
39.27agreement, the initial amount of the adoption assistance agreement must be determined
39.28using the assessment tool and process in this section and the corresponding payment
39.29amount outlined in section 256N.26.

39.30    Sec. 10. Minnesota Statutes 2013 Supplement, section 256N.25, subdivision 3, is
39.31amended to read:
39.32    Subd. 3. Renegotiation of agreement. (a) A relative custodian or adoptive
39.33parent of a child with a guardianship assistance or adoption assistance agreement may
39.34request renegotiation of the agreement when there is a change in the needs of the child
39.35or in the family's circumstances. When a relative custodian or adoptive parent requests
40.1renegotiation of the agreement, a reassessment of the child must be completed consistent
40.2with section 256N.24, subdivisions 9 and 10. If the reassessment indicates that the
40.3child's level has changed, the financially responsible agency or, if there is no financially
40.4responsible agency, the agency designated by the commissioner or the commissioner's
40.5designee, and the caregiver must renegotiate the agreement to include a payment with
40.6the level determined through the reassessment process. The agreement must not be
40.7renegotiated unless the commissioner, the financially responsible agency, and the caregiver
40.8mutually agree to the changes. The effective date of any renegotiated agreement must be
40.9determined by the commissioner.
40.10(b) ~~A relative custodian or~~ An adoptive parent of an at-risk child with ~~a guardianship~~
40.11~~assistance or~~ an adoption assistance agreement may request renegotiation of the agreement
40.12to include a monthly payment ~~higher than the special at-risk monthly payment~~ under
40.13section 256N.26~~, subdivision 7,~~ if the caregiver has written documentation from a
40.14qualified expert that the potential disability upon which eligibility for the agreement
40.15was based has manifested itself. Documentation of the disability must be limited to
40.16evidence deemed appropriate by the commissioner. Prior to renegotiating the agreement, a
40.17reassessment of the child must be conducted as outlined in section 256N.24, subdivision
40.189 . The reassessment must be used to renegotiate the agreement to include an appropriate
40.19monthly payment. The agreement must not be renegotiated unless the commissioner, the
40.20financially responsible agency, and the caregiver mutually agree to the changes. The
40.21effective date of any renegotiated agreement must be determined by the commissioner.
40.22(c) Renegotiation of a guardianship assistance or adoption assistance agreement is
40.23required when one of the circumstances outlined in section 256N.26, subdivision 13,
40.24occurs.

40.25    Sec. 11. Minnesota Statutes 2013 Supplement, section 256N.26, subdivision 1, is
40.26amended to read:
40.27    Subdivision 1. Benefits. (a) There are three benefits under Northstar Care for
40.28Children: medical assistance, basic payment, and supplemental difficulty of care payment.
40.29(b) A child is eligible for medical assistance under subdivision 2.
40.30(c) A child is eligible for the basic payment under subdivision 3, except for a child
40.31assigned level A under section 256N.24, subdivision 1, because the child is determined to
40.32be an at-risk child receiving ~~guardianship assistance or~~ adoption assistance.
40.33(d) A child, including a foster child age 18 to 21, is eligible for an additional
40.34supplemental difficulty of care payment under subdivision 4, as determined by the
40.35assessment under section 256N.24.
41.1(e) An eligible child entering guardianship assistance or adoption assistance under
41.2the age of six receives a basic payment and supplemental difficulty of care payment as
41.3specified in subdivision 5.
41.4(f) A child transitioning in from a pre-Northstar Care for Children program under
41.5section 256N.28, subdivision 7, shall receive basic and difficulty of care supplemental
41.6payments according to those provisions.

41.7    Sec. 12. Minnesota Statutes 2013 Supplement, section 256N.27, subdivision 4, is
41.8amended to read:
41.9    Subd. 4. Nonfederal share. (a) The commissioner shall establish a percentage share
41.10of the maintenance payments, reduced by federal reimbursements under title IV-E of the
41.11Social Security Act, to be paid by the state and to be paid by the financially responsible
41.12agency.
41.13(b) These state and local shares must initially be calculated based on the ratio of the
41.14average appropriate expenditures made by the state and all financially responsible agencies
41.15during calendar years 2011, 2012, 2013, and 2014. For purposes of this calculation,
41.16appropriate expenditures for the financially responsible agencies must include basic and
41.17difficulty of care payments for foster care reduced by federal reimbursements, but not
41.18including any initial clothing allowance, administrative payments to child care agencies
41.19specified in section 317A.907, child care, or other support or ancillary expenditures. For
41.20purposes of this calculation, appropriate expenditures for the state shall include adoption
41.21assistance and relative custody assistance, reduced by federal reimbursements.
41.22(c) For each of the periods January 1, 2015, to June 30, 2016, and fiscal years 2017,
41.232018, and 2019, the commissioner shall adjust this initial percentage of state and local
41.24shares to reflect the relative expenditure trends during calendar years 2011, 2012, 2013, and
41.252014, taking into account appropriations for Northstar Care for Children and the turnover
41.26rates of the components. In making these adjustments, the commissioner's goal shall be to
41.27make these state and local expenditures other than the appropriations for Northstar Care
41.28for Children to be the same as they would have been had Northstar Care for Children not
41.29been implemented, or if that is not possible, proportionally higher or lower, as appropriate.
41.30Except for adjustments so that the costs of the phase-in are borne by the state, the state and
41.31local share percentages for fiscal year 2019 must be used for all subsequent years.

41.32    Sec. 13. Minnesota Statutes 2012, section 257.85, subdivision 11, is amended to read:
41.33    Subd. 11. Financial considerations. (a) Payment of relative custody assistance
41.34under a relative custody assistance agreement is subject to the availability of state funds
42.1and payments may be reduced or suspended on order of the commissioner if insufficient
42.2funds are available.
42.3(b) ~~Upon receipt from a local agency of a claim for reimbursement, the commissioner~~
42.4~~shall reimburse the local agency in an amount equal to 100 percent of the relative custody~~
42.5~~assistance payments provided to relative custodians. The~~ A local agency may not seek and
42.6the commissioner shall not provide reimbursement for the administrative costs associated
42.7with performing the duties described in subdivision 4.
42.8(c) For the purposes of determining eligibility or payment amounts under MFIP,
42.9relative custody assistance payments shall be excluded in determining the family's
42.10available income.
42.11(d) For expenditures made on or before December 31, 2014, upon receipt from a
42.12local agency of a claim for reimbursement, the commissioner shall reimburse the local
42.13agency in an amount equal to 100 percent of the relative custody assistance payments
42.14provided to relative custodians.
42.15(e) For expenditures made on or after January 1, 2015, upon receipt from a local
42.16agency of a claim for reimbursement, the commissioner shall reimburse the local agency as
42.17part of the Northstar Care for Children fiscal reconciliation process under section 256N.27.

42.18    Sec. 14. Minnesota Statutes 2012, section 260C.212, subdivision 1, is amended to read:
42.19    Subdivision 1. Out-of-home placement; plan. (a) An out-of-home placement plan
42.20shall be prepared within 30 days after any child is placed in foster care by court order or a
42.21voluntary placement agreement between the responsible social services agency and the
42.22child's parent pursuant to section 260C.227 or chapter 260D.
42.23    (b) An out-of-home placement plan means a written document which is prepared
42.24by the responsible social services agency jointly with the parent or parents or guardian
42.25of the child and in consultation with the child's guardian ad litem, the child's tribe, if the
42.26child is an Indian child, the child's foster parent or representative of the foster care facility,
42.27and, where appropriate, the child. For a child in voluntary foster care for treatment under
42.28chapter 260D, preparation of the out-of-home placement plan shall additionally include
42.29the child's mental health treatment provider. As appropriate, the plan shall be:
42.30    (1) submitted to the court for approval under section 260C.178, subdivision 7;
42.31    (2) ordered by the court, either as presented or modified after hearing, under section
42.32260C.178 , subdivision 7, or 260C.201, subdivision 6; and
42.33    (3) signed by the parent or parents or guardian of the child, the child's guardian ad
42.34litem, a representative of the child's tribe, the responsible social services agency, and, if
42.35possible, the child.
43.1    (c) The out-of-home placement plan shall be explained to all persons involved in its
43.2implementation, including the child who has signed the plan, and shall set forth:
43.3    (1) a description of the foster care home or facility selected, including how the
43.4out-of-home placement plan is designed to achieve a safe placement for the child in the
43.5least restrictive, most family-like, setting available which is in close proximity to the home
43.6of the parent or parents or guardian of the child when the case plan goal is reunification,
43.7and how the placement is consistent with the best interests and special needs of the child
43.8according to the factors under subdivision 2, paragraph (b);
43.9    (2) the specific reasons for the placement of the child in foster care, and when
43.10reunification is the plan, a description of the problems or conditions in the home of the
43.11parent or parents which necessitated removal of the child from home and the changes the
43.12parent or parents must make in order for the child to safely return home;
43.13    (3) a description of the services offered and provided to prevent removal of the child
43.14from the home and to reunify the family including:
43.15    (i) the specific actions to be taken by the parent or parents of the child to eliminate
43.16or correct the problems or conditions identified in clause (2), and the time period during
43.17which the actions are to be taken; and
43.18    (ii) the reasonable efforts, or in the case of an Indian child, active efforts to be made
43.19to achieve a safe and stable home for the child including social and other supportive
43.20services to be provided or offered to the parent or parents or guardian of the child, the
43.21child, and the residential facility during the period the child is in the residential facility;
43.22    (4) a description of any services or resources that were requested by the child or the
43.23child's parent, guardian, foster parent, or custodian since the date of the child's placement
43.24in the residential facility, and whether those services or resources were provided and if
43.25not, the basis for the denial of the services or resources;
43.26    (5) the visitation plan for the parent or parents or guardian, other relatives as defined
43.27in section 260C.007, subdivision 27, and siblings of the child if the siblings are not placed
43.28together in foster care, and whether visitation is consistent with the best interest of the
43.29child, during the period the child is in foster care;
43.30    (6) when a child cannot return to or be in the care of either parent, documentation of
43.31steps to finalize the permanency plan for the child, including:
43.32    (i) reasonable efforts to place the child for adoption ~~or legal guardianship of the child~~
43.33~~if the court has issued an order terminating the rights of both parents of the child or of the~~
43.34~~only known, living parent of the child~~. At a minimum, the documentation must include
43.35consideration of whether adoption is in the best interests of the child, child-specific
43.36recruitment efforts such as relative search and the use of state, regional, and national
44.1adoption exchanges to facilitate orderly and timely placements in and outside of the state.
44.2A copy of this documentation shall be provided to the court in the review required under
44.3section 260C.317, subdivision 3, paragraph (b); and
44.4    (ii) documentation necessary to support the requirements of the kinship placement
44.5agreement under section 256N.22 when adoption is determined not to be in the child's
44.6best interest;
44.7    (7) efforts to ensure the child's educational stability while in foster care, including:
44.8(i) efforts to ensure that the child remains in the same school in which the child was
44.9enrolled prior to placement or upon the child's move from one placement to another,
44.10including efforts to work with the local education authorities to ensure the child's
44.11educational stability; or
44.12(ii) if it is not in the child's best interest to remain in the same school that the child
44.13was enrolled in prior to placement or move from one placement to another, efforts to
44.14ensure immediate and appropriate enrollment for the child in a new school;
44.15(8) the educational records of the child including the most recent information
44.16available regarding:
44.17    (i) the names and addresses of the child's educational providers;
44.18    (ii) the child's grade level performance;
44.19    (iii) the child's school record;
44.20    (iv) a statement about how the child's placement in foster care takes into account
44.21proximity to the school in which the child is enrolled at the time of placement; and
44.22(v) any other relevant educational information;
44.23    (9) the efforts by the local agency to ensure the oversight and continuity of health
44.24care services for the foster child, including:
44.25(i) the plan to schedule the child's initial health screens;
44.26(ii) how the child's known medical problems and identified needs from the screens,
44.27including any known communicable diseases, as defined in section 144.4172, subdivision
44.282, will be monitored and treated while the child is in foster care;
44.29(iii) how the child's medical information will be updated and shared, including
44.30the child's immunizations;
44.31(iv) who is responsible to coordinate and respond to the child's health care needs,
44.32including the role of the parent, the agency, and the foster parent;
44.33(v) who is responsible for oversight of the child's prescription medications;
44.34(vi) how physicians or other appropriate medical and nonmedical professionals
44.35will be consulted and involved in assessing the health and well-being of the child and
44.36determine the appropriate medical treatment for the child; and
45.1(vii) the responsibility to ensure that the child has access to medical care through
45.2either medical insurance or medical assistance;
45.3(10) the health records of the child including information available regarding:
45.4(i) the names and addresses of the child's health care and dental care providers;
45.5(ii) a record of the child's immunizations;
45.6(iii) the child's known medical problems, including any known communicable
45.7diseases as defined in section 144.4172, subdivision 2;
45.8(iv) the child's medications; and
45.9(v) any other relevant health care information such as the child's eligibility for
45.10medical insurance or medical assistance;
45.11(11) an independent living plan for a child age 16 or older. The plan should include,
45.12but not be limited to, the following objectives:
45.13    (i) educational, vocational, or employment planning;
45.14    (ii) health care planning and medical coverage;
45.15    (iii) transportation including, where appropriate, assisting the child in obtaining a
45.16driver's license;
45.17    (iv) money management, including the responsibility of the agency to ensure that
45.18the youth annually receives, at no cost to the youth, a consumer report as defined under
45.19section 13C.001 and assistance in interpreting and resolving any inaccuracies in the report;
45.20    (v) planning for housing;
45.21    (vi) social and recreational skills; and
45.22    (vii) establishing and maintaining connections with the child's family and
45.23community; and
45.24    (12) for a child in voluntary foster care for treatment under chapter 260D, diagnostic
45.25and assessment information, specific services relating to meeting the mental health care
45.26needs of the child, and treatment outcomes.
45.27    (d) The parent or parents or guardian and the child each shall have the right to legal
45.28counsel in the preparation of the case plan and shall be informed of the right at the time
45.29of placement of the child. The child shall also have the right to a guardian ad litem.
45.30If unable to employ counsel from their own resources, the court shall appoint counsel
45.31upon the request of the parent or parents or the child or the child's legal guardian. The
45.32parent or parents may also receive assistance from any person or social services agency
45.33in preparation of the case plan.
45.34    After the plan has been agreed upon by the parties involved or approved or ordered
45.35by the court, the foster parents shall be fully informed of the provisions of the case plan
45.36and shall be provided a copy of the plan.
46.1    Upon discharge from foster care, the parent, adoptive parent, or permanent legal and
46.2physical custodian, as appropriate, and the child, if appropriate, must be provided with
46.3a current copy of the child's health and education record.

46.4    Sec. 15. Minnesota Statutes 2012, section 260C.515, subdivision 4, is amended to read:
46.5    Subd. 4. Custody to relative. The court may order permanent legal and physical
46.6custody to a fit and willing relative in the best interests of the child according to the
46.7following ~~conditions~~ requirements:
46.8(1) an order for transfer of permanent legal and physical custody to a relative shall
46.9only be made after the court has reviewed the suitability of the prospective legal and
46.10physical custodian, including a review of the background study required under sections
46.11245C.33 and 256N.22, subdivision 4;
46.12(2) in transferring permanent legal and physical custody to a relative, the juvenile
46.13court shall follow the standards applicable under this chapter and chapter 260, and the
46.14procedures in the Minnesota Rules of Juvenile Protection Procedure;
46.15(3) a transfer of legal and physical custody includes responsibility for the protection,
46.16education, care, and control of the child and decision making on behalf of the child;
46.17(4) a permanent legal and physical custodian may not return a child to the permanent
46.18care of a parent from whom the court removed custody without the court's approval and
46.19without notice to the responsible social services agency;
46.20(5) the social services agency may file a petition naming a fit and willing relative as
46.21a proposed permanent legal and physical custodian. A petition for transfer of permanent
46.22legal and physical custody to a relative who is not a parent shall be accompanied by a
46.23kinship placement agreement under section 256N.22, subdivision 2, between the agency
46.24and proposed permanent legal and physical custodian;
46.25(6) another party to the permanency proceeding regarding the child may file a
46.26petition to transfer permanent legal and physical custody to a relative~~, but the~~. The petition
46.27must include facts upon which the court can make the determination required under clause
46.28(7) and must be filed not later than the date for the required admit-deny hearing under
46.29section 260C.507; or if the agency's petition is filed under section 260C.503, subdivision
46.302 , the petition must be filed not later than 30 days prior to the trial required under section
46.31260C.509 ; ~~and~~
46.32(7) where a petition is for transfer of permanent legal and physical custody to a
46.33relative who is not a parent, the court must find that:
47.1(i) transfer of permanent legal and physical custody and receipt of Northstar kinship
47.2assistance under chapter 256N, when requested and the child is eligible, is in the child's
47.3best interests;
47.4(ii) adoption is not in the child's best interests based on the determinations in the
47.5kinship placement agreement required under section 256N.22, subdivision 2;
47.6(iii) the agency made efforts to discuss adoption with the child's parent or parents,
47.7or the agency did not make efforts to discuss adoption and the reasons why efforts were
47.8not made; and
47.9(iv) there are reasons to separate siblings during placement, if applicable;
47.10(8) the court may defer finalization of an order transferring permanent legal and
47.11physical custody to a relative when deferring finalization is necessary to determine
47.12eligibility for Northstar kinship assistance under chapter 256N; and
47.13~~(7)~~ (9) the juvenile court may maintain jurisdiction over the responsible social
47.14services agency, the parents or guardian of the child, the child, and the permanent legal
47.15and physical custodian for purposes of ensuring appropriate services are delivered to the
47.16child and permanent legal custodian for the purpose of ensuring conditions ordered by the
47.17court related to the care and custody of the child are met.

47.18    Sec. 16. Minnesota Statutes 2012, section 260C.611, is amended to read:
47.19260C.611 ADOPTION STUDY REQUIRED.
47.20(a) An adoption study under section 259.41 approving placement of the child in the
47.21home of the prospective adoptive parent shall be completed before placing any child under
47.22the guardianship of the commissioner in a home for adoption. If a prospective adoptive
47.23parent has a current child foster care license under chapter 245A and is seeking to adopt
47.24a foster child who is placed in the prospective adoptive parent's home and is under the
47.25guardianship of the commissioner according to section 260C.325, subdivision 1, the child
47.26foster care home study meets the requirements of this section for an approved adoption
47.27home study if:
47.28(1) the written home study on which the foster care license was based is completed
47.29in the commissioner's designated format, consistent with the requirements in sections
47.30260C.215, subdivision 4, clause (5); and 259.41, subdivision 2; and Minnesota Rules,
47.31part 2960.3060, subpart 4;
47.32(2) the background studies on each prospective adoptive parent and all required
47.33household members were completed according to section 245C.33;
48.1(3) the commissioner has not issued, within the last three years, a sanction on the
48.2license under section 245A.07 or an order of a conditional license under section 245A.06;
48.3and
48.4(4) the legally responsible agency determines that the individual needs of the child
48.5are being met by the prospective adoptive parent through an assessment under section
48.6256N.24, subdivision 2, or a documented placement decision consistent with section
48.7260C.212, subdivision 2.
48.8(b) If a prospective adoptive parent has previously held a foster care license or
48.9adoptive home study, any update necessary to the foster care license, or updated or new
48.10adoptive home study, if not completed by the licensing authority responsible for the
48.11previous license or home study, shall include collateral information from the previous
48.12licensing or approving agency, if available.

48.13    Sec. 17. REVISOR'S INSTRUCTION.
48.14The revisor of statutes shall change the term "guardianship assistance" to "Northstar
48.15kinship assistance" wherever it appears in Minnesota Statutes and Minnesota Rules to
48.16refer to the program components related to Northstar Care for Children under Minnesota
48.17Statutes, chapter 256N.

48.18    Sec. 18. REPEALER.
48.19Minnesota Statutes 2013 Supplement, section 256N.26, subdivision 7, is repealed.

48.20ARTICLE 4

48.21COMMUNITY FIRST SERVICES AND SUPPORTS

48.22    Section 1. Minnesota Statutes 2012, section 245C.03, is amended by adding a
48.23subdivision to read:
48.24    Subd. 8. Community first services and supports organizations. The
48.25commissioner shall conduct background studies on any individual required under section
48.26256B.85 to have a background study completed under this chapter.

48.27    Sec. 2. Minnesota Statutes 2012, section 245C.04, is amended by adding a subdivision
48.28to read:
48.29    Subd. 7. Community first services and supports organizations. (a) The
48.30commissioner shall conduct a background study of an individual required to be studied
48.31under section 245C.03, subdivision 8, at least upon application for initial enrollment
48.32under section 256B.85.
49.1(b) Before an individual described in section 245C.03, subdivision 8, begins a
49.2position allowing direct contact with a person served by an organization required to initiate
49.3a background study under section 256B.85, the organization must receive a notice from
49.4the commissioner that the support worker is:
49.5(1) not disqualified under section 245C.14; or
49.6(2) disqualified, but the individual has received a set-aside of the disqualification
49.7under section 245C.22.

49.8    Sec. 3. Minnesota Statutes 2012, section 245C.10, is amended by adding a subdivision
49.9to read:
49.10    Subd. 10. Community first services and supports organizations. The
49.11commissioner shall recover the cost of background studies initiated by an agency-provider
49.12delivering services under section 256B.85, subdivision 11, or a financial management
49.13services contractor providing service functions under section 256B.85, subdivision 13,
49.14through a fee of no more than $20 per study, charged to the organization responsible for
49.15submitting the background study form. The fees collected under this subdivision are
49.16appropriated to the commissioner for the purpose of conducting background studies.

49.17    Sec. 4. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 2, is
49.18amended to read:
49.19    Subd. 2. Definitions. (a) For the purposes of this section, the terms defined in
49.20this subdivision have the meanings given.
49.21(b) "Activities of daily living" or "ADLs" means eating, toileting, grooming,
49.22dressing, bathing, mobility, positioning, and transferring.
49.23(c) "Agency-provider model" means a method of CFSS under which a qualified
49.24agency provides services and supports through the agency's own employees and policies.
49.25The agency must allow the participant to have a significant role in the selection and
49.26dismissal of support workers of their choice for the delivery of their specific services
49.27and supports.
49.28(d) "Behavior" means a description of a need for services and supports used to
49.29determine the home care rating and additional service units. The presence of Level I
49.30behavior is used to determine the home care rating. "Level I behavior" means physical
49.31aggression towards self or others or destruction of property that requires the immediate
49.32response of another person. If qualified for a home care rating as described in subdivision
49.338, additional service units can be added as described in subdivision 8, paragraph (f), for
49.34the following behaviors:
50.1(1) Level I behavior;
50.2(2) increased vulnerability due to cognitive deficits or socially inappropriate
50.3behavior; or
50.4(3) increased need for assistance for ~~recipients~~ participants who are verbally
50.5aggressive or resistive to care so that time needed to perform activities of daily living is
50.6increased.
50.7(e) "Budget model" means a service delivery method of CFSS that allows the
50.8use of a service budget and assistance from a vendor fiscal/employer agent financial
50.9management services (FMS) contractor for a participant to directly employ support
50.10workers and purchase supports and goods.
50.11~~(e)~~ (f) "Complex health-related needs" means an intervention listed in clauses (1)
50.12to (8) that has been ordered by a physician, and is specified in a community support
50.13plan, including:
50.14(1) tube feedings requiring:
50.15(i) a gastrojejunostomy tube; or
50.16(ii) continuous tube feeding lasting longer than 12 hours per day;
50.17(2) wounds described as:
50.18(i) stage III or stage IV;
50.19(ii) multiple wounds;
50.20(iii) requiring sterile or clean dressing changes or a wound vac; or
50.21(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
50.22specialized care;
50.23(3) parenteral therapy described as:
50.24(i) IV therapy more than two times per week lasting longer than four hours for
50.25each treatment; or
50.26(ii) total parenteral nutrition (TPN) daily;
50.27(4) respiratory interventions, including:
50.28(i) oxygen required more than eight hours per day;
50.29(ii) respiratory vest more than one time per day;
50.30(iii) bronchial drainage treatments more than two times per day;
50.31(iv) sterile or clean suctioning more than six times per day;
50.32(v) dependence on another to apply respiratory ventilation augmentation devices
50.33such as BiPAP and CPAP; and
50.34(vi) ventilator dependence under section 256B.0652;
50.35(5) insertion and maintenance of catheter, including:
50.36(i) sterile catheter changes more than one time per month;
51.1(ii) clean intermittent catheterization, and including self-catheterization more than
51.2six times per day; or
51.3(iii) bladder irrigations;
51.4(6) bowel program more than two times per week requiring more than 30 minutes to
51.5perform each time;
51.6(7) neurological intervention, including:
51.7(i) seizures more than two times per week and requiring significant physical
51.8assistance to maintain safety; or
51.9(ii) swallowing disorders diagnosed by a physician and requiring specialized
51.10assistance from another on a daily basis; and
51.11(8) other congenital or acquired diseases creating a need for significantly increased
51.12direct hands-on assistance and interventions in six to eight activities of daily living.
51.13~~(f)~~ (g) "Community first services and supports" or "CFSS" means the assistance and
51.14supports program under this section needed for accomplishing activities of daily living,
51.15instrumental activities of daily living, and health-related tasks through hands-on assistance
51.16to accomplish the task or constant supervision and cueing to accomplish the task, or the
51.17purchase of goods as defined in subdivision 7, ~~paragraph (a),~~ clause (3), that replace
51.18the need for human assistance.
51.19~~(g)~~ (h) "Community first services and supports service delivery plan" or "service
51.20delivery plan" means a written ~~summary of~~ document detailing the services and supports
51.21chosen by the participant to meet assessed needs that is are within the approved CFSS
51.22service authorization amount. Services and supports are based on the community support
51.23plan identified in section 256B.0911 and coordinated services and support plan and budget
51.24identified in section 256B.0915, subdivision 6, if applicable, that is determined by the
51.25participant to meet the assessed needs, using a person-centered planning process.
51.26(i) "Consultation services" means a Minnesota health care program enrolled provider
51.27organization that is under contract with the department and has the knowledge, skills,
51.28and ability to assist CFSS participants in using either the agency-provider model under
51.29subdivision 11 or the budget model under subdivision 13.
51.30~~(h)~~ (j) "Critical activities of daily living" means transferring, mobility, eating, and
51.31toileting.
51.32~~(i)~~ (k) "Dependency" in activities of daily living means a person requires hands-on
51.33assistance or constant supervision and cueing to accomplish one or more of the activities
51.34of daily living every day or on the days during the week that the activity is performed;
51.35however, a child may not be found to be dependent in an activity of daily living if,
51.36because of the child's age, an adult would either perform the activity for the child or assist
52.1the child with the activity and the assistance needed is the assistance appropriate for
52.2a typical child of the same age.
52.3~~(j)~~ (l) "Extended CFSS" means CFSS services and supports ~~under the~~
52.4~~agency-provider model~~ included in a service plan through one of the home and
52.5community-based services waivers and as approved and authorized under sections
52.6256B.0915 ; 256B.092, subdivision 5; and 256B.49, which exceed the amount, duration,
52.7and frequency of the state plan CFSS services for participants.
52.8~~(k)~~ (m) "Financial management services contractor or vendor" or "FMS contractor"
52.9 means a qualified organization ~~having~~ necessary to use the budget model under subdivision
52.1013 that has a written contract with the department to provide vendor fiscal/employer agent
52.11financial management services ~~necessary to use the budget model under subdivision 13~~
52.12~~that~~ (FMS). Services include but are not limited to: ~~participant education and technical~~
52.13~~assistance; CFSS service delivery planning and budgeting;~~ filing and payment of federal
52.14and state payroll taxes on behalf of the participant; initiating criminal background
52.15checks; billing~~, making payments, and~~ for approved CFSS funds; monitoring of
52.16~~spending~~ expenditures; accounting and disbursing CFSS funds; providing assistance in
52.17obtaining liability, workers' compensation, and unemployment coverage and filings; and
52.18~~assisting~~ participant instruction and technical assistance to the participant in fulfilling
52.19employer-related requirements in accordance with Section 3504 of the Internal Revenue
52.20Code and ~~the Internal Revenue Service Revenue Procedure 70-6~~ related regulations and
52.21interpretations, including Code of Federal Regulations, title 26, section 31.3504-1.
52.22~~(l) "Budget model" means a service delivery method of CFSS that allows the use of~~
52.23~~an individualized CFSS service delivery plan and service budget and provides assistance~~
52.24~~from the financial management services contractor to facilitate participant employment of~~
52.25~~support workers and the acquisition of supports and goods.~~
52.26~~(m)~~ (n) "Health-related procedures and tasks" means procedures and tasks related
52.27to the specific needs of an individual that can be ~~delegated~~ taught or assigned by a
52.28state-licensed healthcare or mental health professional and performed by a support worker.
52.29~~(n)~~ (o) "Instrumental activities of daily living" means activities related to
52.30living independently in the community, including but not limited to: meal planning,
52.31preparation, and cooking; shopping for food, clothing, or other essential items; laundry;
52.32housecleaning; assistance with medications; managing finances; communicating needs
52.33and preferences during activities; arranging supports; and assistance with traveling around
52.34and participating in the community.
52.35~~(o)~~ (p) "Legal representative" means parent of a minor, a court-appointed guardian,
52.36or another representative with legal authority to make decisions about services and
53.1supports for the participant. Other representatives with legal authority to make decisions
53.2include but are not limited to a health care agent or an attorney-in-fact authorized through
53.3a health care directive or power of attorney.
53.4~~(p)~~ (q) "Medication assistance" means providing verbal or visual reminders to take
53.5regularly scheduled medication, and includes any of the following supports listed in clauses
53.6(1) to (3) and other types of assistance, except that a support worker may not determine
53.7medication dose or time for medication or inject medications into veins, muscles, or skin:
53.8(1) under the direction of the participant or the participant's representative, bringing
53.9medications to the participant including medications given through a nebulizer, opening a
53.10container of previously set-up medications, emptying the container into the participant's
53.11hand, opening and giving the medication in the original container to the participant, or
53.12bringing to the participant liquids or food to accompany the medication;
53.13(2) organizing medications as directed by the participant or the participant's
53.14representative; and
53.15(3) providing verbal or visual reminders to perform regularly scheduled medications.
53.16~~(q)~~ (r) "Participant's representative" means a parent, family member, advocate,
53.17or other adult authorized by the participant to serve as a representative in connection
53.18with the provision of CFSS. This authorization must be in writing or by another method
53.19that clearly indicates the participant's free choice. The participant's representative must
53.20have no financial interest in the provision of any services included in the participant's
53.21service delivery plan and must be capable of providing the support necessary to assist
53.22the participant in the use of CFSS. If through the assessment process described in
53.23subdivision 5 a participant is determined to be in need of a participant's representative, one
53.24must be selected. If the participant is unable to assist in the selection of a participant's
53.25representative, the legal representative shall appoint one. Two persons may be designated
53.26as a participant's representative for reasons such as divided households and court-ordered
53.27custodies. Duties of a participant's representatives may include:
53.28(1) being available while ~~care is~~ services are provided in a method agreed upon by
53.29the participant or the participant's legal representative and documented in the participant's
53.30CFSS service delivery plan;
53.31(2) monitoring CFSS services to ensure the participant's CFSS service delivery
53.32plan is being followed; and
53.33(3) reviewing and signing CFSS time sheets after services are provided to provide
53.34verification of the CFSS services.
53.35~~(r)~~ (s) "Person-centered planning process" means a process that is directed by the
53.36participant to plan for services and supports. The person-centered planning process must:
54.1(1) include people chosen by the participant;
54.2(2) provide necessary information and support to ensure that the participant directs
54.3the process to the maximum extent possible, and is enabled to make informed choices
54.4and decisions;
54.5(3) be timely and occur at time and locations of convenience to the participant;
54.6(4) reflect cultural considerations of the participant;
54.7(5) include strategies for solving conflict or disagreement within the process,
54.8including clear conflict-of-interest guidelines for all planning;
54.9(6) provide the participant choices of the services and supports they receive and the
54.10staff providing those services and supports;
54.11(7) include a method for the participant to request updates to the plan; and
54.12(8) record the alternative home and community-based settings that were considered
54.13by the participant.
54.14~~(s)~~ (t) "Shared services" means the provision of CFSS services by the same CFSS
54.15support worker to two or three participants who voluntarily enter into an agreement to
54.16receive services at the same time and in the same setting by the same ~~provider~~ employer.
54.17~~(t) "Support specialist" means a professional with the skills and ability to assist the~~
54.18~~participant using either the agency-provider model under subdivision 11 or the flexible~~
54.19~~spending model under subdivision 13, in services including but not limited to assistance~~
54.20~~regarding:~~
54.21~~(1) the development, implementation, and evaluation of the CFSS service delivery~~
54.22~~plan under subdivision 6;~~
54.23~~(2) recruitment, training, or supervision, including supervision of health-related tasks~~
54.24~~or behavioral supports appropriately delegated or assigned by a health care professional,~~
54.25~~and evaluation of support workers; and~~
54.26~~(3) facilitating the use of informal and community supports, goods, or resources.~~
54.27(u) "Support worker" means an a qualified and trained employee of the ~~agency~~
54.28~~provider~~ agency-provider or of the participant employer under the budget model who
54.29has direct contact with the participant and provides services as specified within the
54.30participant's service delivery plan.
54.31(v) "Wages and benefits" means the hourly wages and salaries, the employer's
54.32share of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers'
54.33compensation, mileage reimbursement, health and dental insurance, life insurance,
54.34disability insurance, long-term care insurance, uniform allowance, contributions to
54.35employee retirement accounts, or other forms of employee compensation and benefits.
55.1(w) "Worker training and development" means services for developing workers'
55.2skills as required by the participant's individual CFSS delivery plan that are arranged for
55.3or provided by the agency-provider or purchased by the participant employer. These
55.4services include training, education, direct observation and supervision, and evaluation
55.5and coaching of job skills and tasks, including supervision of health-related tasks or
55.6behavioral supports.

55.7    Sec. 5. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 3, is
55.8amended to read:
55.9    Subd. 3. Eligibility. (a) CFSS is available to a person who meets one of the
55.10following:
55.11(1) is ~~a recipient~~ an enrollee of medical assistance as determined under section
55.12256B.055 , 256B.056, or 256B.057, subdivisions 5 and 9;
55.13(2) is a ~~recipient of~~ participant in the alternative care program under section
55.14256B.0913 ;
55.15(3) is a waiver ~~recipient~~ participant as defined under section 256B.0915, 256B.092,
55.16256B.093 , or 256B.49; or
55.17(4) has medical services identified in a participant's individualized education
55.18program and is eligible for services as determined in section 256B.0625, subdivision 26.
55.19(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
55.20meet all of the following:
55.21(1) require assistance and be determined dependent in one activity of daily living or
55.22Level I behavior based on assessment under section 256B.0911; and
55.23(2) is not a ~~recipient of~~ participant under a family support grant under section 252.32;.
55.24~~(3) lives in the person's own apartment or home including a family foster care setting~~
55.25~~licensed under chapter 245A, but not in corporate foster care under chapter 245A; or a~~
55.26~~noncertified boarding care home or a boarding and lodging establishment under chapter~~
55.27~~157.~~

55.28    Sec. 6. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 5, is
55.29amended to read:
55.30    Subd. 5. Assessment requirements. (a) The assessment of functional need must:
55.31(1) be conducted by a certified assessor according to the criteria established in
55.32section 256B.0911, subdivision 3a;
56.1(2) be conducted face-to-face, initially and at least annually thereafter, or when there
56.2is a significant change in the participant's condition or a change in the need for services
56.3and supports, or at the request of the participant; and
56.4(3) be completed using the format established by the commissioner.
56.5~~(b) A participant who is residing in a facility may be assessed and choose CFSS for~~
56.6~~the purpose of using CFSS to return to the community as described in subdivisions 3~~
56.7~~and 7, paragraph (a), clause (5).~~
56.8~~(c)~~ (b) The results of the assessment and any recommendations and authorizations
56.9for CFSS must be determined and communicated in writing by the lead agency's certified
56.10assessor as defined in section 256B.0911 to the participant and the agency-provider or
56.11~~financial management services provider~~ FMS contractor chosen by the participant within
56.1240 calendar days and must include the participant's right to appeal under section 256.045,
56.13subdivision 3 .
56.14~~(d)~~ (c) The lead agency assessor may ~~request~~ authorize a temporary authorization
56.15for CFSS services to be provided under the agency-provider model. Authorization for
56.16a temporary level of CFSS services under the agency-provider model is limited to the
56.17time specified by the commissioner, but shall not exceed 45 days. The level of services
56.18authorized under this ~~provision~~ paragraph shall have no bearing on a future authorization.

56.19    Sec. 7. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 6, is
56.20amended to read:
56.21    Subd. 6. Community first services and support service delivery plan. (a) The
56.22CFSS service delivery plan must be developed~~, implemented,~~ and evaluated through a
56.23person-centered planning process by the participant, or the participant's representative
56.24or legal representative who may be assisted by a ~~support specialist~~ consultation services
56.25provider. The CFSS service delivery plan must reflect the services and supports that
56.26are important to the participant and for the participant to meet the needs assessed
56.27by the certified assessor and identified in the community support plan under section
56.28256B.0911, subdivision 3 , or the coordinated services and support plan identified in
56.29section 256B.0915, subdivision 6, if applicable. The CFSS service delivery plan must be
56.30reviewed by the participant, the consultation services provider, and the agency-provider
56.31or ~~financial management services~~ FMS contractor prior to starting services and at least
56.32annually upon reassessment, or when there is a significant change in the participant's
56.33condition, or a change in the need for services and supports.
56.34(b) The commissioner shall establish the format and criteria for the CFSS service
56.35delivery plan.
57.1(c) The CFSS service delivery plan must be person-centered and:
57.2(1) specify the consultation services provider, agency-provider, or ~~financial~~
57.3~~management services~~ FMS contractor selected by the participant;
57.4(2) reflect the setting in which the participant resides that is chosen by the participant;
57.5(3) reflect the participant's strengths and preferences;
57.6(4) include the means to address the clinical and support needs as identified through
57.7an assessment of functional needs;
57.8(5) include individually identified goals and desired outcomes;
57.9(6) reflect the services and supports, paid and unpaid, that will assist the participant
57.10to achieve identified goals, including the costs of the services and supports, and the
57.11providers of those services and supports, including natural supports;
57.12(7) identify the amount and frequency of face-to-face supports and amount and
57.13frequency of remote supports and technology that will be used;
57.14(8) identify risk factors and measures in place to minimize them, including
57.15individualized backup plans;
57.16(9) be understandable to the participant and the individuals providing support;
57.17(10) identify the individual or entity responsible for monitoring the plan;
57.18(11) be finalized and agreed to in writing by the participant and signed by all
57.19individuals and providers responsible for its implementation;
57.20(12) be distributed to the participant and other people involved in the plan; ~~and~~
57.21(13) prevent the provision of unnecessary or inappropriate care.;
57.22(14) include a detailed budget for expenditures for budget model participants or
57.23participants under the agency-provider model if purchasing goods; and
57.24(15) include a plan for worker training and development detailing what service
57.25components will be used, when the service components will be used, how they will be
57.26provided, and how these service components relate to the participant's individual needs
57.27and CFSS support worker services.
57.28(d) The total units of agency-provider services or the service budget ~~allocation~~
57.29 amount for the budget model include both annual totals and a monthly average amount
57.30that cover the number of months of the service authorization. The amount used each
57.31month may vary, but additional funds must not be provided above the annual service
57.32authorization amount unless a change in condition is assessed and authorized by the
57.33certified assessor and documented in the community support plan, coordinated services
57.34and supports plan, and CFSS service delivery plan.
57.35(e) In assisting with the development or modification of the plan during the
57.36authorization time period, the consultation services provider shall:
58.1(1) consult with the FMS contractor on the spending budget when applicable; and
58.2(2) consult with the participant or participant's representative, agency-provider, and
58.3case manager/care coordinator.
58.4(f) The service plan must be approved by the consultation services provider for
58.5participants without a case manager/care coordinator. A case manager/care coordinator
58.6must approve the plan for a waiver or alternative care program participant.

58.7    Sec. 8. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 7, is
58.8amended to read:
58.9    Subd. 7. Community first services and supports; covered services. Within the
58.10service unit authorization or service budget ~~allocation~~ amount, services and supports
58.11covered under CFSS include:
58.12(1) assistance to accomplish activities of daily living (ADLs), instrumental activities
58.13of daily living (IADLs), and health-related procedures and tasks through hands-on
58.14assistance to accomplish the task or constant supervision and cueing to accomplish the task;
58.15(2) assistance to acquire, maintain, or enhance the skills necessary for the participant
58.16to accomplish activities of daily living, instrumental activities of daily living, or
58.17health-related tasks;
58.18(3) expenditures for items, services, supports, environmental modifications, or
58.19goods, including assistive technology. These expenditures must:
58.20(i) relate to a need identified in a participant's CFSS service delivery plan;
58.21(ii) increase independence or substitute for human assistance to the extent that
58.22expenditures would otherwise be made for human assistance for the participant's assessed
58.23needs;
58.24(4) observation and redirection for behavior or symptoms where there is a need for
58.25assistance. An assessment of behaviors must meet the criteria in this clause. A ~~recipient~~
58.26 participant qualifies as having a need for assistance due to behaviors if the ~~recipient's~~
58.27 participant's behavior requires assistance at least four times per week and shows one or
58.28more of the following behaviors:
58.29(i) physical aggression towards self or others, or destruction of property that requires
58.30the immediate response of another person;
58.31(ii) increased vulnerability due to cognitive deficits or socially inappropriate
58.32behavior; or
58.33(iii) increased need for assistance for ~~recipients~~ participants who are verbally
58.34aggressive or resistive to care so that time needed to perform activities of daily living is
58.35increased;
59.1(5) back-up systems or mechanisms, such as the use of pagers or other electronic
59.2devices, to ensure continuity of the participant's services and supports;
59.3~~(6) transition costs, including:~~
59.4~~(i) deposits for rent and utilities;~~
59.5~~(ii) first month's rent and utilities;~~
59.6~~(iii) bedding;~~
59.7~~(iv) basic kitchen supplies;~~
59.8~~(v) other necessities, to the extent that these necessities are not otherwise covered~~
59.9~~under any other funding that the participant is eligible to receive; and~~
59.10~~(vi) other required necessities for an individual to make the transition from a nursing~~
59.11~~facility, institution for mental diseases, or intermediate care facility for persons with~~
59.12~~developmental disabilities to a community-based home setting where the participant~~
59.13~~resides; and~~
59.14~~(7)~~ (6) services provided by a ~~support specialist~~ consultation services provider under
59.15contract with the department and enrolled as a Minnesota health care program provider as
59.16 defined under subdivision ~~2 that are chosen by the participant.~~ 17;
59.17(7) services provided by an FMS contractor under contract with the department
59.18as defined under subdivision 13;
59.19(8) CFSS services provided by a qualified support worker who is a parent, stepparent,
59.20or legal guardian of a participant under age 18, or who is the participant's spouse. These
59.21support workers shall not provide any medical assistance home and community-based
59.22services in excess of 40 hours per seven-day period regardless of the number of parents,
59.23combination of parents and spouses, or number of children who receive medical assistance
59.24services; and
59.25(9) worker training and development services as defined in subdivision 2, paragraph
59.26(w), and described in subdivision 18a.

59.27    Sec. 9. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 8, is
59.28amended to read:
59.29    Subd. 8. Determination of CFSS service methodology. (a) All community first
59.30services and supports must be authorized by the commissioner or the commissioner's
59.31designee before services begin, except for the assessments established in section
59.32256B.0911 . The authorization for CFSS must be completed as soon as possible following
59.33an assessment but no later than 40 calendar days from the date of the assessment.
60.1(b) The amount of CFSS authorized must be based on the ~~recipient's~~ participant's
60.2 home care rating described in paragraphs (d) and (e) and any additional service units for
60.3which the ~~person~~ participant qualifies as described in paragraph (f).
60.4(c) The home care rating shall be determined by the commissioner or the
60.5commissioner's designee based on information submitted to the commissioner identifying
60.6the following for a ~~recipient~~ participant:
60.7(1) the total number of dependencies of activities of daily living as defined in
60.8subdivision 2, paragraph (b);
60.9(2) the presence of complex health-related needs as defined in subdivision 2,
60.10paragraph (e); and
60.11(3) the presence of Level I behavior as defined in subdivision 2, paragraph (d),
60.12~~clause (1)~~.
60.13(d) The methodology to determine the total service units for CFSS for each home
60.14care rating is based on the median paid units per day for each home care rating from
60.15fiscal year 2007 data for the PCA program.
60.16(e) Each home care rating is designated by the letters P through Z and EN and has
60.17the following base number of service units assigned:
60.18(1) P home care rating requires Level I behavior or one to three dependencies in
60.19ADLs and qualifies one for five service units;
60.20(2) Q home care rating requires Level I behavior and one to three dependencies in
60.21ADLs and qualifies one for six service units;
60.22(3) R home care rating requires a complex health-related need and one to three
60.23dependencies in ADLs and qualifies one for seven service units;
60.24(4) S home care rating requires four to six dependencies in ADLs and qualifies
60.25one for ten service units;
60.26(5) T home care rating requires four to six dependencies in ADLs and Level I
60.27behavior and qualifies one for 11 service units;
60.28(6) U home care rating requires four to six dependencies in ADLs and a complex
60.29health-related need and qualifies one for 14 service units;
60.30(7) V home care rating requires seven to eight dependencies in ADLs and qualifies
60.31one for 17 service units;
60.32(8) W home care rating requires seven to eight dependencies in ADLs and Level I
60.33behavior and qualifies one for 20 service units;
60.34(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
60.35health-related need and qualifies one for 30 service units; and
61.1(10) EN home care rating includes ventilator dependency as defined in section
61.2256B.0651, subdivision 1 , paragraph (g). ~~Recipients~~ Participants who meet the definition
61.3of ventilator-dependent and the EN home care rating and utilize a combination of
61.4CFSS and other home care services are limited to a total of 96 service units per day for
61.5those services in combination. Additional units may be authorized when a ~~recipient's~~
61.6 participant's assessment indicates a need for two staff to perform activities. Additional
61.7time is limited to 16 service units per day.
61.8(f) Additional service units are provided through the assessment and identification of
61.9the following:
61.10(1) 30 additional minutes per day for a dependency in each critical activity of daily
61.11living as defined in subdivision 2, paragraph ~~(h)~~ (j);
61.12(2) 30 additional minutes per day for each complex health-related function as
61.13defined in subdivision 2, paragraph ~~(e)~~ (f); and
61.14(3) 30 additional minutes per day for each behavior issue as defined in subdivision 2,
61.15paragraph (d).
61.16(g) The service budget for budget model participants shall be based on:
61.17(1) assessed units as determined by the home care rating; and
61.18(2) an adjustment needed for administrative expenses.

61.19    Sec. 10. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 9, is
61.20amended to read:
61.21    Subd. 9. Noncovered services. (a) Services or supports that are not eligible for
61.22payment under this section include those that:
61.23(1) are not authorized by the certified assessor or included in the written service
61.24delivery plan;
61.25(2) are provided prior to the authorization of services and the approval of the written
61.26CFSS service delivery plan;
61.27(3) are duplicative of other paid services in the written service delivery plan;
61.28(4) supplant natural unpaid supports that appropriately meet a need in the service
61.29plan, are provided voluntarily to the participant, and are selected by the participant in lieu
61.30of other services and supports;
61.31(5) are not effective means to meet the participant's needs; and
61.32(6) are available through other funding sources, including, but not limited to, funding
61.33through title IV-E of the Social Security Act.
61.34(b) Additional services, goods, or supports that are not covered include:
62.1(1) those that are not for the direct benefit of the participant, except that services for
62.2caregivers such as training to improve the ability to provide CFSS are considered to directly
62.3benefit the participant if chosen by the participant and approved in the support plan;
62.4(2) any fees incurred by the participant, such as Minnesota health care programs fees
62.5and co-pays, legal fees, or costs related to advocate agencies;
62.6(3) insurance, except for insurance costs related to employee coverage;
62.7(4) room and board costs for the participant ~~with the exception of allowable~~
62.8~~transition costs in subdivision 7, clause (6)~~;
62.9(5) services, supports, or goods that are not related to the assessed needs;
62.10(6) special education and related services provided under the Individuals with
62.11Disabilities Education Act and vocational rehabilitation services provided under the
62.12Rehabilitation Act of 1973;
62.13(7) assistive technology devices and assistive technology services other than those
62.14for back-up systems or mechanisms to ensure continuity of service and supports listed in
62.15subdivision 7;
62.16(8) medical supplies and equipment listed as a covered benefit under medical
62.17assistance;
62.18(9) environmental modifications, except as specified in subdivision 7;
62.19(10) expenses for travel, lodging, or meals related to training the participant, or the
62.20participant's representative, or legal representative~~, or paid or unpaid caregivers that~~
62.21~~exceed $500 in a 12-month period~~;
62.22(11) experimental treatments;
62.23(12) any service or good covered by other medical assistance state plan services,
62.24including prescription and over-the-counter medications, compounds, and solutions and
62.25related fees, including premiums and co-payments;
62.26(13) membership dues or costs, except when the service is necessary and appropriate
62.27to treat a ~~physical~~ health condition or to improve or maintain the participant's ~~physical~~
62.28 health condition. The condition must be identified in the participant's CFSS plan and
62.29monitored by a ~~physician enrolled in a~~ Minnesota health care program enrolled physician;
62.30(14) vacation expenses other than the cost of direct services;
62.31(15) vehicle maintenance or modifications not related to the disability, health
62.32condition, or physical need; ~~and~~
62.33(16) tickets and related costs to attend sporting or other recreational or entertainment
62.34events.;
63.1(17) instrumental activities of daily living for children under the age of 18, except
63.2when immediate attention is needed for health or hygiene reasons integral to CFSS
63.3services and the assessor has listed the need in the service plan;
63.4(18) services provided and billed by a provider who is not an enrolled CFSS provider;
63.5(19) CFSS provided by a participant's representative or paid legal guardian;
63.6(20) services that are used solely as a child care or babysitting service;
63.7(21) services that are the responsibility or in the daily rate of a residential or program
63.8license holder under the terms of a service agreement and administrative rules;
63.9(22) sterile procedures;
63.10(23) giving of injections into veins, muscles, or skin;
63.11(24) homemaker services that are not an integral part of the assessed CFSS service;
63.12(25) home maintenance or chore services;
63.13(26) home care services, including hospice services if elected by the participant,
63.14covered by Medicare or any other insurance held by the participant;
63.15(27) services to other members of the participant's household;
63.16(28) services not specified as covered under medical assistance as CFSS;
63.17(29) application of restraints or implementation of deprivation procedures;
63.18(30) assessments by CFSS provider organizations or by independently enrolled
63.19registered nurses;
63.20(31) services provided in lieu of legally required staffing in a residential or child
63.21care setting; and
63.22(32) services provided by the residential or program license holder in a residence for
63.23more than four persons.

63.24    Sec. 11. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 10,
63.25is amended to read:
63.26    Subd. 10. ~~Provider~~ Agency-provider and FMS contractor qualifications ~~and~~,
63.27 general requirements, and duties. (a) Agency-providers delivering services under the
63.28agency-provider model under subdivision 11 or ~~financial management service (FMS)~~
63.29 FMS contractors under subdivision 13 shall:
63.30(1) enroll as a medical assistance Minnesota health care programs provider and meet
63.31all applicable provider standards and requirements;
63.32~~(2) comply with medical assistance provider enrollment requirements;~~
63.33~~(3)~~ (2) demonstrate compliance with ~~law~~ federal and state laws and policies of for
63.34 CFSS as determined by the commissioner;
64.1~~(4)~~ (3) comply with background study requirements under chapter 245C and
64.2maintain documentation of background study requests and results;
64.3~~(5)~~ (4) verify and maintain records of all services and expenditures by the participant,
64.4including hours worked by support workers ~~and support specialists~~;
64.5~~(6)~~ (5) not engage in any agency-initiated direct contact or marketing in person, by
64.6telephone, or other electronic means to potential participants, guardians, family members,
64.7or participants' representatives;
64.8(6) directly provide services and not use a subcontractor or reporting agent;
64.9(7) meet the financial requirements established by the commissioner for financial
64.10solvency;
64.11(8) have never had a lead agency contract or provider agreement discontinued due to
64.12fraud, or have never had an owner, board member, or manager fail a state or FBI-based
64.13criminal background check while enrolled or seeking enrollment as a Minnesota health
64.14care programs provider;
64.15(9) have established business practices that include written policies and procedures,
64.16internal controls, and a system that demonstrates the organization's ability to deliver
64.17quality CFSS; and
64.18(10) have an office located in Minnesota.
64.19(b) In conducting general duties, agency-providers and FMS contractors shall:
64.20~~(7)~~ (1) pay support workers ~~and support specialists~~ based upon actual hours of
64.21services provided;
64.22(2) pay for worker training and development services based upon actual hours of
64.23services provided or the unit cost of the training session purchased;
64.24~~(8)~~ (3) withhold and pay all applicable federal and state payroll taxes;
64.25~~(9)~~ (4) make arrangements and pay unemployment insurance, taxes, workers'
64.26compensation, liability insurance, and other benefits, if any;
64.27~~(10)~~ (5) enter into a written agreement with the participant, participant's
64.28representative, or legal representative that assigns roles and responsibilities to be
64.29performed before services, supports, or goods are provided using a format established by
64.30the commissioner;
64.31~~(11)~~ (6) report maltreatment as required under sections 626.556 and 626.557; ~~and~~
64.32~~(12)~~ (7) provide the participant with a copy of the service-related rights under
64.33subdivision 20 at the start of services and supports.; and
64.34(8) comply with any data requests from the department.

65.1    Sec. 12. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 11,
65.2is amended to read:
65.3    Subd. 11. Agency-provider model. (a) The agency-provider model ~~is limited to~~
65.4~~the~~ includes services provided by support workers and ~~support specialists~~ staff providing
65.5worker training and development services who are employed by an agency-provider
65.6that is licensed according to chapter 245A or meets other criteria established by the
65.7commissioner, including required training.
65.8(b) The agency-provider shall allow the participant to have a significant role in the
65.9selection and dismissal of the support workers for the delivery of the services and supports
65.10specified in the participant's service delivery plan.
65.11(c) A participant may use authorized units of CFSS services as needed within a
65.12service authorization that is not greater than 12 months. Using authorized units in a
65.13flexible manner in either the agency-provider model or the budget model does not increase
65.14the total amount of services and supports authorized for a participant or included in the
65.15participant's service delivery plan.
65.16(d) A participant may share CFSS services. Two or three CFSS participants may
65.17share services at the same time provided by the same support worker.
65.18(e) The agency-provider must use a minimum of 72.5 percent of the revenue
65.19generated by the medical assistance payment for CFSS for support worker wages and
65.20benefits. The agency-provider must document how this requirement is being met. The
65.21revenue generated by the ~~support specialist~~ worker training and development services
65.22 and the reasonable costs associated with the ~~support specialist~~ worker training and
65.23development services must not be used in making this calculation.
65.24(f) The agency-provider model must be used by individuals who have been restricted
65.25by the Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160
65.26to 9505.2245.
65.27(g) Participants purchasing goods under this model, along with support worker
65.28services, must:
65.29(1) specify the goods in the service delivery plan and detailed budget for
65.30expenditures that must be approved by the consultation services provider or the case
65.31manager/care coordinator; and
65.32(2) use the FMS contractor for the billing and payment of such goods.

65.33    Sec. 13. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 12,
65.34is amended to read:
66.1    Subd. 12. Requirements for enrollment of CFSS ~~provider~~ agency-provider
66.2 agencies. (a) All CFSS ~~provider agencies~~ agency-providers must provide, at the time of
66.3enrollment, reenrollment, and revalidation as a CFSS ~~provider agency~~ agency-provider in
66.4a format determined by the commissioner, information and documentation that includes,
66.5but is not limited to, the following:
66.6(1) the CFSS ~~provider agency's~~ agency-provider's current contact information
66.7including address, telephone number, and e-mail address;
66.8(2) proof of surety bond coverage. Upon new enrollment, or if the ~~provider agency's~~
66.9 agency-provider's Medicaid revenue in the previous calendar year is less than or equal
66.10to $300,000, the ~~provider agency~~ agency-provider must purchase a performance bond of
66.11$50,000. If the ~~provider agency's~~ agency-provider's Medicaid revenue in the previous
66.12calendar year is greater than $300,000, the ~~provider agency~~ agency-provider must
66.13purchase a performance bond of $100,000. The performance bond must be in a form
66.14approved by the commissioner, must be renewed annually, and must allow for recovery of
66.15costs and fees in pursuing a claim on the bond;
66.16(3) proof of fidelity bond coverage in the amount of $20,000;
66.17(4) proof of workers' compensation insurance coverage;
66.18(5) proof of liability insurance;
66.19(6) a description of the CFSS ~~provider agency's~~ agency-provider's organization
66.20identifying the names of all owners, managing employees, staff, board of directors, and
66.21the affiliations of the directors, and owners~~, or staff~~ to other service providers;
66.22(7) a copy of the CFSS ~~provider agency's~~ agency-provider's written policies and
66.23procedures including: hiring of employees; training requirements; service delivery;
66.24and employee and consumer safety including process for notification and resolution
66.25of consumer grievances, identification and prevention of communicable diseases, and
66.26employee misconduct;
66.27(8) copies of all other forms the CFSS ~~provider agency~~ agency-provider uses in the
66.28course of daily business including, but not limited to:
66.29(i) a copy of the CFSS ~~provider agency's~~ agency-provider's time sheet if the time
66.30sheet varies from the standard time sheet for CFSS services approved by the commissioner,
66.31and a letter requesting approval of the CFSS ~~provider agency's~~ agency-provider's
66.32 nonstandard time sheet; and
66.33(ii) ~~the~~ a copy of the participant's individual CFSS ~~provider agency's template for the~~
66.34~~CFSS care~~ service delivery plan;
66.35(9) a list of all training and classes that the CFSS ~~provider agency~~ agency-provider
66.36 requires of its staff providing CFSS services;
67.1(10) documentation that the CFSS ~~provider agency~~ agency-provider and staff have
67.2successfully completed all the training required by this section;
67.3(11) documentation of the ~~agency's~~ agency-provider's marketing practices;
67.4(12) disclosure of ownership, leasing, or management of all residential properties
67.5that are used or could be used for providing home care services;
67.6(13) documentation that the ~~agency~~ agency-provider will use at least the following
67.7percentages of revenue generated from the medical assistance rate paid for CFSS services
67.8for ~~employee personal care assistant~~ CFSS support worker wages and benefits: 72.5
67.9percent of revenue from CFSS providers. The revenue generated by the ~~support specialist~~
67.10 worker training and development services and the reasonable costs associated with the
67.11~~support specialist~~ worker training and development services shall not be used in making
67.12this calculation; and
67.13(14) documentation that the ~~agency~~ agency-provider does not burden ~~recipients'~~
67.14 participants' free exercise of their right to choose service providers by requiring ~~personal~~
67.15~~care assistants~~ CFSS support workers to sign an agreement not to work with any particular
67.16CFSS ~~recipient~~ participant or for another CFSS ~~provider agency~~ agency-provider after
67.17leaving the agency and that the agency is not taking action on any such agreements or
67.18requirements regardless of the date signed.
67.19(b) CFSS ~~provider agencies~~ agency-providers shall provide to the commissioner
67.20the information specified in paragraph (a).
67.21(c) All CFSS ~~provider agencies~~ agency-providers shall require all employees in
67.22management and supervisory positions and owners of the agency who are active in the
67.23day-to-day management and operations of the agency to complete mandatory training as
67.24determined by the commissioner. Employees in management and supervisory positions
67.25and owners who are active in the day-to-day operations of an agency who have completed
67.26the required training as an employee with a CFSS ~~provider agency~~ agency-provider do
67.27not need to repeat the required training if they are hired by another agency, if they have
67.28completed the training within the past three years. CFSS ~~provider agency~~ agency-provider
67.29 billing staff shall complete training about CFSS program financial management. Any new
67.30owners or employees in management and supervisory positions involved in the day-to-day
67.31operations are required to complete mandatory training as a requisite of working for the
67.32agency. ~~CFSS provider agencies certified for participation in Medicare as home health~~
67.33~~agencies are exempt from the training required in this subdivision.~~
67.34(d) The commissioner shall send annual review notifications to agency-providers 30
67.35days prior to renewal. The notification must:
67.36(1) list the materials and information the agency-provider is required to submit;
68.1(2) provide instructions on submitting information to the commissioner; and
68.2(3) provide a due date by which the commissioner must receive the requested
68.3information.
68.4Agency-providers shall submit the required documentation for annual review within
68.530 days of notification from the commissioner. If no documentation is submitted, the
68.6agency-provider enrollment number must be terminated or suspended.

68.7    Sec. 14. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 13,
68.8is amended to read:
68.9    Subd. 13. Budget model. (a) Under the budget model participants ~~can~~ may exercise
68.10more responsibility and control over the services and supports described and budgeted
68.11within the CFSS service delivery plan. Participants must use services provided by an FMS
68.12contractor as defined in subdivision 2, paragraph (m). Under this model, participants may
68.13use their approved service budget allocation to:
68.14(1) directly employ support workers, and pay wages, federal and state payroll taxes,
68.15and premiums for workers' compensation, liability, and health insurance coverage; and
68.16(2) obtain supports and goods as defined in subdivision 7~~; and~~.
68.17~~(3) choose a range of support assistance services from the financial management~~
68.18~~services (FMS) contractor related to:~~
68.19~~(i) assistance in managing the budget to meet the service delivery plan needs,~~
68.20~~consistent with federal and state laws and regulations;~~
68.21~~(ii) the employment, training, supervision, and evaluation of workers by the~~
68.22~~participant;~~
68.23~~(iii) acquisition and payment for supports and goods; and~~
68.24~~(iv) evaluation of individual service outcomes as needed for the scope of the~~
68.25~~participant's degree of control and responsibility.~~
68.26(b) Participants who are unable to fulfill any of the functions listed in paragraph (a)
68.27may authorize a legal representative or participant's representative to do so on their behalf.
68.28(c) The commissioner shall disenroll or exclude participants from the budget model
68.29and transfer them to the agency-provider model under the following circumstances that
68.30include but are not limited to:
68.31(1) when a participant has been restricted by the Minnesota restricted recipient
68.32program, in which case the participant may be excluded for a specified time period under
68.33Minnesota Rules, parts 9505.2160 to 9505.2245;
69.1(2) when a participant exits the budget model during the participant's service plan
69.2year. Upon transfer, the participant shall not access the budget model for the remainder of
69.3that service plan year; or
69.4(3) when the department determines that the participant or participant's representative
69.5or legal representative cannot manage participant responsibilities under the budget model.
69.6The commissioner must develop policies for determining if a participant is unable to
69.7manage responsibilities under the budget model.
69.8(d) A participant may appeal in writing to the department under section 256.045,
69.9subdivision 3, to contest the department's decision under paragraph (c), clause (3), to
69.10disenroll or exclude the participant from the budget model.
69.11~~(c)~~ (e) The FMS contractor shall not provide CFSS services and supports under the
69.12agency-provider service model.
69.13(f) The FMS contractor shall provide service functions as determined by the
69.14commissioner for budget model participants that include but are not limited to:
69.15~~(1) information and consultation about CFSS;~~
69.16~~(2)~~ (1) assistance with the development of the detailed budget for expenditures
69.17portion of the service delivery plan ~~and budget model~~ as requested by the consultation
69.18services provider or participant;
69.19~~(3)~~ (2) billing and making payments for budget model expenditures;
69.20~~(4)~~ (3) assisting participants in fulfilling employer-related requirements according to
69.21~~Internal Revenue Service Revenue Procedure 70-6, section 3504, Agency Employer Tax~~
69.22~~Liability, regulation 137036-08~~ section 3504 of the Internal Revenue Code and related
69.23regulations and interpretations, including Code of Federal Regulations, title 26, section
69.2431.3504-1, which includes assistance with filing and paying payroll taxes, and obtaining
69.25worker compensation coverage;
69.26~~(5)~~ (4) data recording and reporting of participant spending; ~~and~~
69.27~~(6)~~ (5) other duties established in the contract with the department, including with
69.28respect to providing assistance to the participant, participant's representative, or legal
69.29representative in performing their employer responsibilities regarding support workers.
69.30The support worker shall not be considered the employee of the ~~financial management~~
69.31~~services~~ FMS contractor.; and
69.32(6) billing, payment, and accounting of approved expenditures for goods for
69.33agency-provider participants.
69.34~~(d) A participant who requests to purchase goods and supports along with support~~
69.35~~worker services under the agency-provider model must use the budget model with~~
70.1~~a service delivery plan that specifies the amount of services to be authorized to the~~
70.2~~agency-provider and the expenditures to be paid by the FMS contractor.~~
70.3~~(e)~~ (g) The FMS contractor shall:
70.4(1) not limit or restrict the participant's choice of service or support providers or
70.5service delivery models consistent with any applicable state and federal requirements;
70.6(2) provide the participant, consultation services provider, and ~~the~~ targeted case
70.7manager, if applicable, with a monthly written summary of the spending for services and
70.8supports that were billed against the spending budget;
70.9(3) be knowledgeable of state and federal employment regulations, including those
70.10under the Fair Labor Standards Act of 1938, and comply with the requirements under ~~the~~
70.11~~Internal Revenue Service Revenue Procedure 70-6, Section 3504,~~ section 3504 of the
70.12Internal Revenue Code and related regulations and interpretations, including Code of
70.13Federal Regulations, title 26, section 31.3504-1, regarding agency employer tax liability
70.14for vendor or fiscal employer agent, and any requirements necessary to process employer
70.15and employee deductions, provide appropriate and timely submission of employer tax
70.16liabilities, and maintain documentation to support medical assistance claims;
70.17(4) have current and adequate liability insurance and bonding and sufficient cash
70.18flow as determined by the commissioner and have on staff or under contract a certified
70.19public accountant or an individual with a baccalaureate degree in accounting;
70.20(5) assume fiscal accountability for state funds designated for the program and be
70.21held liable for any overpayments or violations of applicable statutes or rules, including
70.22but not limited to the Minnesota False Claims Act; and
70.23(6) maintain documentation of receipts, invoices, and bills to track all services and
70.24supports expenditures for any goods purchased and maintain time records of support
70.25workers. The documentation and time records must be maintained for a minimum of
70.26five years from the claim date and be available for audit or review upon request by the
70.27commissioner. Claims submitted by the FMS contractor to the commissioner for payment
70.28must correspond with services, amounts, and time periods as authorized in the participant's
70.29~~spending~~ service budget and service plan and must contain specific identifying information
70.30as determined by the commissioner.
70.31~~(f)~~ (h) The commissioner of human services shall:
70.32(1) establish rates and payment methodology for the FMS contractor;
70.33(2) identify a process to ensure quality and performance standards for the FMS
70.34contractor and ensure statewide access to FMS contractors; and
70.35(3) establish a uniform protocol for delivering and administering CFSS services
70.36to be used by eligible FMS contractors.
71.1~~(g) The commissioner of human services shall disenroll or exclude participants from~~
71.2~~the budget model and transfer them to the agency-provider model under the following~~
71.3~~circumstances that include but are not limited to:~~
71.4~~(1) when a participant has been restricted by the Minnesota restricted recipient~~
71.5~~program, the participant may be excluded for a specified time period under Minnesota~~
71.6~~Rules, parts 9505.2160 to 9505.2245;~~
71.7~~(2) when a participant exits the budget model during the participant's service plan~~
71.8~~year. Upon transfer, the participant shall not access the budget model for the remainder of~~
71.9~~that service plan year; or~~
71.10~~(3) when the department determines that the participant or participant's representative~~
71.11~~or legal representative cannot manage participant responsibilities under the budget model.~~
71.12~~The commissioner must develop policies for determining if a participant is unable to~~
71.13~~manage responsibilities under a budget model.~~
71.14~~(h) A participant may appeal under section~~ ~~256.045, subdivision 3, in writing to the~~
71.15~~department to contest the department's decision under paragraph (c), clause (3), to remove~~
71.16~~or exclude the participant from the budget model.~~

71.17    Sec. 15. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 15,
71.18is amended to read:
71.19    Subd. 15. Documentation of support services provided. (a) Support services
71.20provided to a participant by a support worker employed by either an agency-provider
71.21or the participant acting as the employer must be documented daily by each support
71.22worker, on a time sheet form approved by the commissioner. All documentation may be
71.23Web-based, electronic, or paper documentation. The completed form must be submitted
71.24on a ~~monthly~~ regular basis to the provider or the participant and the FMS contractor
71.25selected by the participant to provide assistance with meeting the participant's employer
71.26obligations and kept in the ~~recipient's health~~ participant's record.
71.27(b) The activity documentation must correspond to the written service delivery plan
71.28and be reviewed by the agency-provider or the participant and the FMS contractor when
71.29the participant is ~~acting as~~ the employer of the support worker.
71.30(c) The time sheet must be on a form approved by the commissioner documenting
71.31time the support worker provides services ~~in the home~~ to the participant. The following
71.32criteria must be included in the time sheet:
71.33(1) full name of the support worker and individual provider number;
71.34(2) ~~provider~~ agency-provider name and telephone numbers, if ~~an agency-provider is~~
71.35 responsible for delivery services under the written service plan;
72.1(3) full name of the participant;
72.2(4) consecutive dates, including month, day, and year, and arrival and departure
72.3times with a.m. or p.m. notations;
72.4(5) signatures of the participant or the participant's representative;
72.5(6) personal signature of the support worker;
72.6(7) any shared care provided, if applicable;
72.7(8) a statement that it is a federal crime to provide false information on CFSS
72.8billings for medical assistance payments; and
72.9(9) dates and location of ~~recipient~~ participant stays in a hospital, care facility, or
72.10incarceration.

72.11    Sec. 16. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 16,
72.12is amended to read:
72.13    Subd. 16. Support workers requirements. (a) Support workers shall:
72.14(1) enroll with the department as a support worker after a background study under
72.15chapter 245C has been completed and the support worker has received a notice from the
72.16commissioner that:
72.17(i) the support worker is not disqualified under section 245C.14; or
72.18(ii) is disqualified, but the support worker has received a set-aside of the
72.19disqualification under section 245C.22;
72.20(2) have the ability to effectively communicate with the participant or the
72.21participant's representative;
72.22(3) have the skills and ability to provide the services and supports according to
72.23the ~~person's~~ participant's CFSS service delivery plan and respond appropriately to the
72.24participant's needs;
72.25(4) not be a participant of CFSS, unless the support services provided by the support
72.26worker differ from those provided to the support worker;
72.27(5) complete the basic standardized training as determined by the commissioner
72.28before completing enrollment. The training must be available in languages other than
72.29English and to those who need accommodations due to disabilities. Support worker
72.30training must include successful completion of the following training components: basic
72.31first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic roles
72.32and responsibilities of support workers including information about basic body mechanics,
72.33emergency preparedness, orientation to positive behavioral practices, orientation to
72.34responding to a mental health crisis, fraud issues, time cards and documentation, and an
72.35overview of person-centered planning and self-direction. Upon completion of the training
73.1components, the support worker must pass the certification test to provide assistance
73.2to participants;
73.3(6) complete training and orientation on the participant's individual needs; and
73.4(7) maintain the privacy and confidentiality of the participant, and not independently
73.5determine the medication dose or time for medications for the participant.
73.6(b) The commissioner may deny or terminate a support worker's provider enrollment
73.7and provider number if the support worker:
73.8(1) lacks the skills, knowledge, or ability to adequately or safely perform the
73.9required work;
73.10(2) fails to provide the authorized services required by the participant employer;
73.11(3) has been intoxicated by alcohol or drugs while providing authorized services to
73.12the participant or while in the participant's home;
73.13(4) has manufactured or distributed drugs while providing authorized services to the
73.14participant or while in the participant's home; or
73.15(5) has been excluded as a provider by the commissioner of human services, or the
73.16United States Department of Health and Human Services, Office of Inspector General,
73.17from participation in Medicaid, Medicare, or any other federal health care program.
73.18(c) A support worker may appeal in writing to the commissioner to contest the
73.19decision to terminate the support worker's provider enrollment and provider number.
73.20(d) A support worker must not provide or be paid for more than 275 hours of
73.21CFSS per month, regardless of the number of participants the support worker serves or
73.22the number of agency-providers or participant employers by which the support worker
73.23is employed. The department shall not disallow the number of hours per day a support
73.24worker works unless it violates other law.

73.25    Sec. 17. Minnesota Statutes 2013 Supplement, section 256B.85, is amended by adding
73.26a subdivision to read:
73.27    Subd. 16a. Exception to support worker requirements. The support worker for a
73.28participant may be allowed to enroll with a different CFSS agency-provider or FMS
73.29contractor upon initiation of a new background study according to chapter 245C, if the
73.30following conditions are met:
73.31(1) the commissioner determines that the support worker's change in enrollment or
73.32affiliation is needed to ensure continuity of services and protect the health and safety
73.33of the participant;
74.1(2) the chosen agency-provider or FMS contractor has been continuously enrolled as
74.2a CFSS agency-provider or FMS contractor for at least two years or since the inception of
74.3the CFSS program, whichever is shorter;
74.4(3) the participant served by the support worker chooses to transfer to the CFSS
74.5agency-provider or the FMS contractor to which the support worker is transferring;
74.6(4) the support worker has been continuously enrolled with the former CFSS
74.7agency-provider or FMS contractor since the support worker's last background study
74.8was completed; and
74.9(5) the support worker continues to meet requirements of subdivision 16, excluding
74.10paragraph (a), clause (1).

74.11    Sec. 18. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 17,
74.12is amended to read:
74.13    Subd. 17. ~~Support specialist requirements and payments~~ Consultation services
74.14description and duties. ~~The commissioner shall develop qualifications, scope of~~
74.15~~functions, and payment rates and service limits for a support specialist that may provide~~
74.16~~additional or specialized assistance necessary to plan, implement, arrange, augment, or~~
74.17~~evaluate services and supports.~~
74.18(a) Consultation services means providing assistance to the participant in making
74.19informed choices regarding CFSS services in general and self-directed tasks in particular
74.20and in developing a person-centered service delivery plan to achieve quality service
74.21outcomes.
74.22(b) Consultation services is a required service that may include but is not limited to:
74.23(1) an initial and annual orientation to CFSS information and policies, including
74.24selecting a service model;
74.25(2) assistance with the development, implementation, management, and evaluation
74.26of the person-centered service delivery plan;
74.27(3) consultation on recruiting, selecting, training, managing, directing, evaluating,
74.28and supervising support workers;
74.29(4) reviewing the use of and access to informal and community supports, goods, or
74.30resources;
74.31(5) remediation support; and
74.32(6) assistance with accessing FMS contractors or agency-providers.
74.33(c) Duties of a consultation services provider shall include but are not limited to:
74.34(1) review and finalization of the CFSS service delivery plan by the consultation
74.35services provider organization;
75.1(2) distribution of copies of the final service delivery plan to the participant and
75.2to the agency-provider or FMS contractor, case manager/care coordinator, and other
75.3designated parties;
75.4(3) an evaluation of services upon receiving information from an FMS contractor
75.5indicating spending or participant employer concerns;
75.6(4) a biannual review of services if the participant does not have a case manager/care
75.7coordinator and when the support worker is a paid parent of a minor participant or the
75.8participant's spouse;
75.9(5) collection and reporting of data as required by the department; and
75.10(6) providing the participant with a copy of the service-related rights under
75.11subdivision 20 at the start of consultation services.

75.12    Sec. 19. Minnesota Statutes 2013 Supplement, section 256B.85, is amended by adding
75.13a subdivision to read:
75.14    Subd. 17a. Consultation service provider qualifications and requirements.
75.15The commissioner shall develop the qualifications and requirements for providers of
75.16consultation services under subdivision 17. These providers must satisfy at least the
75.17following qualifications and requirements:
75.18(1) are under contract with the department;
75.19(2) are not the FMS contractor as defined in subdivision 2, paragraph (m), the CFSS
75.20or HCBS waiver agency-provider or vendor to the participant, or a lead agency;
75.21(3) meet the service standards as established by the commissioner;
75.22(4) employ lead professional staff with a minimum of three years of experience
75.23in providing support planning, support broker, or consultation services and consumer
75.24education to participants using a self-directed program using FMS under medical
75.25assistance;
75.26(5) are knowledgeable about CFSS roles and responsibilities including those of the
75.27certified assessor, FMS contractor, agency-provider, and case manager/care coordinator;
75.28(6) comply with medical assistance provider requirements;
75.29(7) understand the CFSS program and its policies;
75.30(8) are knowledgeable about self-directed principles and the application of the
75.31person-centered planning process;
75.32(9) have general knowledge of the FMS contractor duties and participant
75.33employment model, including all applicable federal, state, and local laws and regulations
75.34regarding tax, labor, employment, and liability and workers' compensation coverage for
75.35household workers; and
76.1(10) have all employees, including lead professional staff, staff in management
76.2and supervisory positions, and owners of the agency who are active in the day-to-day
76.3management and operations of the agency, complete training as specified in the contract
76.4with the department.

76.5    Sec. 20. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 18,
76.6is amended to read:
76.7    Subd. 18. Service unit and budget allocation requirements and limits. (a) For the
76.8agency-provider model, services will be authorized in units of service. The total service
76.9unit amount must be established based upon the assessed need for CFSS services, and must
76.10not exceed the maximum number of units available as determined under subdivision 8.
76.11(b) For the budget model, the service budget allocation allowed for services and
76.12supports is ~~established by multiplying the number of units authorized under subdivision 8~~
76.13~~by the payment rate established by the commissioner~~ defined in subdivision 8, paragraph
76.14(g).

76.15    Sec. 21. Minnesota Statutes 2013 Supplement, section 256B.85, is amended by adding
76.16a subdivision to read:
76.17    Subd. 18a. Worker training and development services. (a) The commissioner
76.18shall develop the scope of tasks and functions, service standards, and service limits for
76.19worker training and development services.
76.20(b) Worker training and development services are in addition to the participant's
76.21assessed service units or service budget. Services provided according to this subdivision
76.22must:
76.23(1) help support workers obtain and expand the skills and knowledge necessary to
76.24ensure competency in providing quality services as needed and defined in the participant's
76.25service delivery plan;
76.26(2) be provided or arranged for by the agency-provider under subdivision 11 or
76.27purchased by the participant employer under the budget model under subdivision 13; and
76.28(3) be described in the participant's CFSS service delivery plan and documented in
76.29the participant's file.
76.30(c) Services covered under worker training and development shall include:
76.31(1) support worker training on the participant's individual assessed needs, condition,
76.32or both, provided individually or in a group setting by a skilled and knowledgeable trainer
76.33beyond any training the participant or participant's representative provides;
77.1(2) tuition for professional classes and workshops for the participant's support
77.2workers that relate to the participant's assessed needs, condition, or both;
77.3(3) direct observation, monitoring, coaching, and documentation of support worker
77.4job skills and tasks, beyond any training the participant or participant's representative
77.5provides, including supervision of health-related tasks or behavioral supports that is
77.6conducted by an appropriate professional based on the participant's assessed needs. These
77.7services must be provided within 14 days of the start of services or the start of a new
77.8support worker and must be specified in the participant's service delivery plan; and
77.9(4) reporting service and support concerns to the appropriate provider.
77.10(d) Worker training and development services shall not include:
77.11(1) general agency training, worker orientation, or training on CFSS self-directed
77.12models;
77.13(2) payment for preparation or development time for the trainer or presenter;
77.14(3) payment of the support worker's salary or compensation during the training;
77.15(4) training or supervision provided by the participant, the participant's support
77.16worker, or the participant's informal supports, including the participant's representative; or
77.17(5) services in excess of 96 units per annual service authorization, unless approved
77.18by the department.

77.19    Sec. 22. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 23,
77.20is amended to read:
77.21    Subd. 23. Commissioner's access. When the commissioner is investigating a
77.22possible overpayment of Medicaid funds, the commissioner must be given immediate
77.23access without prior notice to the ~~agency provider~~ agency-provider or FMS contractor's
77.24office during regular business hours and to documentation and records related to services
77.25provided and submission of claims for services provided. Denying the commissioner
77.26access to records is cause for immediate suspension of payment and terminating the agency
77.27provider's enrollment according to section 256B.064 or terminating the FMS contract.

77.28    Sec. 23. Minnesota Statutes 2013 Supplement, section 256B.85, subdivision 24,
77.29is amended to read:
77.30    Subd. 24. CFSS agency-providers; background studies. CFSS agency-providers
77.31enrolled to provide ~~personal care assistance~~ CFSS services under the medical assistance
77.32program shall comply with the following:
77.33(1) owners who have a five percent interest or more and all managing employees
77.34are subject to a background study as provided in chapter 245C. This applies to currently
78.1enrolled CFSS agency-providers and those agencies seeking enrollment as a CFSS
78.2agency-provider. "Managing employee" has the same meaning as Code of Federal
78.3Regulations, title 42, section 455. An organization is barred from enrollment if:
78.4(i) the organization has not initiated background studies on owners managing
78.5employees; or
78.6(ii) the organization has initiated background studies on owners and managing
78.7employees, but the commissioner has sent the organization a notice that an owner or
78.8managing employee of the organization has been disqualified under section 245C.14, and
78.9the owner or managing employee has not received a set-aside of the disqualification
78.10under section 245C.22;
78.11(2) a background study must be initiated and completed for all ~~support specialists~~
78.12 staff who will have direct contact with the participant to provide worker training and
78.13development; and
78.14(3) a background study must be initiated and completed for all support workers.

78.15    Sec. 24. Laws 2013, chapter 108, article 7, section 49, the effective date, is amended to
78.16read:
78.17EFFECTIVE DATE.This section is effective upon federal approval but no earlier
78.18than April 1, 2014. The service will begin 90 days after federal approval ~~or April 1,~~
78.19~~2014, whichever is later~~. The commissioner of human services shall notify the revisor of
78.20statutes when this occurs.

78.21ARTICLE 5

78.22CONTINUING CARE

78.23    Section 1. Minnesota Statutes 2012, section 13.46, subdivision 4, is amended to read:
78.24    Subd. 4. Licensing data. (a) As used in this subdivision:
78.25    (1) "licensing data" are all data collected, maintained, used, or disseminated by the
78.26welfare system pertaining to persons licensed or registered or who apply for licensure
78.27or registration or who formerly were licensed or registered under the authority of the
78.28commissioner of human services;
78.29    (2) "client" means a person who is receiving services from a licensee or from an
78.30applicant for licensure; and
78.31    (3) "personal and personal financial data" are Social Security numbers, identity
78.32of and letters of reference, insurance information, reports from the Bureau of Criminal
78.33Apprehension, health examination reports, and social/home studies.
79.1    (b)(1)(i) Except as provided in paragraph (c), the following data on applicants,
79.2license holders, and former licensees are public: name, address, telephone number of
79.3licensees, date of receipt of a completed application, dates of licensure, licensed capacity,
79.4type of client preferred, variances granted, record of training and education in child care
79.5and child development, type of dwelling, name and relationship of other family members,
79.6previous license history, class of license, the existence and status of complaints, and the
79.7number of serious injuries to or deaths of individuals in the licensed program as reported
79.8to the commissioner of human services, the local social services agency, or any other
79.9county welfare agency. For purposes of this clause, a serious injury is one that is treated
79.10by a physician.
79.11(ii) When a correction order, an order to forfeit a fine, an order of license suspension,
79.12an order of temporary immediate suspension, an order of license revocation, an order
79.13of license denial, or an order of conditional license has been issued, or a complaint is
79.14resolved, the following data on current and former licensees and applicants are public: the
79.15substance and investigative findings of the licensing or maltreatment complaint, licensing
79.16violation, or substantiated maltreatment; the record of informal resolution of a licensing
79.17violation; orders of hearing; findings of fact; conclusions of law; specifications of the final
79.18correction order, fine, suspension, temporary immediate suspension, revocation, denial, or
79.19conditional license contained in the record of licensing action; whether a fine has been
79.20paid; and the status of any appeal of these actions.
79.21(iii) When a license denial under section 245A.05 or a sanction under section
79.22245A.07 is based on a determination that the license holder or applicant is responsible for
79.23maltreatment under section 626.556 or 626.557, the identity of the applicant or license
79.24holder as the individual responsible for maltreatment is public data at the time of the
79.25issuance of the license denial or sanction.
79.26(iv) When a license denial under section 245A.05 or a sanction under section
79.27245A.07 is based on a determination that the license holder or applicant is disqualified
79.28under chapter 245C, the identity of the license holder or applicant as the disqualified
79.29individual and the reason for the disqualification are public data at the time of the
79.30issuance of the licensing sanction or denial. If the applicant or license holder requests
79.31reconsideration of the disqualification and the disqualification is affirmed, the reason for
79.32the disqualification and the reason to not set aside the disqualification are public data.
79.33    (2) Notwithstanding sections 626.556, subdivision 11, and 626.557, subdivision 12b,
79.34when any person subject to disqualification under section 245C.14 in connection with a
79.35license to provide family day care for children, child care center services, foster care for
79.36children in the provider's home, or foster care or day care services for adults in the provider's
80.1home is a substantiated perpetrator of maltreatment, and the substantiated maltreatment is
80.2a reason for a licensing action, the identity of the substantiated perpetrator of maltreatment
80.3is public data. For purposes of this clause, a person is a substantiated perpetrator if the
80.4maltreatment determination has been upheld under section 256.045; 626.556, subdivision
80.510i ; 626.557, subdivision 9d; or chapter 14, or if an individual or facility has not timely
80.6exercised appeal rights under these sections, except as provided under clause (1).
80.7    (3) For applicants who withdraw their application prior to licensure or denial of a
80.8license, the following data are public: the name of the applicant, the city and county in
80.9which the applicant was seeking licensure, the dates of the commissioner's receipt of the
80.10initial application and completed application, the type of license sought, and the date
80.11of withdrawal of the application.
80.12    (4) For applicants who are denied a license, the following data are public: the name
80.13and address of the applicant, the city and county in which the applicant was seeking
80.14licensure, the dates of the commissioner's receipt of the initial application and completed
80.15application, the type of license sought, the date of denial of the application, the nature of
80.16the basis for the denial, the record of informal resolution of a denial, orders of hearings,
80.17findings of fact, conclusions of law, specifications of the final order of denial, and the
80.18status of any appeal of the denial.
80.19    (5) The following data on persons subject to disqualification under section 245C.14 in
80.20connection with a license to provide family day care for children, child care center services,
80.21foster care for children in the provider's home, or foster care or day care services for adults
80.22in the provider's home, are public: the nature of any disqualification set aside under section
80.23245C.22 , subdivisions 2 and 4, and the reasons for setting aside the disqualification; the
80.24nature of any disqualification for which a variance was granted under sections 245A.04,
80.25subdivision 9 ; and 245C.30, and the reasons for granting any variance under section
80.26245A.04, subdivision 9 ; and, if applicable, the disclosure that any person subject to
80.27a background study under section 245C.03, subdivision 1, has successfully passed a
80.28background study. If a licensing sanction under section 245A.07, or a license denial under
80.29section 245A.05, is based on a determination that an individual subject to disqualification
80.30under chapter 245C is disqualified, the disqualification as a basis for the licensing sanction
80.31or denial is public data. As specified in clause (1), item (iv), if the disqualified individual
80.32is the license holder or applicant, the identity of the license holder or applicant and the
80.33reason for the disqualification are public data; and, if the license holder or applicant
80.34requested reconsideration of the disqualification and the disqualification is affirmed, the
80.35reason for the disqualification and the reason to not set aside the disqualification are
81.1public data. If the disqualified individual is an individual other than the license holder or
81.2applicant, the identity of the disqualified individual shall remain private data.
81.3    (6) When maltreatment is substantiated under section 626.556 or 626.557 and the
81.4victim and the substantiated perpetrator are affiliated with a program licensed under
81.5chapter 245A, the commissioner of human services, local social services agency, or
81.6county welfare agency may inform the license holder where the maltreatment occurred of
81.7the identity of the substantiated perpetrator and the victim.
81.8    (7) Notwithstanding clause (1), for child foster care, only the name of the license
81.9holder and the status of the license are public if the county attorney has requested that data
81.10otherwise classified as public data under clause (1) be considered private data based on the
81.11best interests of a child in placement in a licensed program.
81.12    (c) The following are private data on individuals under section 13.02, subdivision
81.1312 , or nonpublic data under section 13.02, subdivision 9: personal and personal financial
81.14data on family day care program and family foster care program applicants and licensees
81.15and their family members who provide services under the license.
81.16    (d) The following are private data on individuals: the identity of persons who have
81.17made reports concerning licensees or applicants that appear in inactive investigative data,
81.18and the records of clients or employees of the licensee or applicant for licensure whose
81.19records are received by the licensing agency for purposes of review or in anticipation of a
81.20contested matter. The names of reporters of complaints or alleged violations of licensing
81.21standards under chapters 245A, 245B, 245C, and 245D, and applicable rules and alleged
81.22maltreatment under sections 626.556 and 626.557, are confidential data and may be
81.23disclosed only as provided in section 626.556, subdivision 11, or 626.557, subdivision 12b.
81.24    (e) Data classified as private, confidential, nonpublic, or protected nonpublic under
81.25this subdivision become public data if submitted to a court or administrative law judge as
81.26part of a disciplinary proceeding in which there is a public hearing concerning a license
81.27which has been suspended, immediately suspended, revoked, or denied.
81.28    (f) Data generated in the course of licensing investigations that relate to an alleged
81.29violation of law are investigative data under subdivision 3.
81.30    (g) Data that are not public data collected, maintained, used, or disseminated under
81.31this subdivision that relate to or are derived from a report as defined in section 626.556,
81.32subdivision 2 , or 626.5572, subdivision 18, are subject to the destruction provisions of
81.33sections 626.556, subdivision 11c, and 626.557, subdivision 12b.
81.34    (h) Upon request, not public data collected, maintained, used, or disseminated under
81.35this subdivision that relate to or are derived from a report of substantiated maltreatment as
81.36defined in section 626.556 or 626.557 may be exchanged with the Department of Health
82.1for purposes of completing background studies pursuant to section 144.057 and with
82.2the Department of Corrections for purposes of completing background studies pursuant
82.3to section 241.021.
82.4    (i) Data on individuals collected according to licensing activities under chapters
82.5245A and 245C, data on individuals collected by the commissioner of human services
82.6according to investigations under chapters 245A, 245B, ~~and~~ 245C, and 245D, and
82.7sections 626.556 and 626.557 may be shared with the Department of Human Rights, the
82.8Department of Health, the Department of Corrections, the ombudsman for mental health
82.9and developmental disabilities, and the individual's professional regulatory board when
82.10there is reason to believe that laws or standards under the jurisdiction of those agencies may
82.11have been violated or the information may otherwise be relevant to the board's regulatory
82.12jurisdiction. Background study data on an individual who is the subject of a background
82.13study under chapter 245C for a licensed service for which the commissioner of human
82.14services is the license holder may be shared with the commissioner and the commissioner's
82.15delegate by the licensing division. Unless otherwise specified in this chapter, the identity
82.16of a reporter of alleged maltreatment or licensing violations may not be disclosed.
82.17    (j) In addition to the notice of determinations required under section 626.556,
82.18subdivision 10f , if the commissioner or the local social services agency has determined
82.19that an individual is a substantiated perpetrator of maltreatment of a child based on sexual
82.20abuse, as defined in section 626.556, subdivision 2, and the commissioner or local social
82.21services agency knows that the individual is a person responsible for a child's care in
82.22another facility, the commissioner or local social services agency shall notify the head
82.23of that facility of this determination. The notification must include an explanation of the
82.24individual's available appeal rights and the status of any appeal. If a notice is given under
82.25this paragraph, the government entity making the notification shall provide a copy of the
82.26notice to the individual who is the subject of the notice.
82.27    (k) All not public data collected, maintained, used, or disseminated under this
82.28subdivision and subdivision 3 may be exchanged between the Department of Human
82.29Services, Licensing Division, and the Department of Corrections for purposes of
82.30regulating services for which the Department of Human Services and the Department
82.31of Corrections have regulatory authority.

82.32    Sec. 2. Minnesota Statutes 2013 Supplement, section 245.8251, is amended to read:
82.33245.8251 POSITIVE SUPPORT STRATEGIES AND EMERGENCY
82.34MANUAL RESTRAINT; LICENSED FACILITIES AND PROGRAMS.
83.1    Subdivision 1. Rules governing the use of positive support strategies and
83.2restricting or prohibiting restrictive interventions. The commissioner of human
83.3services shall, ~~within 24 months of May 23, 2013~~ by August 31, 2015, adopt rules
83.4governing the use of positive support strategies, ~~safety interventions, and~~ emergency use
83.5of manual restraint, and restricting or prohibiting the use of restrictive interventions, in
83.6all facilities and services licensed under chapter 245D., and in all licensed facilities and
83.7licensed services serving persons with a developmental disability or related condition.
83.8For the purposes of this section, "developmental disability or related condition" has the
83.9meaning given in Minnesota Rules, part 9525.0016, subpart 2, items A to E.
83.10    Subd. 2. Data collection. (a) The commissioner shall, with stakeholder input,
83.11~~develop~~ identify data ~~collection~~ elements specific to incidents of emergency use of
83.12manual restraint and positive support transition plans for persons receiving services from
83.13~~providers governed~~ licensed facilities and licensed services under chapter 245D and in
83.14licensed facilities and licensed services serving persons with a developmental disability
83.15or related condition as defined in Minnesota Rules, part 9525.0016, subpart 2, effective
83.16January 1, 2014. ~~Providers~~ Licensed facilities and licensed services shall report the data in
83.17a format and at a frequency determined by the commissioner of human services~~. Providers~~
83.18~~shall submit the data~~ to the commissioner and the Office of the Ombudsman for Mental
83.19Health and Developmental Disabilities.
83.20(b) Beginning July 1, 2013, ~~providers~~ licensed facilities and licensed services
83.21 regulated under Minnesota Rules, parts 9525.2700 to 9525.2810, shall submit data
83.22regarding the use of all controlled procedures identified in Minnesota Rules, part
83.239525.2740, in a format and at a frequency determined by the commissioner~~. Providers~~
83.24~~shall submit the data~~ to the commissioner and the Office of the Ombudsman for Mental
83.25Health and Developmental Disabilities.
83.26    Subd. 3. External program review committee. Rules adopted according to this
83.27section shall establish requirements for an external program review committee appointed
83.28by the commissioner to monitor implementation of the rules and make recommendations
83.29to the commissioner about any needed policy changes after adoption of the rules.
83.30    Subd. 4. Interim review panel. (a) The commissioner shall establish an interim
83.31review panel by August 15, 2014, for the purpose of reviewing requests for emergency
83.32use of procedures that have been part of an approved positive support transition plan
83.33when necessary to protect a person from imminent risk of serious injury as defined in
83.34section 245.91, subdivision 6, due to self-injurious behavior. The panel must make
83.35recommendations to the commissioner to approve or deny these requests based on criteria
84.1to be established by the interim review panel. The interim review panel shall operate until
84.2the external program review committee is established as required under subdivision 3.
84.3(b) Members of the interim review panel shall be selected based on their expertise
84.4and knowledge related to the use of positive support strategies as alternatives to the use
84.5of restrictive interventions. The commissioner shall seek input and recommendations
84.6from the Office of the Ombudsman for Mental Health and Developmental Disabilities in
84.7establishing the interim review panel. Members of the interim review panel shall include
84.8the following representatives:
84.9(1) an expert in positive supports;
84.10(2) a mental health professional, as defined in section 245.462;
84.11(3) a licensed health professional as defined in section 245D.02, subdivision 14;
84.12(4) a representative of the Department of Health; and
84.13(5) a representative of the Minnesota Disability Law Center.

84.14    Sec. 3. Minnesota Statutes 2013 Supplement, section 245A.042, subdivision 3, is
84.15amended to read:
84.16    Subd. 3. Implementation. (a) The commissioner shall implement the
84.17responsibilities of this chapter according to the timelines in paragraphs (b) and (c)
84.18only within the limits of available appropriations or other administrative cost recovery
84.19methodology.
84.20(b) The licensure of home and community-based services according to this section
84.21shall be implemented January 1, 2014. License applications shall be received and
84.22processed on a phased-in schedule as determined by the commissioner beginning July
84.231, 2013. Licenses will be issued thereafter upon the commissioner's determination that
84.24the application is complete according to section 245A.04.
84.25(c) Within the limits of available appropriations or other administrative cost recovery
84.26methodology, implementation of compliance monitoring must be phased in after January
84.271, 2014.
84.28(1) Applicants who do not currently hold a license issued under chapter 245B must
84.29receive an initial compliance monitoring visit after 12 months of the effective date of the
84.30initial license for the purpose of providing technical assistance on how to achieve and
84.31maintain compliance with the applicable law or rules governing the provision of home and
84.32community-based services under chapter 245D. If during the review the commissioner
84.33finds that the license holder has failed to achieve compliance with an applicable law or
84.34rule and this failure does not imminently endanger the health, safety, or rights of the
85.1persons served by the program, the commissioner may issue a licensing review report with
85.2recommendations for achieving and maintaining compliance.
85.3(2) Applicants who do currently hold a license issued under this chapter must receive
85.4a compliance monitoring visit after 24 months of the effective date of the initial license.
85.5(d) Nothing in this subdivision shall be construed to limit the commissioner's
85.6authority to suspend or revoke a license or issue a fine at any time under section 245A.07,
85.7or issue correction orders and make a license conditional for failure to comply with
85.8applicable laws or rules under section 245A.06, based on the nature, chronicity, or severity
85.9of the violation of law or rule and the effect of the violation on the health, safety, or
85.10rights of persons served by the program.
85.11(e) License holders governed under chapter 245D must ensure compliance with the
85.12following requirements within the stated timelines:
85.13(1) service initiation and service planning requirements must be met at the next
85.14annual meeting of the person's support team or by January 1, 2015, whichever is later,
85.15for the following:
85.16    (i) provision of a written notice that identifies the service recipient rights and an
85.17explanation of those rights as required under section 245D.04, subdivision 1;
85.18(ii) service planning for basic support services as required under section 245D.07,
85.19subdivision 2; and
85.20(iii) service planning for intensive support services under section 245D.071,
85.21subdivisions 3 and 4;
85.22(2) staff orientation to program requirements as required under section 245D.09,
85.23subdivision 4, for staff hired before January 1, 2014, must be met by January 1, 2015.
85.24The license holder may otherwise provide documentation verifying these requirements
85.25were met before January 1, 2014;
85.26(3) development of policy and procedures as required under section 245D.11, must
85.27be completed no later than August 31, 2014;
85.28(4) written or electronic notice and copies of policies and procedures must be
85.29provided to all persons or their legal representatives and case managers as required under
85.30section 245D.10, subdivision 4, paragraphs (b) and (c), by September 15, 2014, or within
85.3130 days of development of the required policies and procedures, whichever is earlier; and
85.32(5) all employees must be informed of the revisions and training must be provided on
85.33implementation of the revised policies and procedures as required under section 245D.10,
85.34subdivision 4, paragraph (d), by September 15, 2014, or within 30 days of development of
85.35the required policies and procedures, whichever is earlier.

86.1    Sec. 4. Minnesota Statutes 2013 Supplement, section 245A.16, subdivision 1, is
86.2amended to read:
86.3    Subdivision 1. Delegation of authority to agencies. (a) County agencies and
86.4private agencies that have been designated or licensed by the commissioner to perform
86.5licensing functions and activities under section 245A.04 and background studies for family
86.6child care under chapter 245C; to recommend denial of applicants under section 245A.05;
86.7to issue correction orders, to issue variances, and recommend a conditional license under
86.8section 245A.06, or to recommend suspending or revoking a license or issuing a fine under
86.9section 245A.07, shall comply with rules and directives of the commissioner governing
86.10those functions and with this section. The following variances are excluded from the
86.11delegation of variance authority and may be issued only by the commissioner:
86.12    (1) dual licensure of family child care and child foster care, dual licensure of child
86.13and adult foster care, and adult foster care and family child care;
86.14    (2) adult foster care maximum capacity;
86.15    (3) adult foster care minimum age requirement;
86.16    (4) child foster care maximum age requirement;
86.17    (5) variances regarding disqualified individuals except that county agencies may
86.18issue variances under section 245C.30 regarding disqualified individuals when the county
86.19is responsible for conducting a consolidated reconsideration according to sections 245C.25
86.20and 245C.27, subdivision 2, clauses (a) and (b), of a county maltreatment determination
86.21and a disqualification based on serious or recurring maltreatment;
86.22    (6) the required presence of a caregiver in the adult foster care residence during
86.23normal sleeping hours; and
86.24    (7) variances for community residential setting licenses under chapter 245D.
86.25Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency
86.26must not grant a license holder a variance to exceed the maximum allowable family child
86.27care license capacity of 14 children.
86.28    (b) County agencies must report information about disqualification reconsiderations
86.29under sections 245C.25 and 245C.27, subdivision 2, paragraphs (a) and (b), and variances
86.30granted under paragraph (a), clause (5), to the commissioner at least monthly in a format
86.31prescribed by the commissioner.
86.32    (c) For family day care programs, the commissioner may authorize licensing reviews
86.33every two years after a licensee has had at least one annual review.
86.34    (d) For family adult day services programs, the commissioner may authorize
86.35licensing reviews every two years after a licensee has had at least one annual review.
86.36    (e) A license issued under this section may be issued for up to two years.
87.1(f) During implementation of chapter 245D, the commissioner shall consider:
87.2(1) the role of counties in quality assurance;
87.3(2) the duties of county licensing staff; and
87.4(3) the possible use of joint powers agreements, according to section 471.59, with
87.5counties through which some licensing duties under chapter 245D may be delegated by
87.6the commissioner to the counties.
87.7Any consideration related to this paragraph must meet all of the requirements of the
87.8corrective action plan ordered by the federal Centers for Medicare and Medicaid Services.
87.9(g) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
87.10successor provisions; and section 245D.061 or successor provisions, for family child
87.11foster care programs providing out-of-home respite, as identified in section 245D.03,
87.12subdivision 1, paragraph (b), clause (1), is excluded from the delegation of authority
87.13to county and private agencies.

87.14    Sec. 5. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 3, is
87.15amended to read:
87.16    Subd. 3. Case manager. "Case manager" means the individual designated
87.17to provide waiver case management services, care coordination, or long-term care
87.18consultation, as specified in sections 256B.0913, 256B.0915, 256B.092, and 256B.49,
87.19or successor provisions. For purposes of this chapter, "case manager" includes case
87.20management services as defined in Minnesota Rules, part 9520.0902, subpart 3.

87.21    Sec. 6. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 4b, is
87.22amended to read:
87.23    Subd. 4b. Coordinated service and support plan. "Coordinated service and
87.24support plan" has the meaning given in sections 256B.0913, subdivision 8; 256B.0915,
87.25subdivision 6; 256B.092, subdivision 1b; and 256B.49, subdivision 15, or successor
87.26provisions. For purposes of this chapter, "coordinated service and support plan" includes
87.27the individual program plan or individual treatment plan as defined in Minnesota Rules,
87.28part 9520.0510, subpart 12.

87.29    Sec. 7. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 8b, is
87.30amended to read:
87.31    Subd. 8b. Expanded support team. "Expanded support team" means the members
87.32of the support team defined in subdivision 46 34 and a licensed health or mental health
87.33professional or other licensed, certified, or qualified professionals or consultants working
88.1with the person and included in the team at the request of the person or the person's legal
88.2representative.

88.3    Sec. 8. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 11, is
88.4amended to read:
88.5    Subd. 11. Incident. "Incident" means an occurrence which involves a person and
88.6requires the program to make a response that is not a part of the program's ordinary
88.7provision of services to that person, and includes:
88.8(1) serious injury of a person as determined by section 245.91, subdivision 6;
88.9(2) a person's death;
88.10(3) any medical emergency, unexpected serious illness, or significant unexpected
88.11change in an illness or medical condition of a person that requires the program to call
88.12911, physician treatment, or hospitalization;
88.13(4) any mental health crisis that requires the program to call 911 or, a mental
88.14health crisis intervention team, or a similar mental health response team or service when
88.15available and appropriate;
88.16(5) an act or situation involving a person that requires the program to call 911,
88.17law enforcement, or the fire department;
88.18(6) a person's unauthorized or unexplained absence from a program;
88.19(7) conduct by a person receiving services against another person receiving services
88.20that:
88.21(i) is so severe, pervasive, or objectively offensive that it substantially interferes with
88.22a person's opportunities to participate in or receive service or support;
88.23(ii) places the person in actual and reasonable fear of harm;
88.24(iii) places the person in actual and reasonable fear of damage to property of the
88.25person; or
88.26(iv) substantially disrupts the orderly operation of the program;
88.27(8) any sexual activity between persons receiving services involving force or
88.28coercion as defined under section 609.341, subdivisions 3 and 14;
88.29(9) any emergency use of manual restraint as identified in section 245D.061 or
88.30successor provisions; or
88.31(10) a report of alleged or suspected child or vulnerable adult maltreatment under
88.32section 626.556 or 626.557.

88.33    Sec. 9. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 15b,
88.34is amended to read:
89.1    Subd. 15b. Mechanical restraint. (a) ~~Except for devices worn by the person that~~
89.2~~trigger electronic alarms to warn staff that a person is leaving a room or area, which~~
89.3~~do not, in and of themselves, restrict freedom of movement, or the use of adaptive aids~~
89.4~~or equipment or orthotic devices ordered by a health care professional used to treat or~~
89.5~~manage a medical condition,~~ "Mechanical restraint" means the use of devices, materials,
89.6or equipment attached or adjacent to the person's body, or the use of practices that are
89.7intended to restrict freedom of movement or normal access to one's body or body parts,
89.8or limits a person's voluntary movement or holds a person immobile as an intervention
89.9precipitated by a person's behavior. The term applies to the use of mechanical restraint
89.10used to prevent injury with persons who engage in self-injurious behaviors, such as
89.11head-banging, gouging, or other actions resulting in tissue damage that have caused or
89.12could cause medical problems resulting from the self-injury.
89.13(b) Mechanical restraint does not include the following:
89.14(1) devices worn by the person that trigger electronic alarms to warn staff that a
89.15person is leaving a room or area, which do not, in and of themselves, restrict freedom of
89.16movement; or
89.17(2) the use of adaptive aids or equipment or orthotic devices ordered by a health care
89.18professional used to treat or manage a medical condition.

89.19    Sec. 10. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 29,
89.20is amended to read:
89.21    Subd. 29. Seclusion. "Seclusion" means ~~the placement of a person alone in~~: (1)
89.22removing a person involuntarily to a room from which exit is prohibited by a staff person
89.23or a mechanism such as a lock, a device, or an object positioned to hold the door closed
89.24or otherwise prevent the person from leaving the room.; or (2) otherwise involuntarily
89.25removing or separating a person from an area, activity, situation, or social contact with
89.26others and blocking or preventing the person's return.

89.27    Sec. 11. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 34,
89.28is amended to read:
89.29    Subd. 34. Support team. "Support team" means the service planning team
89.30identified in section 256B.49, subdivision 15~~, or~~; the interdisciplinary team identified in
89.31Minnesota Rules, part 9525.0004, subpart 14; or the case management team as defined in
89.32Minnesota Rules, part 9520.0902, subpart 6.

90.1    Sec. 12. Minnesota Statutes 2013 Supplement, section 245D.02, subdivision 34a,
90.2is amended to read:
90.3    Subd. 34a. Time out. "Time out" means ~~removing a person involuntarily from an~~
90.4~~ongoing activity to a room, either locked or unlocked, or otherwise separating a person~~
90.5~~from others in a way that prevents social contact and prevents the person from leaving the~~
90.6~~situation if the person chooses~~ the involuntary removal of a person for a period of time to
90.7a designated area from which the person is not prevented from leaving. For the purpose of
90.8this chapter, "time out" does not mean voluntary removal or self-removal for the purpose
90.9of calming, prevention of escalation, or de-escalation of behavior ~~for a period of up to 15~~
90.10~~minutes. "Time out" does not include a person voluntarily moving from an ongoing activity~~
90.11~~to an unlocked room or otherwise separating from a situation or social contact with others~~
90.12~~if the person chooses. For the purposes of this definition, "voluntarily" means without~~
90.13~~being forced, compelled, or coerced.~~; nor does it mean taking a brief "break" or "rest" from
90.14an activity for the purpose of providing the person an opportunity to regain self-control.
90.15For the purpose of this subdivision, "brief" means a duration of three minutes or less.

90.16    Sec. 13. Minnesota Statutes 2013 Supplement, section 245D.02, is amended by adding
90.17a subdivision to read:
90.18    Subd. 35b. Unlicensed staff. "Unlicensed staff" means individuals not otherwise
90.19licensed or certified by a governmental health board or agency.

90.20    Sec. 14. Minnesota Statutes 2013 Supplement, section 245D.03, subdivision 1, is
90.21amended to read:
90.22    Subdivision 1. Applicability. (a) The commissioner shall regulate the provision of
90.23home and community-based services to persons with disabilities and persons age 65 and
90.24older pursuant to this chapter. The licensing standards in this chapter govern the provision
90.25of basic support services and intensive support services.
90.26(b) Basic support services provide the level of assistance, supervision, and care that
90.27is necessary to ensure the health and safety of the person and do not include services that
90.28are specifically directed toward the training, treatment, habilitation, or rehabilitation of
90.29the person. Basic support services include:
90.30(1) in-home and out-of-home respite care services as defined in section 245A.02,
90.31subdivision 15, and under the brain injury, community alternative care, community
90.32alternatives for disabled individuals, developmental disability, and elderly waiver plans,
90.33excluding out-of-home respite care provided to children in a family child foster care home
90.34licensed under Minnesota Rules, parts 2960.3000 to 2960.3100, when the child foster care
91.1license holder complies with the requirements under section 245D.06, subdivisions 5, 6,
91.27, and 8, or successor provisions; and section 245D.061 or successor provisions, which
91.3must be stipulated in the statement of intended use required under Minnesota Rules,
91.4part 2960.3000, subpart 4;
91.5(2) adult companion services as defined under the brain injury, community
91.6alternatives for disabled individuals, and elderly waiver plans, excluding adult companion
91.7services provided under the Corporation for National and Community Services Senior
91.8Companion Program established under the Domestic Volunteer Service Act of 1973,
91.9Public Law 98-288;
91.10(3) personal support as defined under the developmental disability waiver plan;
91.11(4) 24-hour emergency assistance, personal emergency response as defined under the
91.12community alternatives for disabled individuals and developmental disability waiver plans;
91.13(5) night supervision services as defined under the brain injury waiver plan; and
91.14(6) homemaker services as defined under the community alternatives for disabled
91.15individuals, brain injury, community alternative care, developmental disability, and elderly
91.16waiver plans, excluding providers licensed by the Department of Health under chapter
91.17144A and those providers providing cleaning services only.
91.18(c) Intensive support services provide assistance, supervision, and care that is
91.19necessary to ensure the health and safety of the person and services specifically directed
91.20toward the training, habilitation, or rehabilitation of the person. Intensive support services
91.21include:
91.22(1) intervention services, including:
91.23(i) behavioral support services as defined under the brain injury and community
91.24alternatives for disabled individuals waiver plans;
91.25(ii) in-home or out-of-home crisis respite services as defined under the developmental
91.26disability waiver plan; and
91.27(iii) specialist services as defined under the current developmental disability waiver
91.28plan;
91.29(2) in-home support services, including:
91.30(i) in-home family support and supported living services as defined under the
91.31developmental disability waiver plan;
91.32(ii) independent living services training as defined under the brain injury and
91.33community alternatives for disabled individuals waiver plans; and
91.34(iii) semi-independent living services;
91.35(3) residential supports and services, including:
92.1(i) supported living services as defined under the developmental disability waiver
92.2plan provided in a family or corporate child foster care residence, a family adult foster
92.3care residence, a community residential setting, or a supervised living facility;
92.4(ii) foster care services as defined in the brain injury, community alternative care,
92.5and community alternatives for disabled individuals waiver plans provided in a family or
92.6corporate child foster care residence, a family adult foster care residence, or a community
92.7residential setting; and
92.8(iii) residential services provided to more than four persons with developmental
92.9disabilities in a supervised living facility ~~that is certified by the Department of Health as~~
92.10~~an ICF/DD~~, including ICFs/DD;
92.11(4) day services, including:
92.12(i) structured day services as defined under the brain injury waiver plan;
92.13(ii) day training and habilitation services under sections 252.40 to 252.46, and as
92.14defined under the developmental disability waiver plan; and
92.15(iii) prevocational services as defined under the brain injury and community
92.16alternatives for disabled individuals waiver plans; and
92.17(5) supported employment as defined under the brain injury, developmental
92.18disability, and community alternatives for disabled individuals waiver plans.

92.19    Sec. 15. Minnesota Statutes 2013 Supplement, section 245D.03, is amended by adding
92.20a subdivision to read:
92.21    Subd. 1a. Effect. The home and community-based services standards establish
92.22health, safety, welfare, and rights protections for persons receiving services governed by
92.23this chapter. The standards recognize the diversity of persons receiving these services and
92.24require that these services are provided in a manner that meets each person's individual
92.25needs and ensures continuity in service planning, care, and coordination between the
92.26license holder and members of each person's support team or expanded support team.

92.27    Sec. 16. Minnesota Statutes 2013 Supplement, section 245D.03, subdivision 2, is
92.28amended to read:
92.29    Subd. 2. Relationship to other standards governing home and community-based
92.30services. (a) A license holder governed by this chapter is also subject to the licensure
92.31requirements under chapter 245A.
92.32(b) ~~A corporate or family child foster care site controlled by a license holder and~~
92.33~~providing services governed by this chapter is exempt from compliance with section~~
92.34~~245D.04. This exemption applies to foster care homes where at least one resident is~~
93.1~~receiving residential supports and services licensed according to this chapter.~~ This chapter
93.2does not apply to corporate or family child foster care homes that do not provide services
93.3licensed under this chapter.
93.4(c) A family adult foster care site controlled by a license holder ~~and~~ providing
93.5services governed by this chapter is exempt from compliance with Minnesota Rules,
93.6parts 9555.6185; 9555.6225, subpart 8; 9555.6245; 9555.6255; and 9555.6265. These
93.7exemptions apply to family adult foster care homes where at least one resident is receiving
93.8residential supports and services licensed according to this chapter. This chapter does
93.9not apply to family adult foster care homes that do not provide services licensed under
93.10this chapter.
93.11(d) A license holder providing services licensed according to this chapter in a
93.12supervised living facility is exempt from compliance with ~~sections~~ section 245D.04;
93.13~~245D.05, subdivision 2; and~~ ~~245D.06, subdivision 2, clauses (1), (4), and (5)~~.
93.14(e) A license holder providing residential services to persons in an ICF/DD is exempt
93.15from compliance with sections 245D.04; 245D.05, subdivision 1b; 245D.06, subdivision
93.162 , clauses (4) and (5); 245D.071, subdivisions 4 and 5; 245D.081, subdivision 2; 245D.09,
93.17subdivision 7; 245D.095, subdivision 2; and 245D.11, subdivision 3.
93.18(f) A license holder providing homemaker services licensed according to this chapter
93.19and registered according to chapter 144A is exempt from compliance with section 245D.04.
93.20(g) Nothing in this chapter prohibits a license holder from concurrently serving
93.21persons without disabilities or people who are or are not age 65 and older, provided this
93.22chapter's standards are met as well as other relevant standards.
93.23(h) The documentation required under sections 245D.07 and 245D.071 must meet
93.24the individual program plan requirements identified in section 256B.092 or successor
93.25provisions.

93.26    Sec. 17. Minnesota Statutes 2013 Supplement, section 245D.03, subdivision 3, is
93.27amended to read:
93.28    Subd. 3. Variance. If the conditions in section 245A.04, subdivision 9, are met,
93.29the commissioner may grant a variance to any of the requirements in this chapter, except
93.30sections 245D.04; 245D.06, subdivision 4, paragraph (b), and subdivision 6, or successor
93.31provisions; and ~~245D.061, subdivision 3, or~~ provisions governing data practices and
93.32information rights of persons.

93.33    Sec. 18. Minnesota Statutes 2013 Supplement, section 245D.04, subdivision 3, is
93.34amended to read:
94.1    Subd. 3. Protection-related rights. (a) A person's protection-related rights include
94.2the right to:
94.3(1) have personal, financial, service, health, and medical information kept private,
94.4and be advised of disclosure of this information by the license holder;
94.5(2) access records and recorded information about the person in accordance with
94.6applicable state and federal law, regulation, or rule;
94.7(3) be free from maltreatment;
94.8(4) be free from restraint, time out, or seclusion, restrictive intervention, or other
94.9prohibited procedure identified in section 245D.06, subdivision 5, or successor provisions,
94.10 except for: (i) emergency use of manual restraint to protect the person from imminent
94.11danger to self or others according to the requirements in section ~~245D.06~~; 245D.061 or
94.12successor provisions; or (ii) the use of safety interventions as part of a positive support
94.13transition plan under section 245D.06, subdivision 8, or successor provisions;
94.14(5) receive services in a clean and safe environment when the license holder is the
94.15owner, lessor, or tenant of the service site;
94.16(6) be treated with courtesy and respect and receive respectful treatment of the
94.17person's property;
94.18(7) reasonable observance of cultural and ethnic practice and religion;
94.19(8) be free from bias and harassment regarding race, gender, age, disability,
94.20spirituality, and sexual orientation;
94.21(9) be informed of and use the license holder's grievance policy and procedures,
94.22including knowing how to contact persons responsible for addressing problems and to
94.23appeal under section 256.045;
94.24(10) know the name, telephone number, and the Web site, e-mail, and street
94.25addresses of protection and advocacy services, including the appropriate state-appointed
94.26ombudsman, and a brief description of how to file a complaint with these offices;
94.27(11) assert these rights personally, or have them asserted by the person's family,
94.28authorized representative, or legal representative, without retaliation;
94.29(12) give or withhold written informed consent to participate in any research or
94.30experimental treatment;
94.31(13) associate with other persons of the person's choice;
94.32(14) personal privacy; and
94.33(15) engage in chosen activities.
94.34(b) For a person residing in a residential site licensed according to chapter 245A,
94.35or where the license holder is the owner, lessor, or tenant of the residential service site,
94.36protection-related rights also include the right to:
95.1(1) have daily, private access to and use of a non-coin-operated telephone for local
95.2calls and long-distance calls made collect or paid for by the person;
95.3(2) receive and send, without interference, uncensored, unopened mail or electronic
95.4correspondence or communication;
95.5(3) have use of and free access to common areas in the residence; and
95.6(4) privacy for visits with the person's spouse, next of kin, legal counsel, religious
95.7advisor, or others, in accordance with section 363A.09 of the Human Rights Act, including
95.8privacy in the person's bedroom.
95.9(c) Restriction of a person's rights under ~~subdivision 2, clause (10), or~~ paragraph (a),
95.10clauses (13) to (15), or paragraph (b) is allowed only if determined necessary to ensure
95.11the health, safety, and well-being of the person. Any restriction of those rights must be
95.12documented in the person's coordinated service and support plan or coordinated service
95.13and support plan addendum. The restriction must be implemented in the least restrictive
95.14alternative manner necessary to protect the person and provide support to reduce or
95.15eliminate the need for the restriction in the most integrated setting and inclusive manner.
95.16The documentation must include the following information:
95.17(1) the justification for the restriction based on an assessment of the person's
95.18vulnerability related to exercising the right without restriction;
95.19(2) the objective measures set as conditions for ending the restriction;
95.20(3) a schedule for reviewing the need for the restriction based on the conditions
95.21for ending the restriction to occur semiannually from the date of initial approval, at a
95.22minimum, or more frequently if requested by the person, the person's legal representative,
95.23if any, and case manager; and
95.24(4) signed and dated approval for the restriction from the person, or the person's
95.25legal representative, if any. A restriction may be implemented only when the required
95.26approval has been obtained. Approval may be withdrawn at any time. If approval is
95.27withdrawn, the right must be immediately and fully restored.

95.28    Sec. 19. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1, is
95.29amended to read:
95.30    Subdivision 1. Health needs. (a) The license holder is responsible for meeting
95.31health service needs assigned in the coordinated service and support plan or the
95.32coordinated service and support plan addendum, consistent with the person's health needs.
95.33The license holder is responsible for promptly notifying the person's legal representative,
95.34if any, and the case manager of changes in a person's physical and mental health needs
95.35affecting health service needs assigned to the license holder in the coordinated service and
96.1support plan or the coordinated service and support plan addendum, when discovered by
96.2the license holder, unless the license holder has reason to know the change has already
96.3been reported. The license holder must document when the notice is provided.
96.4(b) If responsibility for meeting the person's health service needs has been assigned
96.5to the license holder in the coordinated service and support plan or the coordinated service
96.6and support plan addendum, the license holder must maintain documentation on how the
96.7person's health needs will be met, including a description of the procedures the license
96.8holder will follow in order to:
96.9(1) provide medication setup, assistance, or ~~medication~~ administration according
96.10to this chapter. Unlicensed staff responsible for medication setup or medication
96.11administration under this section must complete training according to section 245D.09,
96.12subdivision 4a, paragraph (d);
96.13(2) monitor health conditions according to written instructions from a licensed
96.14health professional;
96.15(3) assist with or coordinate medical, dental, and other health service appointments; or
96.16(4) use medical equipment, devices, or adaptive aides or technology safely and
96.17correctly according to written instructions from a licensed health professional.

96.18    Sec. 20. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1a,
96.19is amended to read:
96.20    Subd. 1a. Medication setup. (a) For the purposes of this subdivision, "medication
96.21setup" means the arranging of medications according to instructions from the pharmacy,
96.22the prescriber, or a licensed nurse, for later administration when the license holder
96.23is assigned responsibility ~~for medication assistance or medication administration~~ in
96.24the coordinated service and support plan or the coordinated service and support plan
96.25addendum. A prescription label or the prescriber's written or electronically recorded order
96.26for the prescription is sufficient to constitute written instructions from the prescriber.
96.27(b) If responsibility for medication setup is assigned to the license holder in
96.28the coordinated service and support plan or the coordinated service and support plan
96.29addendum, or if the license holder provides it as part of medication assistance or
96.30medication administration, the license holder must document in the person's medication
96.31administration record: dates of setup, name of medication, quantity of dose, times to be
96.32administered, and route of administration at time of setup; and, when the person will be
96.33away from home, to whom the medications were given.

97.1    Sec. 21. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 1b,
97.2is amended to read:
97.3    Subd. 1b. Medication assistance. (a) For purposes of this subdivision, "medication
97.4assistance" means any of the following:
97.5(1) bringing to the person and opening a container of previously set up medications,
97.6emptying the container into the person's hand, or opening and giving the medications in
97.7the original container to the person under the direction of the person;
97.8(2) bringing to the person liquids or food to accompany the medication; or
97.9(3) providing reminders to take regularly scheduled medication or perform regularly
97.10scheduled treatments and exercises.
97.11(b) If responsibility for medication assistance is assigned to the license holder
97.12in the coordinated service and support plan or the coordinated service and support
97.13plan addendum, the license holder must ensure that ~~the requirements of subdivision 2,~~
97.14~~paragraph (b), have been met when staff provides~~ medication assistance ~~to enable~~ is
97.15provided in a manner that enables a person to self-administer medication or treatment
97.16when the person is capable of directing the person's own care, or when the person's legal
97.17representative is present and able to direct care for the person. ~~For the purposes of this~~
97.18~~subdivision, "medication assistance" means any of the following:~~
97.19~~(1) bringing to the person and opening a container of previously set up medications,~~
97.20~~emptying the container into the person's hand, or opening and giving the medications in~~
97.21~~the original container to the person;~~
97.22~~(2) bringing to the person liquids or food to accompany the medication; or~~
97.23~~(3) providing reminders to take regularly scheduled medication or perform regularly~~
97.24~~scheduled treatments and exercises.~~

97.25    Sec. 22. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 2, is
97.26amended to read:
97.27    Subd. 2. Medication administration. (a) ~~If responsibility for medication~~
97.28~~administration is assigned to the license holder in the coordinated service and support~~
97.29~~plan or the coordinated service and support plan addendum, the license holder must~~
97.30~~implement the following medication administration procedures to ensure a person takes~~
97.31~~medications and treatments as prescribed~~ For purposes of this subdivision, "medication
97.32administration" means:
97.33(1) checking the person's medication record;
97.34(2) preparing the medication as necessary;
97.35(3) administering the medication or treatment to the person;
98.1(4) documenting the administration of the medication or treatment or the reason for
98.2not administering the medication or treatment; and
98.3(5) reporting to the prescriber or a nurse any concerns about the medication or
98.4treatment, including side effects, effectiveness, or a pattern of the person refusing to
98.5take the medication or treatment as prescribed. Adverse reactions must be immediately
98.6reported to the prescriber or a nurse.
98.7(b)(1) If responsibility for medication administration is assigned to the license holder
98.8in the coordinated service and support plan or the coordinated service and support plan
98.9addendum, the license holder must implement medication administration procedures
98.10to ensure a person takes medications and treatments as prescribed. The license holder
98.11must ensure that the requirements in clauses (2) ~~to (4)~~ and (3) have been met before
98.12administering medication or treatment.
98.13(2) The license holder must obtain written authorization from the person or the
98.14person's legal representative to administer medication or treatment and must obtain
98.15reauthorization annually as needed. This authorization shall remain in effect unless it is
98.16withdrawn in writing and may be withdrawn at any time. If the person or the person's
98.17legal representative refuses to authorize the license holder to administer medication, the
98.18medication must not be administered. The refusal to authorize medication administration
98.19must be reported to the prescriber as expediently as possible.
98.20~~(3) The staff person responsible for administering the medication or treatment must~~
98.21~~complete medication administration training according to section~~ ~~245D.09, subdivision~~
98.22 ~~4a, paragraphs (a) and (c), and, as applicable to the person, paragraph (d).~~
98.23~~(4)~~ (3) For a license holder providing intensive support services, the medication or
98.24treatment must be administered according to the license holder's medication administration
98.25policy and procedures as required under section 245D.11, subdivision 2, clause (3).
98.26(c) The license holder must ensure the following information is documented in the
98.27person's medication administration record:
98.28(1) the information on the current prescription label or the prescriber's current
98.29written or electronically recorded order or prescription that includes the person's name,
98.30description of the medication or treatment to be provided, and the frequency and other
98.31information needed to safely and correctly administer the medication or treatment to
98.32ensure effectiveness;
98.33(2) information on any risks or other side effects that are reasonable to expect, and
98.34any contraindications to its use. This information must be readily available to all staff
98.35administering the medication;
99.1(3) the possible consequences if the medication or treatment is not taken or
99.2administered as directed;
99.3(4) instruction on when and to whom to report the following:
99.4(i) if a dose of medication is not administered or treatment is not performed as
99.5prescribed, whether by error by the staff or the person or by refusal by the person; and
99.6(ii) the occurrence of possible adverse reactions to the medication or treatment;
99.7(5) notation of any occurrence of a dose of medication not being administered or
99.8treatment not performed as prescribed, whether by error by the staff or the person or by
99.9refusal by the person, or of adverse reactions, and when and to whom the report was
99.10made; and
99.11(6) notation of when a medication or treatment is started, administered, changed, or
99.12discontinued.

99.13    Sec. 23. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 4, is
99.14amended to read:
99.15    Subd. 4. Reviewing and reporting medication and treatment issues. (a) When
99.16assigned responsibility for medication administration, the license holder must ensure
99.17that the information maintained in the medication administration record is current and
99.18is regularly reviewed to identify medication administration errors. At a minimum, the
99.19review must be conducted every three months, or more frequently as directed in the
99.20coordinated service and support plan or coordinated service and support plan addendum
99.21or as requested by the person or the person's legal representative. Based on the review,
99.22the license holder must develop and implement a plan to correct patterns of medication
99.23administration errors when identified.
99.24(b) If assigned responsibility for medication assistance or medication administration,
99.25the license holder must report the following to the person's legal representative and case
99.26manager as they occur or as otherwise directed in the coordinated service and support plan
99.27or the coordinated service and support plan addendum:
99.28(1) any reports ~~made to the person's physician or prescriber~~ required under
99.29subdivision 2, paragraph (c), clause (4);
99.30(2) a person's refusal or failure to take or receive medication or treatment as
99.31prescribed; or
99.32(3) concerns about a person's self-administration of medication or treatment.

99.33    Sec. 24. Minnesota Statutes 2013 Supplement, section 245D.05, subdivision 5, is
99.34amended to read:
100.1    Subd. 5. Injectable medications. Injectable medications may be administered
100.2according to a prescriber's order and written instructions when one of the following
100.3conditions has been met:
100.4(1) a registered nurse or licensed practical nurse will administer the ~~subcutaneous or~~
100.5~~intramuscular~~ injection;
100.6(2) a supervising registered nurse with a physician's order has delegated the
100.7administration of ~~subcutaneous~~ injectable medication to an unlicensed staff member
100.8and has provided the necessary training; or
100.9(3) there is an agreement signed by the license holder, the prescriber, and the
100.10person or the person's legal representative specifying what ~~subcutaneous~~ injections may
100.11be given, when, how, and that the prescriber must retain responsibility for the license
100.12holder's giving the injections. A copy of the agreement must be placed in the person's
100.13service recipient record.
100.14Only licensed health professionals are allowed to administer psychotropic
100.15medications by injection.

100.16    Sec. 25. Minnesota Statutes 2013 Supplement, section 245D.051, is amended to read:
100.17245D.051 PSYCHOTROPIC MEDICATION USE AND MONITORING.
100.18    Subdivision 1. Conditions for psychotropic medication administration. (a)
100.19When a person is prescribed a psychotropic medication and the license holder is assigned
100.20responsibility for administration of the medication in the person's coordinated service
100.21and support plan or the coordinated service and support plan addendum, the license
100.22holder must ensure that the requirements in ~~paragraphs (b) to (d) and~~ section 245D.05,
100.23subdivision 2, are met.
100.24~~(b) Use of the medication must be included in the person's coordinated service and~~
100.25~~support plan or in the coordinated service and support plan addendum and based on a~~
100.26~~prescriber's current written or electronically recorded prescription.~~
100.27~~(c)~~ (b) The license holder must develop, implement, and maintain the following
100.28documentation in the person's coordinated service and support plan addendum according
100.29to the requirements in sections 245D.07 and 245D.071:
100.30(1) a description of the target symptoms that the psychotropic medication is to
100.31alleviate; and
100.32(2) documentation methods the license holder will use to monitor and measure
100.33changes in the target symptoms that are to be alleviated by the psychotropic medication if
100.34required by the prescriber. The license holder must collect and report on medication and
100.35symptom-related data as instructed by the prescriber. The license holder must provide
101.1the monitoring data to the expanded support team for review every three months, or as
101.2otherwise requested by the person or the person's legal representative.
101.3For the purposes of this section, "target symptom" refers to any perceptible
101.4diagnostic criteria for a person's diagnosed mental disorder, as defined by the Diagnostic
101.5and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) or
101.6successive editions, that has been identified for alleviation.
101.7    Subd. 2. Refusal to authorize psychotropic medication. If the person or the
101.8person's legal representative refuses to authorize the administration of a psychotropic
101.9medication as ordered by the prescriber, the license holder must ~~follow the requirement in~~
101.10~~section~~ ~~245D.05, subdivision 2, paragraph (b), clause (2).~~ not administer the medication.
101.11The refusal to authorize medication administration must be reported to the prescriber as
101.12expediently as possible. After reporting the refusal to the prescriber, the license holder
101.13must follow any directives or orders given by the prescriber. ~~A court order must be~~
101.14~~obtained to override the refusal.~~ A refusal may not be overridden without a court order.
101.15Refusal to authorize administration of a specific psychotropic medication is not grounds
101.16for service termination and does not constitute an emergency. A decision to terminate
101.17services must be reached in compliance with section 245D.10, subdivision 3.

101.18    Sec. 26. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 1, is
101.19amended to read:
101.20    Subdivision 1. Incident response and reporting. (a) The license holder must
101.21respond to incidents under section 245D.02, subdivision 11, that occur while providing
101.22services to protect the health and safety of and minimize risk of harm to the person.
101.23(b) The license holder must maintain information about and report incidents to the
101.24person's legal representative or designated emergency contact and case manager within
101.2524 hours of an incident occurring while services are being provided, within 24 hours of
101.26discovery or receipt of information that an incident occurred, unless the license holder
101.27has reason to know that the incident has already been reported, or as otherwise directed
101.28in a person's coordinated service and support plan or coordinated service and support
101.29plan addendum. An incident of suspected or alleged maltreatment must be reported as
101.30required under paragraph (d), and an incident of serious injury or death must be reported
101.31as required under paragraph (e).
101.32(c) When the incident involves more than one person, the license holder must not
101.33disclose personally identifiable information about any other person when making the report
101.34to each person and case manager unless the license holder has the consent of the person.
102.1(d) Within 24 hours of reporting maltreatment as required under section 626.556
102.2or 626.557, the license holder must inform the case manager of the report unless there is
102.3reason to believe that the case manager is involved in the suspected maltreatment. The
102.4license holder must disclose the nature of the activity or occurrence reported and the
102.5agency that received the report.
102.6(e) The license holder must report the death or serious injury of the person as
102.7required in paragraph (b) and to the Department of Human Services Licensing Division,
102.8and the Office of Ombudsman for Mental Health and Developmental Disabilities as
102.9required under section 245.94, subdivision 2a, within 24 hours of the death, or receipt of
102.10information that the death occurred, unless the license holder has reason to know that the
102.11death has already been reported.
102.12(f) When a death or serious injury occurs in a facility certified as an intermediate
102.13care facility for persons with developmental disabilities, the death or serious injury must
102.14be reported to the Department of Health, Office of Health Facility Complaints, and the
102.15Office of Ombudsman for Mental Health and Developmental Disabilities, as required
102.16under sections 245.91 and 245.94, subdivision 2a, unless the license holder has reason to
102.17know that the death has already been reported.
102.18(g) The license holder must conduct an internal review of incident reports of deaths
102.19and serious injuries that occurred while services were being provided and that were not
102.20reported by the program as alleged or suspected maltreatment, for identification of incident
102.21patterns, and implementation of corrective action as necessary to reduce occurrences.
102.22The review must include an evaluation of whether related policies and procedures were
102.23followed, whether the policies and procedures were adequate, whether there is a need for
102.24additional staff training, whether the reported event is similar to past events with the
102.25persons or the services involved, and whether there is a need for corrective action by the
102.26license holder to protect the health and safety of persons receiving services. Based on
102.27the results of this review, the license holder must develop, document, and implement a
102.28corrective action plan designed to correct current lapses and prevent future lapses in
102.29performance by staff or the license holder, if any.
102.30(h) The license holder must verbally report the emergency use of manual restraint
102.31of a person as required in paragraph (b) within 24 hours of the occurrence. The license
102.32holder must ensure the written report and internal review of all incident reports of the
102.33emergency use of manual restraints are completed according to the requirements in section
102.34245D.061 or successor provisions.

103.1    Sec. 27. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 2, is
103.2amended to read:
103.3    Subd. 2. Environment and safety. The license holder must:
103.4(1) ensure the following when the license holder is the owner, lessor, or tenant
103.5of the service site:
103.6(i) the service site is a safe and hazard-free environment;
103.7(ii) that toxic substances or dangerous items are inaccessible to persons served by
103.8the program only to protect the safety of a person receiving services when a known safety
103.9threat exists and not as a substitute for staff supervision or interactions with a person who
103.10is receiving services. If toxic substances or dangerous items are made inaccessible, the
103.11license holder must document an assessment of the physical plant, its environment, and its
103.12population identifying the risk factors which require toxic substances or dangerous items
103.13to be inaccessible and a statement of specific measures to be taken to minimize the safety
103.14risk to persons receiving services and to restore accessibility to all persons receiving
103.15services at the service site;
103.16(iii) doors are locked from the inside to prevent a person from exiting only when
103.17necessary to protect the safety of a person receiving services and not as a substitute for
103.18staff supervision or interactions with the person. If doors are locked from the inside, the
103.19license holder must document an assessment of the physical plant, the environment and
103.20the population served, identifying the risk factors which require the use of locked doors,
103.21and a statement of specific measures to be taken to minimize the safety risk to persons
103.22receiving services at the service site; and
103.23(iv) a staff person is available at the service site who is trained in basic first aid and,
103.24when required in a person's coordinated service and support plan or coordinated service
103.25and support plan addendum, cardiopulmonary resuscitation (CPR) whenever persons are
103.26present and staff are required to be at the site to provide direct support service. The CPR
103.27training must include in-person instruction, hands-on practice, and an observed skills
103.28assessment under the direct supervision of a CPR instructor;
103.29(2) maintain equipment, vehicles, supplies, and materials owned or leased by the
103.30license holder in good condition when used to provide services;
103.31(3) follow procedures to ensure safe transportation, handling, and transfers of the
103.32person and any equipment used by the person, when the license holder is responsible for
103.33transportation of a person or a person's equipment;
103.34(4) be prepared for emergencies and follow emergency response procedures to
103.35ensure the person's safety in an emergency; and
104.1(5) follow universal precautions and sanitary practices, including hand washing, for
104.2infection prevention and control, and to prevent communicable diseases.

104.3    Sec. 28. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 4, is
104.4amended to read:
104.5    Subd. 4. Funds and property; legal representative restrictions. (a) Whenever the
104.6license holder assists a person with the safekeeping of funds or other property according
104.7to section 245A.04, subdivision 13, the license holder must obtain written authorization
104.8to do so from the person or the person's legal representative and the case manager.
104.9Authorization must be obtained within five working days of service initiation and renewed
104.10annually thereafter. At the time initial authorization is obtained, the license holder must
104.11survey, document, and implement the preferences of the person or the person's legal
104.12representative and the case manager for frequency of receiving a statement that itemizes
104.13receipts and disbursements of funds or other property. The license holder must document
104.14changes to these preferences when they are requested.
104.15(b) A license holder or staff person may not accept powers-of-attorney from a person
104.16receiving services from the license holder for any purpose. This does not apply to license
104.17holders that are Minnesota counties or other units of government or to staff persons
104.18employed by license holders who were acting as attorney-in-fact for specific individuals
104.19prior to implementation of this chapter. The license holder must maintain documentation
104.20of the power-of-attorney in the service recipient record.
104.21(c) A license holder or staff person is restricted from accepting an appointment
104.22as a guardian as follows:
104.23(1) under section 524.5-309 of the Uniform Probate Code, any individual or agency
104.24that provides residence, custodial care, medical care, employment training, or other care
104.25or services for which the individual or agency receives a fee may not be appointed as
104.26guardian unless related to the respondent by blood, marriage, or adoption; and
104.27(2) under section 245A.03, subdivision 2, paragraph (a), clause (1), a related
104.28individual as defined under section 245A.02, subdivision 13, is excluded from licensure.
104.29Services provided by a license holder to a person under the license holder's guardianship
104.30are not licensed services.
104.31~~(c)~~ (d) Upon the transfer or death of a person, any funds or other property of the
104.32person must be surrendered to the person or the person's legal representative, or given to
104.33the executor or administrator of the estate in exchange for an itemized receipt.

105.1    Sec. 29. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 6, is
105.2amended to read:
105.3    Subd. 6. Restricted procedures. (a) The following procedures are allowed when
105.4the procedures are implemented in compliance with the standards governing their use as
105.5identified in clauses (1) to (3). Allowed but restricted procedures include:
105.6(1) permitted actions and procedures subject to the requirements in subdivision 7;
105.7(2) procedures identified in a positive support transition plan subject to the
105.8requirements in subdivision 8; or
105.9(3) emergency use of manual restraint subject to the requirements in section
105.10245D.061 .
105.11For purposes of this chapter, this section supersedes the requirements identified in
105.12Minnesota Rules, part 9525.2740.
105.13    (b) A restricted procedure identified in paragraph (a) must not:
105.14    (1) be implemented with a child in a manner that constitutes sexual abuse, neglect,
105.15physical abuse, or mental injury, as defined in section 626.556, subdivision 2;
105.16(2) be implemented with an adult in a manner that constitutes abuse or neglect as
105.17defined in section 626.5572, subdivision 2 or 17;
105.18(3) be implemented in a manner that violates a person's rights identified in section
105.19245D.04;
105.20(4) restrict a person's normal access to a nutritious diet, drinking water, adequate
105.21ventilation, necessary medical care, ordinary hygiene facilities, normal sleeping
105.22conditions, necessary clothing, or any protection required by state licensing standards or
105.23federal regulations governing the program;
105.24(5) deny the person visitation or ordinary contact with legal counsel, a legal
105.25representative, or next of kin;
105.26(6) be used for the convenience of staff, as punishment, as a substitute for adequate
105.27staffing, or as a consequence if the person refuses to participate in the treatment or services
105.28provided by the program;
105.29(7) use prone restraint. For purposes of this section, "prone restraint" means use
105.30of manual restraint that places a person in a face-down position. Prone restraint does
105.31not include brief physical holding of a person who, during an emergency use of manual
105.32restraint, rolls into a prone position, if the person is restored to a standing, sitting, or
105.33side-lying position as quickly as possible;
105.34(8) apply back or chest pressure while a person is in a prone position as identified in
105.35clause (7), supine position, or side-lying position; or
106.1(9) be implemented in a manner that is contraindicated for any of the person's known
106.2medical or psychological limitations.

106.3    Sec. 30. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 7, is
106.4amended to read:
106.5    Subd. 7. Permitted actions and procedures. (a) Use of the instructional techniques
106.6and intervention procedures as identified in paragraphs (b) and (c) is permitted when used
106.7on an intermittent or continuous basis. When used on a continuous basis, it must be
106.8addressed in a person's coordinated service and support plan addendum as identified in
106.9sections 245D.07 and 245D.071. For purposes of this chapter, the requirements of this
106.10subdivision supersede the requirements identified in Minnesota Rules, part 9525.2720.
106.11(b) Physical contact or instructional techniques must use the least restrictive
106.12alternative possible to meet the needs of the person and may be used:
106.13(1) to calm or comfort a person by holding that person with no resistance from
106.14that person;
106.15(2) to protect a person known to be at risk or of injury due to frequent falls as a result
106.16of a medical condition;
106.17(3) to facilitate the person's completion of a task or response when the person does
106.18not resist or the person's resistance is minimal in intensity and duration; or
106.19(4) to ~~briefly~~ block or redirect a person's limbs or body without holding the person or
106.20limiting the person's movement to interrupt the person's behavior that may result in injury
106.21to self or others. with less than 60 seconds of physical contact by staff; or
106.22(5) to redirect a person's behavior when the behavior does not pose a serious threat
106.23to the person or others and the behavior is effectively redirected with less than 60 seconds
106.24of physical contact by staff.
106.25(c) Restraint may be used as an intervention procedure to:
106.26(1) allow a licensed health care professional to safely conduct a medical examination
106.27or to provide medical treatment ordered by a licensed health care professional to a person
106.28necessary to promote healing or recovery from an acute, meaning short-term, medical
106.29condition;
106.30(2) assist in the safe evacuation or redirection of a person in the event of an
106.31emergency and the person is at imminent risk of harm.; or
106.32~~Any use of manual restraint as allowed in this paragraph must comply with the restrictions~~
106.33~~identified in section~~ ~~245D.061,~~ ~~subdivision~~ 3~~; or~~
106.34(3) position a person with physical disabilities in a manner specified in the person's
106.35coordinated service and support plan addendum.
107.1Any use of manual restraint as allowed in this paragraph must comply with the restrictions
107.2identified in subdivision 6, paragraph (b).
107.3(d) Use of adaptive aids or equipment, orthotic devices, or other medical equipment
107.4ordered by a licensed health professional to treat a diagnosed medical condition do not in
107.5and of themselves constitute the use of mechanical restraint.
107.6(e) Use of an auxiliary device to ensure a person does not unfasten a seat belt when
107.7being transported in a vehicle in accordance with seat belt use requirements in section
107.8169.686 does not constitute the use of mechanical restraint.

107.9    Sec. 31. Minnesota Statutes 2013 Supplement, section 245D.06, subdivision 8, is
107.10amended to read:
107.11    Subd. 8. Positive support transition plan. (a) License holders must develop
107.12a positive support transition plan on the forms and in the manner prescribed by the
107.13commissioner for a person who requires intervention in order to maintain safety when
107.14it is known that the person's behavior poses an immediate risk of physical harm to self
107.15or others. The positive support transition plan forms and instructions will supersede the
107.16requirements in Minnesota Rules, parts 9525.2750; 9525.2760; and 9525.2780. The
107.17positive support transition plan must phase out any existing plans for the emergency
107.18or programmatic use of ~~aversive or deprivation procedures~~ restrictive interventions
107.19 prohibited under this chapter within the following timelines:
107.20(1) for persons receiving services from the license holder before January 1, 2014,
107.21the plan must be developed and implemented by February 1, 2014, and phased out no
107.22later than December 31, 2014; and
107.23(2) for persons admitted to the program on or after January 1, 2014, the plan must be
107.24developed and implemented within 30 calendar days of service initiation and phased out
107.25no later than 11 months from the date of plan implementation.
107.26(b) The commissioner has limited authority to grant approval for the emergency use
107.27of procedures identified in subdivision 6 that had been part of an approved positive support
107.28transition plan when a person is at imminent risk of serious injury as defined in section
107.29245.91, subdivision 6, due to self-injurious behavior and the following conditions are met:
107.30(1) the person's expanded support team approves the emergency use of the
107.31procedures; and
107.32(2) the interim review panel established in section 245.8251, subdivision 4,
107.33recommends commissioner approval of the emergency use of the procedures.
107.34(c) Written requests for the emergency use of the procedures must be developed
107.35and submitted to the commissioner by the designated coordinator with input from the
108.1person's expanded support team in accordance with the requirements set by the interim
108.2review panel, in addition to the following:
108.3(1) a copy of the person's current positive support transition plan and copies of
108.4each positive support transition plan review containing data on the progress of the plan
108.5from the previous year;
108.6(2) documentation of a good faith effort to eliminate the use of the procedures that
108.7had been part of an approved positive support transition plan;
108.8(3) justification for the continued use of the procedures that identifies the imminent
108.9risk of serious injury due to the person's self-injurious behavior if the procedures were
108.10eliminated;
108.11(4) documentation of the clinicians consulted in creating and maintaining the
108.12positive support transition plan; and
108.13(5) documentation of the expanded support team's approval and the recommendation
108.14from the interim panel required under paragraph (b).
108.15(d) A copy of the written request, supporting documentation, and the commissioner's
108.16final determination on the request must be maintained in the person's service recipient
108.17record.

108.18    Sec. 32. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 3,
108.19is amended to read:
108.20    Subd. 3. Assessment and initial service planning. (a) Within 15 days of service
108.21initiation the license holder must complete a preliminary coordinated service and support
108.22plan addendum based on the coordinated service and support plan.
108.23~~(b) Within 45 days of service initiation the license holder must meet with the person,~~
108.24~~the person's legal representative, the case manager, and other members of the support team~~
108.25~~or expanded support team to assess and determine the following based on the person's~~
108.26~~coordinated service and support plan and the requirements in subdivision 4 and section~~
108.27~~245D.07, subdivision 1a~~:
108.28~~(1) the scope of the services to be provided to support the person's daily needs~~
108.29~~and activities;~~
108.30~~(2) the person's desired outcomes and the supports necessary to accomplish the~~
108.31~~person's desired outcomes;~~
108.32~~(3) the person's preferences for how services and supports are provided;~~
108.33~~(4) whether the current service setting is the most integrated setting available and~~
108.34~~appropriate for the person; and~~
109.1~~(5) how services must be coordinated across other providers licensed under this~~
109.2~~chapter serving the same person to ensure continuity of care for the person.~~
109.3~~(c) Within the scope of services, the license holder must, at a minimum, assess~~
109.4~~the following areas:~~
109.5~~(1) the person's ability to self-manage health and medical needs to maintain or~~
109.6~~improve physical, mental, and emotional well-being, including, when applicable, allergies,~~
109.7~~seizures, choking, special dietary needs, chronic medical conditions, self-administration~~
109.8~~of medication or treatment orders, preventative screening, and medical and dental~~
109.9~~appointments;~~
109.10~~(2) the person's ability to self-manage personal safety to avoid injury or accident in~~
109.11~~the service setting, including, when applicable, risk of falling, mobility, regulating water~~
109.12~~temperature, community survival skills, water safety skills, and sensory disabilities; and~~
109.13~~(3) the person's ability to self-manage symptoms or behavior that may otherwise~~
109.14~~result in an incident as defined in section~~ ~~245D.02, subdivision 11, clauses (4) to~~
109.15~~(7), suspension or termination of services by the license holder, or other symptoms~~
109.16~~or behaviors that may jeopardize the health and safety of the person or others. The~~
109.17~~assessments must produce information about the person that is descriptive of the person's~~
109.18~~overall strengths, functional skills and abilities, and behaviors or symptoms.~~
109.19(b) Within the scope of services, the license holder must, at a minimum, complete
109.20assessments in the following areas before the 45-day planning meeting:
109.21(1) the person's ability to self-manage health and medical needs to maintain or
109.22improve physical, mental, and emotional well-being, including, when applicable, allergies,
109.23seizures, choking, special dietary needs, chronic medical conditions, self-administration
109.24of medication or treatment orders, preventative screening, and medical and dental
109.25appointments;
109.26(2) the person's ability to self-manage personal safety to avoid injury or accident in
109.27the service setting, including, when applicable, risk of falling, mobility, regulating water
109.28temperature, community survival skills, water safety skills, and sensory disabilities; and
109.29(3) the person's ability to self-manage symptoms or behavior that may otherwise
109.30result in an incident as defined in section 245D.02, subdivision 11, clauses (4) to (7),
109.31suspension or termination of services by the license holder, or other symptoms or
109.32behaviors that may jeopardize the health and safety of the person or others.
109.33Assessments must produce information about the person that describes the person's overall
109.34strengths, functional skills and abilities, and behaviors or symptoms. Assessments must
109.35be based on the person's status within the last 12 months at the time of service initiation.
109.36Assessments based on older information must be documented and justified. Assessments
110.1must be conducted annually at a minimum or within 30 days of a written request from the
110.2person or the person's legal representative or case manager. The results must be reviewed
110.3by the support team or expanded support team as part of a service plan review.
110.4(c) Within 45 days of service initiation, the license holder must meet with the
110.5person, the person's legal representative, the case manager, and other members of the
110.6support team or expanded support team to determine the following based on information
110.7obtained from the assessments identified in paragraph (b), the person's identified needs
110.8in the coordinated service and support plan, and the requirements in subdivision 4 and
110.9section 245D.07, subdivision 1a:
110.10(1) the scope of the services to be provided to support the person's daily needs
110.11and activities;
110.12(2) the person's desired outcomes and the supports necessary to accomplish the
110.13person's desired outcomes;
110.14(3) the person's preferences for how services and supports are provided;
110.15(4) whether the current service setting is the most integrated setting available and
110.16appropriate for the person; and
110.17(5) how services must be coordinated across other providers licensed under this
110.18chapter serving the person and members of the support team or expanded support team to
110.19ensure continuity of care and coordination of services for the person.

110.20    Sec. 33. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 4,
110.21is amended to read:
110.22    Subd. 4. Service outcomes and supports. (a) Within ten working days of the
110.2345-day planning meeting, the license holder must develop ~~and document~~ a service plan that
110.24documents the service outcomes and supports based on the assessments completed under
110.25subdivision 3 and the requirements in section 245D.07, subdivision 1a. The outcomes and
110.26supports must be included in the coordinated service and support plan addendum.
110.27(b) The license holder must document the supports and methods to be implemented
110.28to support the ~~accomplishment of~~ person and accomplish outcomes related to acquiring,
110.29retaining, or improving skills and physical, mental, and emotional health and well-being.
110.30The documentation must include:
110.31(1) the methods or actions that will be used to support the person and to accomplish
110.32the service outcomes, including information about:
110.33(i) any changes or modifications to the physical and social environments necessary
110.34when the service supports are provided;
110.35(ii) any equipment and materials required; and
111.1(iii) techniques that are consistent with the person's communication mode and
111.2learning style;
111.3(2) the measurable and observable criteria for identifying when the desired outcome
111.4has been achieved and how data will be collected;
111.5(3) the projected starting date for implementing the supports and methods and
111.6the date by which progress towards accomplishing the outcomes will be reviewed and
111.7evaluated; and
111.8(4) the names of the staff or position responsible for implementing the supports
111.9and methods.
111.10(c) Within 20 working days of the 45-day meeting, the license holder must obtain
111.11dated signatures from the person or the person's legal representative and case manager
111.12to document completion and approval of the assessment and coordinated service and
111.13support plan addendum.

111.14    Sec. 34. Minnesota Statutes 2013 Supplement, section 245D.071, subdivision 5,
111.15is amended to read:
111.16    Subd. 5. ~~Progress reviews~~ Service plan review and evaluation. (a) The license
111.17holder must give the person or the person's legal representative and case manager an
111.18opportunity to participate in the ongoing review and development of the service plan
111.19and the methods used to support the person and accomplish outcomes identified in
111.20subdivisions 3 and 4. The license holder, in coordination with the person's support team
111.21or expanded support team, must meet with the person, the person's legal representative,
111.22and the case manager, and participate in ~~progress~~ service plan review meetings following
111.23stated timelines established in the person's coordinated service and support plan or
111.24coordinated service and support plan addendum or within 30 days of a written request
111.25by the person, the person's legal representative, or the case manager, at a minimum of
111.26once per year. The purpose of the service plan review is to determine whether changes
111.27are needed to the service plan based on the assessment information, the license holder's
111.28evaluation of progress towards accomplishing outcomes, or other information provided by
111.29the support team or expanded support team.
111.30(b) The license holder must summarize the person's status and progress toward
111.31achieving the identified outcomes and make recommendations and identify the rationale
111.32for changing, continuing, or discontinuing implementation of supports and methods
111.33identified in subdivision 4 in a written report sent to the person or the person's legal
111.34representative and case manager five working days prior to the review meeting, unless
112.1the person, the person's legal representative, or the case manager requests to receive the
112.2report at the time of the meeting.
112.3(c) Within ten working days of the progress review meeting, the license holder
112.4must obtain dated signatures from the person or the person's legal representative and
112.5the case manager to document approval of any changes to the coordinated service and
112.6support plan addendum.

112.7    Sec. 35. Minnesota Statutes 2013 Supplement, section 245D.081, subdivision 2,
112.8is amended to read:
112.9    Subd. 2. Coordination and evaluation of individual service delivery. (a) Delivery
112.10and evaluation of services provided by the license holder must be coordinated by a
112.11designated staff person. The designated coordinator must provide supervision, support,
112.12and evaluation of activities that include:
112.13(1) oversight of the license holder's responsibilities assigned in the person's
112.14coordinated service and support plan and the coordinated service and support plan
112.15addendum;
112.16(2) taking the action necessary to facilitate the accomplishment of the outcomes
112.17according to the requirements in section 245D.07;
112.18(3) instruction and assistance to direct support staff implementing the coordinated
112.19service and support plan and the service outcomes, including direct observation of service
112.20delivery sufficient to assess staff competency; and
112.21(4) evaluation of the effectiveness of service delivery, methodologies, and progress on
112.22the person's outcomes based on the measurable and observable criteria for identifying when
112.23the desired outcome has been achieved according to the requirements in section 245D.07.
112.24(b) The license holder must ensure that the designated coordinator is competent to
112.25perform the required duties identified in paragraph (a) through education ~~and~~, training
112.26~~in human services and disability-related fields~~, and work experience ~~in providing direct~~
112.27~~care services and supports to persons with disabilities~~ relevant to the needs of the general
112.28population of persons served by the license holder and the individual persons for whom
112.29the designated coordinator is responsible. The designated coordinator must have the
112.30skills and ability necessary to develop effective plans and to design and use data systems
112.31to measure effectiveness of services and supports. The license holder must verify and
112.32document competence according to the requirements in section 245D.09, subdivision 3.
112.33The designated coordinator must minimally have:
113.1(1) a baccalaureate degree in a field related to human services, and one year of
113.2full-time work experience providing direct care services to persons with disabilities or
113.3persons age 65 and older;
113.4(2) an associate degree in a field related to human services, and two years of
113.5full-time work experience providing direct care services to persons with disabilities or
113.6persons age 65 and older;
113.7(3) a diploma in a field related to human services from an accredited postsecondary
113.8institution and three years of full-time work experience providing direct care services to
113.9persons with disabilities or persons age 65 and older; or
113.10(4) a minimum of 50 hours of education and training related to human services
113.11and disabilities; and
113.12(5) four years of full-time work experience providing direct care services to persons
113.13with disabilities or persons age 65 and older under the supervision of a staff person who
113.14meets the qualifications identified in clauses (1) to (3).

113.15    Sec. 36. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 3, is
113.16amended to read:
113.17    Subd. 3. Staff qualifications. (a) The license holder must ensure that staff providing
113.18direct support, or staff who have responsibilities related to supervising or managing the
113.19provision of direct support service, are competent as demonstrated through skills and
113.20knowledge training, experience, and education to meet the person's needs and additional
113.21requirements as written in the coordinated service and support plan or coordinated
113.22service and support plan addendum, or when otherwise required by the case manager or
113.23the federal waiver plan. The license holder must verify and maintain evidence of staff
113.24competency, including documentation of:
113.25(1) education and experience qualifications relevant to the job responsibilities
113.26assigned to the staff and to the needs of the general population of persons served by the
113.27program, including a valid degree and transcript, or a current license, registration, or
113.28certification, when a degree or licensure, registration, or certification is required by this
113.29chapter or in the coordinated service and support plan or coordinated service and support
113.30plan addendum;
113.31(2) demonstrated competency in the orientation and training areas required under
113.32this chapter, and when applicable, completion of continuing education required to
113.33maintain professional licensure, registration, or certification requirements. Competency in
113.34these areas is determined by the license holder through knowledge testing ~~and~~ or observed
113.35skill assessment conducted by the trainer or instructor; and
114.1(3) except for a license holder who is the sole direct support staff, periodic
114.2performance evaluations completed by the license holder of the direct support staff
114.3person's ability to perform the job functions based on direct observation.
114.4(b) Staff under 18 years of age may not perform overnight duties or administer
114.5medication.

114.6    Sec. 37. Minnesota Statutes 2013 Supplement, section 245D.09, subdivision 4a,
114.7is amended to read:
114.8    Subd. 4a. Orientation to individual service recipient needs. (a) Before having
114.9unsupervised direct contact with a person served by the program, or for whom the staff
114.10person has not previously provided direct support, or any time the plans or procedures
114.11identified in paragraphs (b) to ~~(f)~~ (g) are revised, the staff person must review and receive
114.12instruction on the requirements in paragraphs (b) to ~~(f)~~ (g) as they relate to the staff
114.13person's job functions for that person.
114.14(b) Training and competency evaluations must include the following:
114.15(1) appropriate and safe techniques in personal hygiene and grooming, including
114.16hair care; bathing; care of teeth, gums, and oral prosthetic devices; and other activities of
114.17daily living (ADLs) as defined under section 256B.0659, subdivision 1;
114.18(2) an understanding of what constitutes a healthy diet according to data from the
114.19Centers for Disease Control and Prevention and the skills necessary to prepare that diet;
114.20(3) skills necessary to provide appropriate support in instrumental activities of daily
114.21living (IADLs) as defined under section 256B.0659, subdivision 1; and
114.22(4) demonstrated competence in providing first aid.
114.23(c) The staff person must review and receive instruction on the person's coordinated
114.24service and support plan or coordinated service and support plan addendum as it relates
114.25to the responsibilities assigned to the license holder, and when applicable, the person's
114.26individual abuse prevention plan, to achieve and demonstrate an understanding of the
114.27person as a unique individual, and how to implement those plans.
114.28(d) The staff person must review and receive instruction on medication setup,
114.29assistance, or administration procedures established for the person when ~~medication~~
114.30~~administration is~~ assigned to the license holder according to section 245D.05, subdivision
114.311 , paragraph (b). Unlicensed staff may ~~administer medications~~ perform medication setup
114.32or medication administration only after successful completion of a medication setup or
114.33medication administration training, from a training curriculum developed by a registered
114.34nurse~~, clinical nurse specialist in psychiatric and mental health nursing, certified nurse~~
114.35~~practitioner, physician's assistant, or physician~~ or appropriate licensed health professional.
115.1The training curriculum must incorporate an observed skill assessment conducted by the
115.2trainer to ensure unlicensed staff demonstrate the ability to safely and correctly follow
115.3medication procedures.
115.4Medication administration must be taught by a registered nurse, clinical nurse
115.5specialist, certified nurse practitioner, physician's assistant, or physician if, at the time of
115.6service initiation or any time thereafter, the person has or develops a health care condition
115.7that affects the service options available to the person because the condition requires:
115.8(1) specialized or intensive medical or nursing supervision; and
115.9(2) nonmedical service providers to adapt their services to accommodate the health
115.10and safety needs of the person.
115.11(e) The staff person must review and receive instruction on the safe and correct
115.12operation of medical equipment used by the person to sustain life, including but not
115.13limited to ventilators, feeding tubes, or endotracheal tubes. The training must be provided
115.14by a licensed health care professional or a manufacturer's representative and incorporate
115.15an observed skill assessment to ensure staff demonstrate the ability to safely and correctly
115.16operate the equipment according to the treatment orders and the manufacturer's instructions.
115.17(f) The staff person must review and receive instruction on what constitutes use of
115.18restraints, time out, and seclusion, including chemical restraint, and staff responsibilities
115.19related to the prohibitions of their use according to the requirements in section 245D.06,
115.20subdivision 5 or successor provisions, why such procedures are not effective for reducing
115.21or eliminating symptoms or undesired behavior and why they are not safe, and the safe
115.22and correct use of manual restraint on an emergency basis according to the requirements
115.23in section 245D.061 or successor provisions.
115.24(g) The staff person must review and receive instruction on mental health crisis
115.25response, de-escalation techniques, and suicide intervention when providing direct support
115.26to a person with a serious mental illness.
115.27~~(g)~~ (h) In the event of an emergency service initiation, the license holder must ensure
115.28the training required in this subdivision occurs within 72 hours of the direct support staff
115.29person first having unsupervised contact with the person receiving services. The license
115.30holder must document the reason for the unplanned or emergency service initiation and
115.31maintain the documentation in the person's service recipient record.
115.32~~(h)~~ (i) License holders who provide direct support services themselves must
115.33complete the orientation required in subdivision 4, clauses (3) to (7).

115.34    Sec. 38. Minnesota Statutes 2013 Supplement, section 245D.091, subdivision 2,
115.35is amended to read:
116.1    Subd. 2. Behavior professional qualifications. A behavior professional providing
116.2behavioral support services as identified in section 245D.03, subdivision 1, paragraph (c),
116.3clause (1), item (i), ~~as defined in the brain injury and community alternatives for disabled~~
116.4~~individuals waiver plans or successor plans,~~ must have competencies in the following
116.5areas ~~related to~~ as required under the brain injury and community alternatives for disabled
116.6individuals waiver plans or successor plans:
116.7(1) ethical considerations;
116.8(2) functional assessment;
116.9(3) functional analysis;
116.10(4) measurement of behavior and interpretation of data;
116.11(5) selecting intervention outcomes and strategies;
116.12(6) behavior reduction and elimination strategies that promote least restrictive
116.13approved alternatives;
116.14(7) data collection;
116.15(8) staff and caregiver training;
116.16(9) support plan monitoring;
116.17(10) co-occurring mental disorders or neurocognitive disorder;
116.18(11) demonstrated expertise with populations being served; and
116.19(12) must be a:
116.20(i) psychologist licensed under sections 148.88 to 148.98, who has stated to the
116.21Board of Psychology competencies in the above identified areas;
116.22(ii) clinical social worker licensed as an independent clinical social worker under
116.23chapter 148D, or a person with a master's degree in social work from an accredited college
116.24or university, with at least 4,000 hours of post-master's supervised experience in the
116.25delivery of clinical services in the areas identified in clauses (1) to (11);
116.26(iii) physician licensed under chapter 147 and certified by the American Board
116.27of Psychiatry and Neurology or eligible for board certification in psychiatry with
116.28competencies in the areas identified in clauses (1) to (11);
116.29(iv) licensed professional clinical counselor licensed under sections 148B.29 to
116.30148B.39 with at least 4,000 hours of post-master's supervised experience in the delivery
116.31of clinical services who has demonstrated competencies in the areas identified in clauses
116.32(1) to (11);
116.33(v) person with a master's degree from an accredited college or university in one
116.34of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
116.35supervised experience in the delivery of clinical services with demonstrated competencies
116.36in the areas identified in clauses (1) to (11); or
117.1(vi) registered nurse who is licensed under sections 148.171 to 148.285, and who is
117.2certified as a clinical specialist or as a nurse practitioner in adult or family psychiatric and
117.3mental health nursing by a national nurse certification organization, or who has a master's
117.4degree in nursing or one of the behavioral sciences or related fields from an accredited
117.5college or university or its equivalent, with at least 4,000 hours of post-master's supervised
117.6experience in the delivery of clinical services.

117.7    Sec. 39. Minnesota Statutes 2013 Supplement, section 245D.091, subdivision 3,
117.8is amended to read:
117.9    Subd. 3. Behavior analyst qualifications. (a) A behavior analyst providing
117.10behavioral support services as identified in section 245D.03, subdivision 1, paragraph
117.11(c), clause (1), item (i), ~~as defined in the brain injury and community alternatives for~~
117.12~~disabled individuals waiver plans or successor plans,~~ must have competencies in the
117.13following areas as required under the brain injury and community alternatives for disabled
117.14individuals waiver plans or successor plans:
117.15(1) have obtained a baccalaureate degree, master's degree, or PhD in a social services
117.16discipline; or
117.17(2) meet the qualifications of a mental health practitioner as defined in section
117.18245.462, subdivision 17 .
117.19(b) In addition, a behavior analyst must:
117.20(1) have four years of supervised experience working with individuals who exhibit
117.21challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder;
117.22(2) have received ten hours of instruction in functional assessment and functional
117.23analysis;
117.24(3) have received 20 hours of instruction in the understanding of the function of
117.25behavior;
117.26(4) have received ten hours of instruction on design of positive practices behavior
117.27support strategies;
117.28(5) have received 20 hours of instruction on the use of behavior reduction approved
117.29strategies used only in combination with behavior positive practices strategies;
117.30(6) be determined by a behavior professional to have the training and prerequisite
117.31skills required to provide positive practice strategies as well as behavior reduction
117.32approved and permitted intervention to the person who receives behavioral support; and
117.33(7) be under the direct supervision of a behavior professional.

118.1    Sec. 40. Minnesota Statutes 2013 Supplement, section 245D.091, subdivision 4,
118.2is amended to read:
118.3    Subd. 4. Behavior specialist qualifications. (a) A behavior specialist providing
118.4behavioral support services as identified in section 245D.03, subdivision 1, paragraph (c),
118.5clause (1), item (i), ~~as defined in the brain injury and community alternatives for disabled~~
118.6~~individuals waiver plans or successor plans,~~ must ~~meet the following qualifications~~ have
118.7competencies in the following areas as required under the brain injury and community
118.8alternatives for disabled individuals waiver plans or successor plans:
118.9(1) have an associate's degree in a social services discipline; or
118.10(2) have two years of supervised experience working with individuals who exhibit
118.11challenging behaviors as well as co-occurring mental disorders or neurocognitive disorder.
118.12(b) In addition, a behavior specialist must:
118.13(1) have received a minimum of four hours of training in functional assessment;
118.14(2) have received 20 hours of instruction in the understanding of the function of
118.15behavior;
118.16(3) have received ten hours of instruction on design of positive practices behavioral
118.17support strategies;
118.18(4) be determined by a behavior professional to have the training and prerequisite
118.19skills required to provide positive practices strategies as well as behavior reduction
118.20approved intervention to the person who receives behavioral support; and
118.21(5) be under the direct supervision of a behavior professional.

118.22    Sec. 41. Minnesota Statutes 2013 Supplement, section 245D.10, subdivision 3, is
118.23amended to read:
118.24    Subd. 3. Service suspension and service termination. (a) The license holder must
118.25establish policies and procedures for temporary service suspension and service termination
118.26that promote continuity of care and service coordination with the person and the case
118.27manager and with other licensed caregivers, if any, who also provide support to the person.
118.28(b) The policy must include the following requirements:
118.29(1) the license holder must notify the person or the person's legal representative and
118.30case manager in writing of the intended termination or temporary service suspension, and
118.31the person's right to seek a temporary order staying the termination of service according to
118.32the procedures in section 256.045, subdivision 4a, or 6, paragraph (c);
118.33(2) notice of the proposed termination of services, including those situations that
118.34began with a temporary service suspension, must be given at least 60 days before the
118.35proposed termination is to become effective when a license holder is providing intensive
119.1supports and services identified in section 245D.03, subdivision 1, paragraph (c), and 30
119.2days prior to termination for all other services licensed under this chapter. This notice
119.3may be given in conjunction with a notice of temporary service suspension;
119.4(3) notice of temporary service suspension must be given on the first day of the
119.5service suspension;
119.6~~(3)~~ (4) the license holder must provide information requested by the person or case
119.7manager when services are temporarily suspended or upon notice of termination;
119.8~~(4)~~ (5) prior to giving notice of service termination or temporary service suspension,
119.9the license holder must document actions taken to minimize or eliminate the need for
119.10service suspension or termination;
119.11~~(5)~~ (6) during the temporary service suspension or service termination notice period,
119.12the license holder ~~will~~ must work with the ~~appropriate county agency~~ support team or
119.13expanded support team to develop reasonable alternatives to protect the person and others;
119.14~~(6)~~ (7) the license holder must maintain information about the service suspension or
119.15termination, including the written termination notice, in the service recipient record; and
119.16~~(7)~~ (8) the license holder must restrict temporary service suspension to situations in
119.17which the person's conduct poses an imminent risk of physical harm to self or others and
119.18less restrictive or positive support strategies would not achieve and maintain safety.

119.19    Sec. 42. Minnesota Statutes 2013 Supplement, section 245D.10, subdivision 4, is
119.20amended to read:
119.21    Subd. 4. Availability of current written policies and procedures. (a) The license
119.22holder must review and update, as needed, the written policies and procedures required
119.23under this chapter.
119.24(b) (1) The license holder must inform the person and case manager of the policies
119.25and procedures affecting a person's rights under section 245D.04, and provide copies of
119.26those policies and procedures, within five working days of service initiation.
119.27(2) If a license holder only provides basic services and supports, this includes the:
119.28(i) grievance policy and procedure required under subdivision 2; and
119.29(ii) service suspension and termination policy and procedure required under
119.30subdivision 3.
119.31(3) For all other license holders this includes the:
119.32(i) policies and procedures in clause (2);
119.33(ii) emergency use of manual restraints policy and procedure required under section
119.34245D.061, subdivision 10, or successor provisions ; and
119.35(iii) data privacy requirements under section 245D.11, subdivision 3.
120.1(c) The license holder must provide a written notice to all persons or their legal
120.2representatives and case managers at least 30 days before implementing any procedural
120.3revisions to policies affecting a person's service-related or protection-related rights under
120.4section 245D.04 and maltreatment reporting policies and procedures. The notice must
120.5explain the revision that was made and include a copy of the revised policy and procedure.
120.6The license holder must document the reasonable cause for not providing the notice at
120.7least 30 days before implementing the revisions.
120.8(d) Before implementing revisions to required policies and procedures, the license
120.9holder must inform all employees of the revisions and provide training on implementation
120.10of the revised policies and procedures.
120.11(e) The license holder must annually notify all persons, or their legal representatives,
120.12and case managers of any procedural revisions to policies required under this chapter,
120.13other than those in paragraph (c). Upon request, the license holder must provide the
120.14person, or the person's legal representative, and case manager with copies of the revised
120.15policies and procedures.

120.16    Sec. 43. Minnesota Statutes 2013 Supplement, section 245D.11, subdivision 2, is
120.17amended to read:
120.18    Subd. 2. Health and safety. The license holder must establish policies and
120.19procedures that promote health and safety by ensuring:
120.20(1) use of universal precautions and sanitary practices in compliance with section
120.21245D.06, subdivision 2 , clause (5);
120.22(2) if the license holder operates a residential program, health service coordination
120.23and care according to the requirements in section 245D.05, subdivision 1;
120.24(3) safe medication assistance and administration according to the requirements
120.25in sections 245D.05, subdivisions 1a, 2, and 5, and 245D.051, that are established in
120.26consultation with a registered nurse, nurse practitioner, physician's assistant, or medical
120.27doctor and require completion of medication administration training according to the
120.28requirements in section 245D.09, subdivision 4a, paragraph (d). Medication assistance
120.29and administration includes, but is not limited to:
120.30(i) providing medication-related services for a person;
120.31(ii) medication setup;
120.32(iii) medication administration;
120.33(iv) medication storage and security;
120.34(v) medication documentation and charting;
121.1(vi) verification and monitoring of effectiveness of systems to ensure safe medication
121.2handling and administration;
121.3(vii) coordination of medication refills;
121.4(viii) handling changes to prescriptions and implementation of those changes;
121.5(ix) communicating with the pharmacy; and
121.6(x) coordination and communication with prescriber;
121.7(4) safe transportation, when the license holder is responsible for transportation of
121.8persons, with provisions for handling emergency situations according to the requirements
121.9in section 245D.06, subdivision 2, clauses (2) to (4);
121.10(5) a plan for ensuring the safety of persons served by the program in emergencies as
121.11defined in section 245D.02, subdivision 8, and procedures for staff to report emergencies
121.12to the license holder. A license holder with a community residential setting or a day service
121.13facility license must ensure the policy and procedures comply with the requirements in
121.14section 245D.22, subdivision 4;
121.15(6) a plan for responding to all incidents as defined in section 245D.02, subdivision
121.1611; and reporting all incidents required to be reported according to section 245D.06,
121.17subdivision 1. The plan must:
121.18(i) provide the contact information of a source of emergency medical care and
121.19transportation; and
121.20(ii) require staff to first call 911 when the staff believes a medical emergency may
121.21be life threatening, or to call the mental health crisis intervention team or similar mental
121.22health response team or service when such a team is available and appropriate when the
121.23person is experiencing a mental health crisis; and
121.24(7) a procedure for the review of incidents and emergencies to identify trends or
121.25patterns, and corrective action if needed. The license holder must establish and maintain
121.26a record-keeping system for the incident and emergency reports. Each incident and
121.27emergency report file must contain a written summary of the incident. The license holder
121.28must conduct a review of incident reports for identification of incident patterns, and
121.29implementation of corrective action as necessary to reduce occurrences. Each incident
121.30report must include:
121.31(i) the name of the person or persons involved in the incident. It is not necessary
121.32to identify all persons affected by or involved in an emergency unless the emergency
121.33resulted in an incident;
121.34(ii) the date, time, and location of the incident or emergency;
121.35(iii) a description of the incident or emergency;
122.1(iv) a description of the response to the incident or emergency and whether a person's
122.2coordinated service and support plan addendum or program policies and procedures were
122.3implemented as applicable;
122.4(v) the name of the staff person or persons who responded to the incident or
122.5emergency; and
122.6(vi) the determination of whether corrective action is necessary based on the results
122.7of the review.

122.8    Sec. 44. Minnesota Statutes 2012, section 252.451, subdivision 2, is amended to read:
122.9    Subd. 2. Vendor participation and reimbursement. Notwithstanding requirements
122.10in ~~chapter~~ chapters 245A and 245D, and sections 252.28, 252.40 to 252.46, and 256B.501,
122.11vendors of day training and habilitation services may enter into written agreements with
122.12qualified businesses to provide additional training and supervision needed by individuals
122.13to maintain their employment.

122.14    Sec. 45. Minnesota Statutes 2012, section 256.9752, subdivision 2, is amended to read:
122.15    Subd. 2. Authority. The Minnesota Board on Aging shall allocate to area agencies
122.16on aging the state and federal funds which are received for the senior nutrition programs
122.17of congregate dining and home-delivered meals in a manner consistent with federal
122.18requirements.

122.19    Sec. 46. Minnesota Statutes 2013 Supplement, section 256B.439, subdivision 1,
122.20is amended to read:
122.21    Subdivision 1. Development and implementation of quality profiles. (a) The
122.22commissioner of human services, in cooperation with the commissioner of health, shall
122.23develop and implement quality profiles for nursing facilities and, beginning not later than
122.24July 1, 2014, for home and community-based services providers, except when the quality
122.25profile system would duplicate requirements under section 256B.5011, 256B.5012, or
122.26256B.5013 . For purposes of this section, home and community-based services providers
122.27are defined as providers of home and community-based services under sections 256B.0625,
122.28subdivisions 6a, 7, and 19a; 256B.0913 ,; 256B.0915,; 256B.092~~, and~~; 256B.49,; and
122.29256B.85, and intermediate care facilities for persons with developmental disabilities
122.30providers under section 256B.5013. To the extent possible, quality profiles must be
122.31developed for providers of services to older adults and people with disabilities, regardless
122.32of payor source, for the purposes of providing information to consumers. The quality
122.33profiles must be developed using existing data sets maintained by the commissioners of
123.1health and human services to the extent possible. The profiles must incorporate or be
123.2coordinated with information on quality maintained by area agencies on aging, long-term
123.3care trade associations, the ombudsman offices, counties, tribes, health plans, and other
123.4entities and the long-term care database maintained under section 256.975, subdivision 7.
123.5The profiles must be designed to provide information on quality to:
123.6(1) consumers and their families to facilitate informed choices of service providers;
123.7(2) providers to enable them to measure the results of their quality improvement
123.8efforts and compare quality achievements with other service providers; and
123.9(3) public and private purchasers of long-term care services to enable them to
123.10purchase high-quality care.
123.11(b) The profiles must be developed in consultation with the long-term care task
123.12force, area agencies on aging, and representatives of consumers, providers, and labor
123.13unions. Within the limits of available appropriations, the commissioners may employ
123.14consultants to assist with this project.
123.15EFFECTIVE DATE.This section is effective retroactively from February 1, 2014.

123.16    Sec. 47. Minnesota Statutes 2013 Supplement, section 256B.439, subdivision 7,
123.17is amended to read:
123.18    Subd. 7. Calculation of home and community-based services quality add-on.
123.19~~Effective~~ On July 1, 2015, the commissioner shall determine the quality add-on rate
123.20change and adjust payment rates for ~~participating~~ all home and community-based services
123.21providers for services rendered on or after that date. The adjustment to a provider payment
123.22rate determined under this subdivision shall become part of the ongoing rate paid to that
123.23provider. The payment rate for the quality add-on shall be a variable amount based on
123.24each provider's quality score as determined in subdivisions 1 and 2a. All home and
123.25community-based services providers shall receive a minimum rate increase under this
123.26subdivision. In addition to a minimum rate increase, a home and community-based
123.27services provider shall receive a quality add-on payment. The commissioner shall limit
123.28the types of home and community-based services providers that may receive the quality
123.29add-on ~~and~~ based on availability of quality measures and outcome data. The commissioner
123.30shall limit the amount of the minimum rate increase and quality add-on payments to
123.31~~operate the quality add-on within funds appropriated for this purpose and based on the~~
123.32~~availability of the quality measures~~ the equivalent of a one percent rate increase for all
123.33home and community-based services providers.

124.1    Sec. 48. Minnesota Statutes 2013 Supplement, section 256B.441, subdivision 53,
124.2is amended to read:
124.3    Subd. 53. Calculation of payment rate for external fixed costs. The commissioner
124.4shall calculate a payment rate for external fixed costs.
124.5    (a) For a facility licensed as a nursing home, the portion related to section 256.9657
124.6shall be equal to $8.86. For a facility licensed as both a nursing home and a boarding care
124.7home, the portion related to section 256.9657 shall be equal to $8.86 multiplied by the
124.8result of its number of nursing home beds divided by its total number of licensed beds.
124.9    (b) The portion related to the licensure fee under section 144.122, paragraph (d),
124.10shall be the amount of the fee divided by actual resident days.
124.11    (c) The portion related to scholarships shall be determined under section 256B.431,
124.12subdivision 36.
124.13    (d) Until September 30, 2013, the portion related to long-term care consultation shall
124.14be determined according to section 256B.0911, subdivision 6.
124.15    (e) The portion related to development and education of resident and family advisory
124.16councils under section 144A.33 shall be $5 divided by 365.
124.17    (f) The portion related to planned closure rate adjustments shall be as determined
124.18under section 256B.437, subdivision 6, and Minnesota Statutes 2010, section 256B.436.
124.19Planned closure rate adjustments that take effect before October 1, 2014, shall no longer
124.20be included in the payment rate for external fixed costs beginning October 1, 2016.
124.21Planned closure rate adjustments that take effect on or after October 1, 2014, shall no
124.22longer be included in the payment rate for external fixed costs beginning on October 1 of
124.23the first year not less than two years after their effective date.
124.24    (g) The portions related to property insurance, real estate taxes, special assessments,
124.25and payments made in lieu of real estate taxes directly identified or allocated to the nursing
124.26facility shall be the actual amounts divided by actual resident days.
124.27    (h) The portion related to the Public Employees Retirement Association shall be
124.28actual costs divided by resident days.
124.29    (i) The single bed room incentives shall be as determined under section 256B.431,
124.30subdivision 42. Single bed room incentives that take effect before October 1, 2014, shall
124.31no longer be included in the payment rate for external fixed costs beginning October 1,
124.322016. Single bed room incentives that take effect on or after October 1, 2014, shall no
124.33longer be included in the payment rate for external fixed costs beginning on October 1 of
124.34the first year not less than two years after their effective date.
124.35    (j) The portion related to the rate adjustment as provided in subdivision 64.
125.1    (k) The payment rate for external fixed costs shall be the sum of the amounts in
125.2paragraphs (a) to ~~(i)~~ (j).

125.3    Sec. 49. Minnesota Statutes 2012, section 256B.441, is amended by adding a
125.4subdivision to read:
125.5    Subd. 64. Rate adjustment for compensation-related costs. (a) Total payment
125.6rates of all nursing facilities that are reimbursed under this section or section 256B.434
125.7shall be increased effective October 1, 2014, to address compensation costs for nursing
125.8facility employees paid less than $14.00 per hour.
125.9(b) Based on the application in paragraph (d), the commissioner shall calculate
125.10the annualized compensation costs by adding the totals of clauses (1), (2), and (3). The
125.11result must be divided by the resident days from the most recently available cost report to
125.12determine a per diem amount, which must be included in the external fixed cost portion of
125.13the total payment rate under subdivision 53:
125.14(1) the sum of the difference between $9.50 and any hourly wage rate of less than
125.15$9.50, multiplied by the number of compensated hours at that wage rate;
125.16(2) the sum of items (i) to (viii):
125.17(i) for all compensated hours from $8.00 to $8.49 per hour, the number of
125.18compensated hours is multiplied by $0.13;
125.19(ii) for all compensated hours from $8.50 to $8.99 per hour, the number of
125.20compensated hours is multiplied by $0.25;
125.21(iii) for all compensated hours from $9.00 to $9.49 per hour, the number of
125.22compensated hours is multiplied by $0.38;
125.23(iv) for all compensated hours from $9.50 to $10.49 per hour, the number of
125.24compensated hours is multiplied by $0.50;
125.25(v) for all compensated hours from $10.50 to $10.99 per hour, the number of
125.26compensated hours is multiplied by $0.40;
125.27(vi) for all compensated hours from $11.00 to $11.49 per hour, the number of
125.28compensated hours is multiplied by $0.30;
125.29(vii) for all compensated hours from $11.50 to $11.99 per hour, the number of
125.30compensated hours is multiplied by $0.20; and
125.31(viii) for all compensated hours from $12.00 to $13.00 per hour, the number of
125.32compensated hours is multiplied by $0.10; and
125.33(3) the sum of the employer's share of FICA taxes, Medicare taxes, state and federal
125.34unemployment taxes, workers' compensation, pensions, and contributions to employee
125.35retirement accounts attributable to the amounts in clauses (1) and (2).
126.1(c) For the rate year beginning October 1, 2014, nursing facilities that receive
126.2approval of the application in paragraph (d) must receive a rate adjustment according to
126.3paragraph (b). The rate adjustment must be used to pay compensation costs for nursing
126.4facility employees paid less than $14.00 per hour. The rate adjustment must continue to
126.5be included in the total payment rate in subsequent years.
126.6(d) To receive a rate adjustment, nursing facilities must submit an application to the
126.7commissioner in a form and manner determined by the commissioner. The application
126.8shall include data for a period beginning with the first pay period after January 1, 2015,
126.9including at least three months of employee compensated hours by wage rate, and a
126.10spending plan that describes how the funds from the rate adjustment will be allocated
126.11for compensation to employees paid less than $14.00 per hour. The application must
126.12be submitted by December 31, 2014. The commissioner may request any additional
126.13information needed to determine the rate adjustment within three weeks of receiving
126.14a complete application. The nursing facility must provide any additional information
126.15requested by the commissioner by March 31, 2015. The commissioner may waive the
126.16deadlines in this subdivision under extraordinary circumstances.
126.17(e) For nursing facilities in which employees are represented by an exclusive
126.18bargaining representative, the commissioner shall approve the application submitted under
126.19this subdivision only upon receipt of a letter of acceptance of the spending plan in regard
126.20to members of the bargaining unit, signed by the exclusive bargaining agent and dated
126.21after May 31, 2014. Upon receipt of the letter of acceptance, the commissioner shall
126.22deem all requirements of this subdivision as having been met in regard to the members of
126.23the bargaining unit.

126.24    Sec. 50. Minnesota Statutes 2013 Supplement, section 256B.4912, subdivision 1,
126.25is amended to read:
126.26    Subdivision 1. Provider qualifications. (a) For the home and community-based
126.27waivers providing services to seniors and individuals with disabilities under sections
126.28256B.0913 , 256B.0915, 256B.092, and 256B.49, the commissioner shall establish:
126.29(1) agreements with enrolled waiver service providers to ensure providers meet
126.30Minnesota health care program requirements;
126.31(2) regular reviews of provider qualifications, and including requests of proof of
126.32documentation; and
126.33(3) processes to gather the necessary information to determine provider qualifications.
126.34    (b) Beginning July 1, 2012, staff that provide direct contact, as defined in section
126.35245C.02, subdivision 11 , for services specified in the federally approved waiver plans
127.1must meet the requirements of chapter 245C prior to providing waiver services and as
127.2part of ongoing enrollment. Upon federal approval, this requirement must also apply to
127.3consumer-directed community supports.
127.4    (c) Beginning January 1, 2014, service owners and managerial officials overseeing
127.5the management or policies of services that provide direct contact as specified in the
127.6federally approved waiver plans must meet the requirements of chapter 245C prior to
127.7reenrollment or revalidation or, for new providers, prior to initial enrollment if they have
127.8not already done so as a part of service licensure requirements.

127.9    Sec. 51. Minnesota Statutes 2013 Supplement, section 256B.492, is amended to read:
127.10256B.492 HOME AND COMMUNITY-BASED SETTINGS FOR PEOPLE
127.11WITH DISABILITIES.
127.12    Subdivision 1. Home and community-based waivers. (a) Individuals receiving
127.13services under a home and community-based waiver under section 256B.092 or 256B.49
127.14may receive services in the following settings:
127.15(1) an individual's own home or family home;
127.16(2) a licensed adult foster care or child foster care setting of up to five people; and
127.17(3) community living settings as defined in section 256B.49, subdivision 23, where
127.18individuals with disabilities who are receiving services under a home and community-based
127.19waiver may reside in all of the units in a building of four or fewer units, and no more than
127.20the greater of four or 25 percent of the units in a multifamily building of more than four
127.21units, unless required by the Housing Opportunities for Persons with AIDS Program.
127.22(b) The settings in paragraph (a) must not:
127.23(1) be located in a building that is a publicly or privately operated facility that
127.24provides institutional treatment or custodial care;
127.25(2) be located in a building on the grounds of or adjacent to a public or private
127.26institution;
127.27(3) be a housing complex designed expressly around an individual's diagnosis or
127.28disability, unless required by the Housing Opportunities for Persons with AIDS Program;
127.29(4) be segregated based on a disability, either physically or because of setting
127.30characteristics, from the larger community; and
127.31(5) have the qualities of an institution which include, but are not limited to:
127.32regimented meal and sleep times, limitations on visitors, and lack of privacy. Restrictions
127.33agreed to and documented in the person's individual service plan shall not result in a
127.34residence having the qualities of an institution as long as the restrictions for the person are
128.1not imposed upon others in the same residence and are the least restrictive alternative,
128.2imposed for the shortest possible time to meet the person's needs.
128.3(c) The provisions of paragraphs (a) and (b) do not apply to any setting in which
128.4individuals receive services under a home and community-based waiver as of July 1,
128.52012, and the setting does not meet the criteria of this section.
128.6(d) Notwithstanding paragraph (c), a program in Hennepin County established as
128.7part of a Hennepin County demonstration project is qualified for the exception allowed
128.8under paragraph (c).
128.9(e) The commissioner shall submit an amendment to the waiver plan no later than
128.10December 31, 2012.
128.11    Subd. 2. Exceptions for home and community-based waiver housing programs.
128.12(a) Beginning no later than January 2015, based on the consultation with interested
128.13stakeholders as specified in subdivision 3, the commissioner shall accept and process
128.14applications for exceptions to subdivision 1 based on the criteria in this subdivision.
128.15(b) An owner, operator, or developer of a community living setting may apply to
128.16the commissioner for the granting of an exception from the requirement in subdivision
128.171, paragraph (a), clause (3), that individuals receiving services under a home and
128.18community-based waiver under section 256B.092 or 256B.49 may only reside in all of the
128.19units in a building of four or fewer units, and no more than the greater of four or 25 percent
128.20of the units in a multifamily building of more than four units and from the requirement
128.21in subdivision 1, paragraph (b), clause (3), that a setting cannot be a housing complex
128.22designed expressly around an individual's diagnosis or disability. Such an exception from
128.23the requirements in subdivision 1, paragraphs (a), clause (3), and (b), clause (3), may be
128.24granted when the organization requesting the exception submits to the commissioner an
128.25application providing the information requested in subdivision 2, paragraph (c). The
128.26exception shall require that housing costs be separated from service costs and allow the
128.27client to choose the vendor who provides personal services under the client's waiver.
128.28(c) A community living setting application for an exemption must provide the
128.29following information and affirmations:
128.30(1) affirms the community living setting materially meets all the requirements for
128.31home and community-based settings in paragraph (b) other than clause (3);
128.32(2) explains the scope and necessity of the exception, including documentation of
128.33the characteristics of the population to be served and the demand for the number of units
128.34the applicant anticipates will be occupied by individuals receiving services under a home
128.35and community-based waiver in the proposed setting;
129.1(3) explains how the community living setting supports all individuals receiving
129.2services under a home and community-based waiver in choosing the setting from
129.3among other options and the availability of those other options in the community for
129.4the specific population the program proposes to serve, and outlines the proposed rents
129.5and service costs, if any, of services to be provided by the applicant and addresses the
129.6cost-effectiveness of the model proposed; and
129.7(4) includes a quality assurance plan affirming that the organization requesting
129.8the exception:
129.9(i) supports or develops scattered-site alternatives to the setting for which the
129.10exception is requested;
129.11(ii) supports the transition of individuals receiving services under a home and
129.12community-based waiver to the most integrated setting appropriate to the individual's
129.13needs;
129.14(iii) has a history of meeting recognized quality standards for the population it serves
129.15or is targeting, or that it will meet recognized quality standards;
129.16(iv) provides and facilitates for tenants receiving services under a home and
129.17community-based waiver unlimited access to the community, including opportunities to
129.18interact with nonstaff people without disabilities, appropriate to the individual's needs; and
129.19(v) supports a safe and healthy environment for all individuals living in the setting.
129.20(d) In assessing whether to grant the applicant's exception request, the commissioner
129.21shall:
129.22(1) evaluate all of the assertions in the application, verify the assertions are accurate,
129.23and ensure that the application is complete;
129.24(2) consult with all divisions in the Department of Human Services relevant to the
129.25specific populations being served by the applicant and the Minnesota Housing Finance
129.26Agency;
129.27(3) within 30 days of receiving the application notify the city, county, and local press
129.28of the 14-day public comment period to consider community input on the application,
129.29including input from tenants, potential tenants, and other interested stakeholders;
129.30(4) within 60 days of receiving the application issue an approval, conditional
129.31approval, or denial of the exception sought; and
129.32(5) accept and process applications from settings throughout the calendar year.
129.33If conditional approval is granted under this section, the commissioner must specify
129.34the reasons for conditional approval of the exception and allow the applicant 30 days
129.35to amend the application and issue a renewed decision within 15 days of receiving the
130.1amended application. If the commissioner denies an exception under this section, the
130.2commissioner must specify reasons for denial of the exception.
130.3(e) If the applicant's exception is approved, the setting must inform the commissioner
130.4of any material changes that occur in the conditions that warranted the approved exception.
130.5Failure to advise the commissioner within 60 days of the material changes may result in
130.6revocation of the exception. Upon a determination by the commissioner that a material
130.7modification has been made, the exception may be suspended and the setting shall have 90
130.8days to correct modifications resulting in the suspension. After an applicant's exception is
130.9approved, any material change in the population to be served or the services to be offered
130.10must be submitted to the commissioner who shall decide if it is consistent with the basis
130.11on which the exception was granted or if another exception request needs to be submitted.
130.12(f) If an exception is approved and later revoked, no tenant shall be displaced as a
130.13result of this revocation until a relocation plan has been implemented that provides for an
130.14acceptable alternative placement.
130.15(g) Notwithstanding the above provision, no organization that meets the requirements
130.16under subdivision 1 shall be required to apply for an exception described in subdivision 2.
130.17    Subd. 3. Public input on exception process. The commissioner shall consult
130.18with interested stakeholders to develop a plan for implementing the exceptions process
130.19described in subdivision 2. The implementation plan for the applications shall be based
130.20upon the criteria in subdivision 2 and any other information necessary to manage the
130.21exceptions process. The commissioner must consult with representatives from each
130.22relevant division of the Department of Human Services, The Coalition for Choice in
130.23Housing, NAMI, The Arc Minnesota, Mental Health Association of Minnesota, Minnesota
130.24Disability Law Center, and other provider organizations, counties, disability advocates,
130.25and individuals with disabilities or family members of an individual with disabilities.

130.26    Sec. 52. Minnesota Statutes 2012, section 256B.5012, is amended by adding a
130.27subdivision to read:
130.28    Subd. 16. ICF/DD rate increases effective July 1, 2014. (a) For each facility
130.29reimbursed under this section, for the rate period beginning July 1, 2014, the commissioner
130.30shall increase operating payments equal to four percent of the operating payment rates in
130.31effect on July 1, 2014. For each facility, the commissioner shall apply the rate increase
130.32based on occupied beds, using the percentage specified in this subdivision multiplied by
130.33the total payment rate, including the variable rate but excluding the property-related
130.34payment rate in effect on the preceding date.
131.1(b) To receive the rate increase under paragraph (a), each facility reimbursed under
131.2this section must submit to the commissioner documentation that identifies a quality
131.3improvement project the facility will implement by June 30, 2015. Documentation must
131.4be provided in a format specified by the commissioner. Projects must:
131.5(1) improve the quality of life of intermediate care facility residents in a meaningful
131.6way;
131.7(2) improve the quality of services in a measurable way; or
131.8(3) deliver good quality service more efficiently.
131.9(c) For a facility that fails to submit the documentation described in paragraph (b)
131.10by a date or in a format specified by the commissioner, the commissioner shall reduce
131.11the facility's rate by one percent effective January 1, 2015.
131.12(d) Facilities that receive a rate increase under this subdivision shall use 75 percent
131.13of the rate increase to increase compensation-related costs for employees directly
131.14employed by the facility on or after the effective date of the rate adjustments, except:
131.15(1) persons employed in the central office of a corporation or entity that has an
131.16ownership interest in the facility or exercises control over the facility; and
131.17(2) persons paid by the facility under a management contract.
131.18This requirement is subject to audit by the commissioner.
131.19(e) Compensation-related costs include:
131.20(1) wages and salaries;
131.21(2) the employer's share of FICA taxes, Medicare taxes, state and federal
131.22unemployment taxes, workers' compensation, and mileage reimbursement;
131.23(3) the employer's share of health and dental insurance, life insurance, disability
131.24insurance, long-term care insurance, uniform allowance, pensions, and contributions to
131.25employee retirement accounts; and
131.26(4) other benefits provided and workforce needs, including the recruiting and
131.27training of employees as specified in the distribution plan required under paragraph (f).
131.28(f) A facility that receives a rate adjustment under paragraph (a) that is subject to
131.29paragraphs (d) and (e) shall prepare and produce for the commissioner, upon request, a
131.30plan that specifies the amount of money the provider expects to receive that is subject to
131.31the requirements of paragraphs (d) and (e), as well as how that money will be distributed
131.32to increase compensation for employees. The commissioner may recover funds from a
131.33facility that fails to comply with this requirement.
131.34(g) Within six months after the effective date of the rate adjustment, the facility shall
131.35post the distribution plan required under paragraph (f) for a period of at least six weeks in
131.36an area of the facility's operation to which all eligible employees have access, and shall
132.1provide instructions for employees who believe they have not received the wage and other
132.2compensation-related increases specified in the distribution plan. These instructions must
132.3include a mailing address, e-mail address, and telephone number that an employee may
132.4use to contact the commissioner or the commissioner's representative. Facilities shall
132.5make assurances to the commissioner of compliance with this subdivision using forms
132.6prescribed by the commissioner.
132.7(h) For public employees, the increase for wages and benefits for certain staff is
132.8available and pay rates must be increased only to the extent that the increases comply with
132.9laws governing public employees' collective bargaining. Money received by a provider for
132.10pay increases for public employees under this subdivision may be used only for increases
132.11implemented within one month of the effective date of the rate increase and must not be
132.12used for increases implemented prior to that date.

132.13    Sec. 53. PROVIDER RATE AND GRANT INCREASES EFFECTIVE JULY
132.141, 2014.
132.15(a) The commissioner of human services shall increase reimbursement rates, grants,
132.16allocations, individual limits, and rate limits, as applicable, by four percent for the rate
132.17period beginning July 1, 2014, for services rendered on or after that date. County or tribal
132.18contracts for services specified in this section must be amended to pass through these rate
132.19increases within 60 days of the effective date.
132.20(b) The rate changes described in this section must be provided to:
132.21(1) home and community-based waiver services for persons with developmental
132.22disabilities, including consumer-directed community supports, under Minnesota Statutes,
132.23section 256B.092;
132.24(2) waiver services under community alternatives for disabled individuals, including
132.25consumer-directed community supports, under Minnesota Statutes, section 256B.49;
132.26(3) community alternative care waiver services, including consumer-directed
132.27community supports, under Minnesota Statutes, section 256B.49;
132.28(4) brain injury waiver services, including consumer-directed community supports,
132.29under Minnesota Statutes, section 256B.49;
132.30(5) home and community-based waiver services for the elderly under Minnesota
132.31Statutes, section 256B.0915;
132.32(6) nursing services and home health services under Minnesota Statutes, section
132.33256B.0625, subdivision 6a;
132.34(7) personal care services and qualified professional supervision of personal care
132.35services under Minnesota Statutes, section 256B.0625, subdivisions 6a and 19a;
133.1(8) private duty nursing services under Minnesota Statutes, section 256B.0625,
133.2subdivision 7;
133.3(9) community first services and supports under Minnesota Statutes, section 256B.85;
133.4(10) essential community supports under Minnesota Statutes, section 256B.0922;
133.5(11) day training and habilitation services for adults with developmental disabilities
133.6or related conditions under Minnesota Statutes, sections 252.41 to 252.46, including the
133.7additional cost to counties for rate adjustments to day training and habilitation services
133.8provided as a social service;
133.9(12) alternative care services under Minnesota Statutes, section 256B.0913;
133.10(13) living skills training programs for persons with intractable epilepsy who need
133.11assistance in the transition to independent living under Laws 1988, chapter 689;
133.12(14) consumer support grants under Minnesota Statutes, section 256.476;
133.13(15) semi-independent living services under Minnesota Statutes, section 252.275;
133.14(16) family support grants under Minnesota Statutes, section 252.32;
133.15(17) housing access grants under Minnesota Statutes, section 256B.0658;
133.16(18) self-advocacy grants under Laws 2009, chapter 101;
133.17(19) technology grants under Laws 2009, chapter 79;
133.18(20) aging grants under Minnesota Statutes, sections 256.975 to 256.977 and
133.19256B.0917;
133.20(21) deaf and hard-of-hearing grants, including community support services for deaf
133.21and hard-of-hearing adults with mental illness who use or wish to use sign language as their
133.22primary means of communication under Minnesota Statutes, section 256.01, subdivision 2;
133.23(22) deaf and hard-of-hearing grants under Minnesota Statutes, sections 256C.233,
133.24256C.25, and 256C.261;
133.25(23) Disability Linkage Line grants under Minnesota Statutes, section 256.01,
133.26subdivision 24;
133.27(24) transition initiative grants under Minnesota Statutes, section 256.478;
133.28(25) employment support grants under Minnesota Statutes, section 256B.021,
133.29subdivision 6; and
133.30(26) grants provided to people who are eligible for the Housing Opportunities for
133.31Persons with AIDS program under Minnesota Statutes, section 256B.492.
133.32(c) A managed care plan receiving state payments for the services in paragraph (b)
133.33must include the increases in paragraph (a) in payments to providers. To implement the
133.34rate increase in this section, capitation rates paid by the commissioner to managed care
133.35organizations under Minnesota Statutes, section 256B.69, shall reflect a four percent
133.36increase for the specified services for the period beginning July 1, 2014.
134.1(d) Counties shall increase the budget for each recipient of consumer-directed
134.2community supports by the amounts in paragraph (a) on the effective dates in paragraph (a).
134.3(e) To implement this section, the commissioner shall increase service rates in the
134.4disability waiver payment system authorized in Minnesota Statutes, sections 256B.4913
134.5and 256B.4914.
134.6(f) To receive the rate increase described in this section, providers under paragraphs
134.7(a) and (b) must submit to the commissioner documentation that identifies a quality
134.8improvement project that the provider will implement by June 30, 2015. Documentation
134.9must be provided in a format specified by the commissioner. Projects must:
134.10(1) improve the quality of life of home and community-based services recipients in
134.11a meaningful way;
134.12(2) improve the quality of services in a measurable way; or
134.13(3) deliver good quality service more efficiently.
134.14Providers listed in paragraph (b), clauses (7), (9), (10), and (13) to (26), are not subject
134.15to this requirement.
134.16(g) For a provider that fails to submit documentation described in paragraph (f) by
134.17a date or in a format specified by the commissioner, the commissioner shall reduce the
134.18provider's rate by one percent effective January 1, 2015.
134.19(h) Providers that receive a rate increase under this subdivision shall use 75 percent
134.20of the rate increase to increase compensation-related costs for employees directly
134.21employed by the facility on or after the effective date of the rate adjustments, except:
134.22(1) persons employed in the central office of a corporation or entity that has an
134.23ownership interest in the facility or exercises control over the facility; and
134.24(2) persons paid by the facility under a management contract.
134.25This requirement is subject to audit by the commissioner.
134.26(i) Compensation-related costs include:
134.27(1) wages and salaries;
134.28(2) the employer's share of FICA taxes, Medicare taxes, state and federal
134.29unemployment taxes, workers' compensation, and mileage reimbursement;
134.30(3) the employer's share of health and dental insurance, life insurance, disability
134.31insurance, long-term care insurance, uniform allowance, pensions, and contributions to
134.32employee retirement accounts; and
134.33(4) other benefits provided and workforce needs, including the recruiting and
134.34training of employees as specified in the distribution plan required under paragraph (k).
134.35(j) For public employees, the increase for wages and benefits for certain staff is
134.36available and pay rates must be increased only to the extent that the increases comply with
135.1laws governing public employees' collective bargaining. Money received by a provider
135.2for pay increases for public employees under this section may be used only for increases
135.3implemented within one month of the effective date of the rate increase and must not be
135.4used for increases implemented prior to that date.
135.5(k) A provider that receives a rate adjustment under paragraph (b) that is subject to
135.6paragraphs (h) and (i) shall prepare and produce for the commissioner, upon request, a
135.7plan that specifies the amount of money the provider expects to receive that is subject to
135.8the requirements of paragraphs (h) and (i), as well as how that money will be distributed
135.9to increase compensation for employees. The commissioner may recover funds from a
135.10facility that fails to comply with this requirement.
135.11(l) Within six months after the effective date of the rate adjustment, the provider
135.12shall post the distribution plan required under paragraph (k) for a period of at least six
135.13weeks in an area of the provider's operation to which all eligible employees have access,
135.14and shall provide instructions for employees who believe they have not received the
135.15wage and other compensation-related increases specified in the distribution plan. These
135.16instructions must include a mailing address, e-mail address, and telephone number that
135.17an employee may use to contact the commissioner or the commissioner's representative.
135.18Providers shall make assurances to the commissioner of compliance with this section
135.19using forms prescribed by the commissioner.

135.20    Sec. 54. REVISOR'S INSTRUCTION.
135.21In each section of Minnesota Statutes or part of Minnesota Rules referred to in
135.22column A, the revisor of statutes shall delete the word or phrase in column B and insert
135.23the phrase in column C. The revisor shall also make related grammatical changes and
135.24changes in headnotes.

`135.25`	Column A	Column B	Column C
`135.26` `135.27`	section 158.13	defective persons	persons with intellectual disabilities
`135.28` `135.29`	section 158.14	defective persons	persons with intellectual disabilities
`135.30` `135.31`	section 158.17	defective persons	persons with intellectual disabilities
`135.32` `135.33`	section 158.18	persons not defective	persons without intellectual disabilities
`135.34` `135.35`		defective person	person with intellectual disabilities
`135.36` `135.37`		defective persons	persons with intellectual disabilities
`135.38` `135.39`	section 158.19	defective	person with intellectual disabilities
`136.1` `136.2`	section 256.94	defective	children with intellectual disabilities and
`136.3` `136.4`	section 257.175	defective	children with intellectual disabilities and
`136.5`	part 2911.1350	retardation	developmental disability

136.6 Sec. 55. REPEALER.
136.7(a) Minnesota Statutes 2012, section 245.825, subdivisions 1 and 1b, are repealed
136.8upon the effective date of rules adopted according to Minnesota Statutes, section 245.8251,
136.9or, if sequential effective dates are used, the latest effective date. The commissioner of
136.10human services shall notify the revisor of statutes when this occurs.
136.11(b) Minnesota Statutes 2013 Supplement, sections 245D.02, subdivisions 2b, 2c,
136.125a, and 23b; 245D.06, subdivisions 5, 6, 7, and 8; and 245D.061, are repealed upon the
136.13effective date of rules adopted according to Minnesota Statutes, section 245.8251, or, if
136.14sequential effective dates are used, the latest effective date. The commissioner of human
136.15services shall notify the revisor of statutes when this occurs.
136.16(c) Minnesota Rules, parts 9525.2700; and 9525.2810, are repealed upon the
136.17effective date of rules adopted according to Minnesota Statutes, section 245.8251, or, if
136.18sequential effective dates are used, the latest effective date. The commissioner of human
136.19services shall notify the revisor of statutes when this occurs.

136.20ARTICLE 6

136.21MISCELLANEOUS

136.22    Section 1. Minnesota Statutes 2013 Supplement, section 16A.724, subdivision 2,
136.23is amended to read:
136.24    Subd. 2. Transfers. (a) Notwithstanding section 295.581, to the extent available
136.25resources in the health care access fund exceed expenditures in that fund, effective for
136.26the biennium beginning July 1, 2007, the commissioner of management and budget shall
136.27transfer the excess funds from the health care access fund to the general fund on June 30
136.28of each year, provided that the amount transferred in any fiscal biennium shall not exceed
136.29$96,000,000. The purpose of this transfer is to meet the rate increase required under Laws
136.302003, First Special Session chapter 14, article 13C, section 2, subdivision 6.
136.31    (b) For fiscal ~~years 2006 to 2011~~ year 2018 and thereafter, MinnesotaCare shall be a
136.32forecasted program, and, if necessary, the commissioner shall reduce these transfers from
136.33the health care access fund to the general fund to meet annual MinnesotaCare expenditures
136.34or, if necessary, transfer sufficient funds from the general fund to the health care access
136.35fund to meet annual MinnesotaCare expenditures.
137.1(c) Notwithstanding section 295.581, to the extent available resources in the health
137.2care access fund exceed expenditures in that fund after the transfer required in paragraph
137.3(a), effective for the biennium beginning July 1, 2013, the commissioner of management
137.4and budget shall transfer $1,000,000 each fiscal year from the health access fund to
137.5the medical education and research costs fund established under section 62J.692, for
137.6distribution under section 62J.692, subdivision 4, paragraph (c).

137.7    Sec. 2. Minnesota Statutes 2012, section 254B.12, is amended to read:
137.8254B.12 RATE METHODOLOGY.
137.9    Subdivision 1. CCDTF rate methodology established. The commissioner shall
137.10establish a new rate methodology for the consolidated chemical dependency treatment
137.11fund. The new methodology must replace county-negotiated rates with a uniform
137.12statewide methodology that must include a graduated reimbursement scale based on the
137.13patients' level of acuity and complexity. At least biennially, the commissioner shall review
137.14the financial information provided by vendors to determine the need for rate adjustments.
137.15    Subd. 2. Payment methodology for state-operated vendors. (a) Notwithstanding
137.16subdivision 1, the commissioner shall seek federal authority to develop a separate
137.17payment methodology for chemical dependency treatment services provided under the
137.18consolidated chemical dependency treatment fund by a state-operated vendor. This
137.19payment methodology is effective for services provided on or after October 1, 2015, or on
137.20or after the receipt of federal approval, whichever is later.
137.21(b) Before implementing an approved payment methodology under paragraph
137.22(a), the commissioner must also receive any necessary legislative approval of required
137.23changes to state law or funding.

137.24    Sec. 3. Minnesota Statutes 2012, section 256I.05, subdivision 2, is amended to read:
137.25    Subd. 2. Monthly rates; exemptions. ~~The maximum group residential housing rate~~
137.26~~does not apply~~ This subdivision applies to a residence that on August 1, 1984, was licensed
137.27by the commissioner of health only as a boarding care home, certified by the commissioner
137.28of health as an intermediate care facility, and licensed by the commissioner of human
137.29services under Minnesota Rules, parts 9520.0500 to 9520.0690. Notwithstanding the
137.30provisions of subdivision 1c, the rate paid to a facility reimbursed under this subdivision
137.31shall be determined under section 256B.431, or under section 256B.434 if the facility is
137.32accepted by the commissioner for participation in the alternative payment demonstration
137.33project. The rate paid to this facility shall also include adjustments to the group residential
138.1housing rate according to subdivision 1, and any adjustments applicable to supplemental
138.2service rates statewide.

138.3    Sec. 4. Minnesota Statutes 2012, section 256J.49, subdivision 13, is amended to read:
138.4    Subd. 13. Work activity. (a) "Work activity" means any activity in a participant's
138.5approved employment plan that leads to employment. For purposes of the MFIP program,
138.6this includes activities that meet the definition of work activity under the participation
138.7requirements of TANF. Work activity includes:
138.8    (1) unsubsidized employment, including work study and paid apprenticeships or
138.9internships;
138.10    (2) subsidized private sector or public sector employment, including grant diversion
138.11as specified in section 256J.69, on-the-job training as specified in section 256J.66, paid
138.12work experience, and supported work when a wage subsidy is provided;
138.13    (3) unpaid work experience, including community service, volunteer work,
138.14the community work experience program as specified in section 256J.67, unpaid
138.15apprenticeships or internships, and supported work when a wage subsidy is not provided.
138.16Unpaid work experience is only an option if the participant has been unable to obtain or
138.17maintain paid employment in the competitive labor market, and no paid work experience
138.18programs are available to the participant. Prior to placing a participant in unpaid work,
138.19the county must inform the participant that the participant will be notified if a paid work
138.20experience or supported work position becomes available. Unless a participant consents in
138.21writing to participate in unpaid work experience, the participant's employment plan may
138.22only include unpaid work experience if including the unpaid work experience in the plan
138.23will meet the following criteria:
138.24    (i) the unpaid work experience will provide the participant specific skills or
138.25experience that cannot be obtained through other work activity options where the
138.26participant resides or is willing to reside; and
138.27    (ii) the skills or experience gained through the unpaid work experience will result
138.28in higher wages for the participant than the participant could earn without the unpaid
138.29work experience;
138.30    (4) job search including job readiness assistance, job clubs, job placement,
138.31job-related counseling, and job retention services;
138.32    (5) job readiness education, including English as a second language (ESL) or
138.33functional work literacy classes ~~as limited by the provisions of section~~ ~~256J.531,~~
138.34~~subdivision 2~~ , general educational development (GED) or Minnesota adult diploma course
139.1work, high school completion, and adult basic education ~~as limited by the provisions of~~
139.2~~section~~ ~~256J.531, subdivision 1~~;
139.3    (6) job skills training directly related to employment, including postsecondary
139.4education and training that can reasonably be expected to lead to employment~~, as limited~~
139.5~~by the provisions of section~~ ~~256J.53~~;
139.6    (7) providing child care services to a participant who is working in a community
139.7service program;
139.8    (8) activities included in the employment plan that is developed under section
139.9256J.521, subdivision 3 ; and
139.10    (9) preemployment activities including chemical and mental health assessments,
139.11treatment, and services; learning disabilities services; child protective services; family
139.12stabilization services; or other programs designed to enhance employability.
139.13(b) "Work activity" does not include activities done for political purposes as defined
139.14in section 211B.01, subdivision 6.

139.15    Sec. 5. Minnesota Statutes 2012, section 256J.53, subdivision 1, is amended to read:
139.16    Subdivision 1. Length of program. (a) In order for a postsecondary education
139.17or training program to be an approved work activity as defined in section 256J.49,
139.18subdivision 13 , clause (6), it must be a program lasting ~~24 months~~ four years or less, and
139.19the participant must meet the requirements of subdivisions 2, 3, and 5.
139.20(b) Participants with a high school diploma, general educational development (GED)
139.21credential, or Minnesota adult diploma must be informed of the opportunity to participate
139.22in postsecondary education or training while in the Minnesota family investment program.

139.23    Sec. 6. Minnesota Statutes 2012, section 256J.53, subdivision 2, is amended to read:
139.24    Subd. 2. Approval of postsecondary education or training. (a) ~~In order for a~~
139.25~~postsecondary education or training program to be an approved activity in an employment~~
139.26~~plan, the plan must include additional work activities if the education and training~~
139.27~~activities do not meet the minimum hours required to meet the federal work participation~~
139.28~~rate under Code of Federal Regulations, title 45, sections 261.31 and 261.35.~~
139.29    ~~(b)~~ Participants ~~seeking approval of a~~ who are interested in participating in
139.30 postsecondary education or training ~~plan~~ as part of their employment plan must ~~provide~~
139.31~~documentation that~~ discuss their education plans with their job counselor. Job counselors
139.32must work with participants to evaluate options by:
139.33    (1) ~~the employment goal can only be met with the additional education or training;~~
140.1    ~~(2)~~ advising whether there are suitable employment opportunities that require the
140.2specific education or training in the area in which the participant resides or is willing
140.3to reside;
140.4    ~~(3) the education or training will result in significantly higher wages for the~~
140.5~~participant than the participant could earn without the education or training;~~
140.6    ~~(4)~~ (2) assisting the participant in exploring whether the participant can meet the
140.7requirements for admission into the program; and
140.8    ~~(5)~~ (3) ~~there is a reasonable expectation that the participant will complete the training~~
140.9~~program~~ discussing the participant's strengths and challenges based on ~~such factors as~~ the
140.10participant's MFIP assessment, previous education, training, and work history~~; current~~
140.11~~motivation; and changes in previous circumstances~~.
140.12(b) The requirements of this subdivision do not apply to participants who are in:
140.13(1) a recognized career pathway program that leads to stackable credentials;
140.14(2) a training program lasting 12 weeks or less; or
140.15(3) the final year of a multi-year postsecondary education or training program.

140.16    Sec. 7. Minnesota Statutes 2012, section 256J.53, subdivision 5, is amended to read:
140.17    Subd. 5. Requirements after postsecondary education or training. Upon
140.18completion of an approved education or training program, a participant who does not meet
140.19the participation requirements in section 256J.55, subdivision 1, through unsubsidized
140.20employment must participate in job search. If, after ~~six~~ 12 weeks of job search, the
140.21participant does not find a full-time job consistent with the employment goal, the
140.22participant must accept any offer of full-time suitable employment, or meet with the job
140.23counselor to revise the employment plan to include additional work activities necessary to
140.24meet hourly requirements.

140.25    Sec. 8. Minnesota Statutes 2012, section 256J.531, is amended to read:
140.26256J.531 BASIC EDUCATION; ENGLISH AS A SECOND LANGUAGE.
140.27    Subdivision 1. Approval of adult basic education. ~~With the exception of classes~~
140.28~~related to obtaining a general educational development credential (GED), a participant~~
140.29~~must have reading or mathematics proficiency below a ninth grade level in order for adult~~
140.30~~basic education classes to be an~~ A participant who lacks a high school diploma, general
140.31educational development (GED) credential, or Minnesota adult diploma must be allowed
140.32to pursue these credentials as an approved work activity, provided that the participant
140.33is making satisfactory progress. Participants eligible to pursue a general educational
140.34development (GED) credential or Minnesota adult diploma under this subdivision must
141.1be informed of the opportunity to participate while in the Minnesota family investment
141.2program. ~~The employment plan must also specify that the participant fulfill no more than~~
141.3~~one-half of the participation requirements in section~~ ~~256J.55, subdivision 1, through~~
141.4~~attending adult basic education or general educational development classes.~~
141.5    Subd. 2. Approval of English as a second language. In order for English as a
141.6second language (ESL) classes to be an approved work activity in an employment plan, a
141.7participant must be below a spoken language proficiency level of SPL6 or its equivalent,
141.8as measured by a nationally recognized test. In approving ESL as a work activity, the job
141.9counselor must give preference to enrollment in a functional work literacy program,
141.10if one is available, over a regular ESL program. ~~A participant may not be approved~~
141.11~~for more than a combined total of 24 months of ESL classes while participating in the~~
141.12~~diversionary work program and the employment and training services component of~~
141.13~~MFIP. The employment plan must also specify that the participant fulfill no more than~~
141.14~~one-half of the participation requirements in section~~ ~~256J.55, subdivision 1, through~~
141.15~~attending ESL classes. For participants enrolled in functional work literacy classes, no~~
141.16~~more than two-thirds of the participation requirements in section~~ ~~256J.55, subdivision 1~~,
141.17~~may be met through attending functional work literacy classes.~~

141.18    Sec. 9. RECOVERY SCHOOL PROGRAMS; GRANTS.
141.19(a) The commissioner of human services shall award grants to qualifying recovery
141.20school programs for the purpose of paying salaries for licensed chemical dependency
141.21counselors. A qualifying recovery school program may apply for a grant in the manner
141.22and form determined by the commissioner.
141.23(b) For purposes of this section, "qualifying recovery school program" means an
141.24academic setting designed to meet graduation requirements that provides assistance
141.25with recovery and continuing care to students who are recovering from substance abuse
141.26or dependence.

141.27    Sec. 10. CIVIL COMMITMENT TRAINING PROGRAM.
141.28The commissioner of human services shall develop an online training program for
141.29interested individuals and personnel, specifically county and hospital staff and mental
141.30health providers, to understand, clarify, and interpret the Civil Commitment Act under
141.31Minnesota Statutes, chapter 253B, as it pertains to persons with mental illnesses. The
141.32training must be developed in collaboration with the ombudsman for mental health
141.33and developmental disabilities, Minnesota County Attorneys Association, National
141.34Alliance on Mental Illness of Minnesota, Mental Health Consumer/Survivor Network
142.1of Minnesota, Mental Health Association, Minnesota Psychiatric Society, Hennepin
142.2Commitment Defense Panel, Minnesota Disability Law Center, Minnesota Association of
142.3Community Mental Health Programs, Minnesota Hospital Association, and Minnesota
142.4Board of Public Defense. The purpose of the training is to promote better clarity and
142.5interpretation of the civil commitment laws.

142.6ARTICLE 7

142.7HEALTH AND HUMAN SERVICES APPROPRIATIONS

142.8

Section 1. HEALTH AND HUMAN SERVICES APPROPRIATIONS.

142.9The sums shown in the columns marked "Appropriations" are added to or, if shown
142.10in parentheses, subtracted from the appropriations in Laws 2013, chapter 108, articles 14
142.11and 15, to the agencies and for the purposes specified in this article. The appropriations
142.12are from the general fund and are available for the fiscal years indicated for each purpose.
142.13The figures "2014" and "2015" used in this article mean that the addition to or subtraction
142.14from the appropriation listed under them is available for the fiscal year ending June 30,
142.152014, or June 30, 2015, respectively. Supplemental appropriations and reductions to
142.16appropriations for the fiscal year ending June 30, 2014, are effective the day following
142.17final enactment unless a different effective date is explicit.

`142.18`	APPROPRIATIONS
`142.19`	Available for the Year
`142.20`	Ending June 30
`142.21`		2014	2015

142.22
142.23

Sec. 2. COMMISSIONER OF HUMAN
SERVICES

142.24

Subdivision 1.Total Appropriation

785,000

72,335,000

`142.25`	Appropriations by Fund
`142.26`	General	785,000	71,766,000
`142.27`	Federal TANF	-0-	569,000

142.28The appropriation modifications for
142.29each purpose are shown in the following
142.30subdivisions.

142.31

Subd. 2.Central Office Operations

142.32

(a) Operations

-0-

58,000

143.1Base adjustment. The general fund base is
143.2decreased by $6,000 in fiscal years 2016 and
143.32017.

143.4

(b) Health Care

-0-

118,000

143.5Base adjustment. The general fund base is
143.6increased by $108,000 in fiscal years 2016
143.7and 2017.

143.8

-0-

1,084,000

143.9Base adjustment. The general fund base is
143.10increased by $156,000 in fiscal year 2016
143.11and $19,000 in fiscal year 2017.

143.12

Subd. 3.Forecasted Programs

143.13

(a) MFIP/DWP

`143.14`	Appropriations by Fund
`143.15`	General	-0-	122,000
`143.16`	Federal TANF	-0-	217,000

143.17

(b) MFIP Child Care Assistance

`143.18`	Appropriations by Fund
`143.19`	Federal TANF	-0-	352,000

143.20

-0-

681,000

143.21

(d) Medical Assistance

800,000

63,723,000

143.22

(e) Alternative Care

-0-

772,000

143.23

Subd. 4.Grant Programs

143.24

(a) Children's Services Grants

-0-

(3,000)

143.25Base adjustment. The general fund base is
143.26increased by $9,000 in fiscal year 2017.

143.27

(b) Child and Economic Support Grants

-0-

1,669,000

143.28Safe harbor. $569,000 in fiscal year 2015
143.29from the general fund is for housing and
143.30supportive services for sexually exploited
143.31youth.
144.1Homeless youth. $1,100,000 in fiscal year
144.22015 is for purposes of Minnesota Statutes,
144.3section 256K.45.

144.4

(15,000)

1,180,000

144.5Senior nutrition. $425,000 in fiscal year
144.62015 from the general fund is for congregate
144.7dining services under Minnesota Statutes,
144.8section 256.9752.
144.9Base adjustment. The general fund base is
144.10decreased by $429,000 in fiscal year 2016
144.11and $419,000 in fiscal year 2017.

144.12

(d) Deaf and Hard-of-Hearing Grants

-0-

66,000

144.13Base adjustment. The general fund base is
144.14increased by $6,000 in fiscal years 2016 and
144.152017.

144.16

(e) Disabilities Grants

-0-

1,015,000

144.17Base adjustment. The general fund base is
144.18increased by $224,000 in fiscal year 2016
144.19and $233,000 in fiscal year 2017.

144.20

(f) CD Treatment Support Grants

-0-

400,000

144.21Recovery school programs. $400,000 in
144.22fiscal year 2015 from the general fund is
144.23for grants to qualifying recovery school
144.24programs. The commissioner may award a
144.25grant of up to $100,000 to the fiscal agent for
144.26each qualifying recovery school program for
144.27the purpose of paying salaries for licensed
144.28chemical dependency counselors. The
144.29base budget for each qualifying school is
144.30$100,000.

144.31

Subd. 5.State-Operated Services

144.32

(a) SOS Mental Health

-0-

881,000

145.1Civil commitments. $35,000 in fiscal year
145.22015 is for developing an online training
145.3program to help interested parties understand
145.4the civil commitment process.
145.5Base adjustment. The general fund base is
145.6increased by $213,000 in fiscal years 2016
145.7and 2017.

145.8

(b) SOS Enterprise Services

-0-

145.9Community Addiction Recovery
145.10Enterprise deficiency funding.
145.11Notwithstanding Minnesota Statutes, section
145.12254B.06, subdivision 1, $4,000,000 is
145.13transferred in fiscal years 2014 and 2015
145.14from the consolidated chemical dependency
145.15treatment fund administrative account in the
145.16special revenue fund and deposited into the
145.17enterprise fund for the Community Addiction
145.18Recovery Enterprise. This clause is effective
145.19the day following final enactment.

145.20

Sec. 3. COMMISSIONER OF HEALTH.

145.21

Subdivision 1.Total Appropriation

967,000

1,416,000

`145.22`	Appropriations by Fund
`145.23`		2014	2015
`145.24`	General	1,150,000	1,694,000
`145.25` `145.26`	State Government Special Revenue	817,000	722,000
`145.27`	Health Care Access	(1,000,000)	(1,000,000)

145.28

Subd. 2.Health Improvement

`145.29`	Appropriations by Fund
`145.30`	General	75,000	1,519,000

145.31Poison information centers. $750,000
145.32in fiscal year 2015 from the general fund
145.33is for regional poison information centers
145.34under Minnesota Statutes, section 145.93,
146.1and is added to the base. The appropriation
146.2is (1) to enhance staffing to meet national
146.3accreditation standards; (2) for health care
146.4provider education and training; (3) for
146.5surveillance of emerging toxicology and
146.6poison issues; and (4) to cooperate with local
146.7public health officials on outreach efforts.
146.8Dementia outreach. $100,000 in fiscal
146.9year 2014 and $100,000 in fiscal year 2015
146.10from the general fund are for education
146.11and outreach pilot grants targeting minority
146.12communities.
146.13Safe harbor. $569,000 in fiscal year
146.142015 from the general fund is for grants
146.15for comprehensive services, including
146.16trauma-informed, culturally specific
146.17services, for sexually exploited youth. The
146.18commissioner shall use no more than 6.67
146.19percent of these funds for administration of
146.20the grants.
146.21Immigrant and refugee mental health
146.22conference. $75,000 in fiscal year 2015
146.23from the general fund is for planning
146.24and conducting a training conference on
146.25immigrant and refugee mental health issues.
146.26The conference shall include an emphasis
146.27on mental health concerns in the Somali
146.28community. Conference planning shall
146.29include input from the Somali community
146.30and other stakeholders.
146.31Base level adjustment. The general fund
146.32base for fiscal year 2016 is $47,619,000.
146.33The general fund base for fiscal year 2017
146.34is $47,669,000.

146.35

Subd. 3.Policy Quality and Compliance

`147.1`	Appropriations by Fund
`147.2`	General	-0-	75,000
`147.3` `147.4`	State Government Special Revenue	-0-	62,000
`147.5`	Health Care Access	(1,000,000)	(1,000,000)

147.6Legislative health care workforce
147.7commission. $75,000 in fiscal year 2015 is
147.8for the health care workforce commission
147.9in article 1, section 7. This is a onetime
147.10appropriation.
147.11Base level adjustment. The state
147.12government special revenue fund base
147.13for fiscal years 2016 and 2017 shall be
147.14$16,529,000.

147.15

Subd. 4.Health Protection

`147.16`	Appropriations by Fund
`147.17`	General	100,000	100,000
`147.18` `147.19`	State Government Special Revenue	817,000	648,000

147.20Healthy housing. $100,000 in fiscal years
147.212014 and 2015 from the general fund are
147.22for education and training grants under
147.23Minnesota Statutes, section 144.9513,
147.24subdivision 3, and are added to the base.

147.25

Subd. 5.Administrative Support Services

975,000

-0-

`147.26`	Appropriations by Fund
`147.27`	General	975,000	-0-
`147.28` `147.29`	State Government Special Revenue	-0-	12,000

147.30Lawsuit settlement. In fiscal year 2014,
147.31$975,000 from the general fund is a onetime
147.32appropriation for the cost of settling the
147.33lawsuit Bearder v. State.

148.1
148.2
148.3

Sec. 4. OMBUDSMAN FOR MENTAL
HEALTH AND DEVELOPMENTAL
DISABILITIES

100,000

148.4    Sec. 5. Laws 2013, chapter 1, section 6, as amended by Laws 2013, chapter 108,
148.5article 6, section 32, is amended to read:
148.6    Sec. 6. TRANSFER.
148.7(a) The commissioner of management and budget shall transfer from the health care
148.8access fund to the general fund up to $21,319,000 in fiscal year 2014; up to $42,314,000
148.9in fiscal year 2015; up to $56,147,000 in fiscal year 2016; and up to $64,683,000 in fiscal
148.10year 2017.
148.11(b) The commissioner of human services shall determine the difference between the
148.12actual or forecasted cost to the medical assistance program of adding 19- and 20-year-olds
148.13and parents and relative caretaker populations with income between 100 and 138 percent of
148.14the federal poverty guidelines and the cost of adding those populations that was estimated
148.15during the 2013 legislative session based on the data from the February 2013 forecast.
148.16(c) For each fiscal year from 2014 to 2017, the commissioner of human services shall
148.17certify and report to the commissioner of management and budget the actual or ~~forecasted~~
148.18 estimated cost difference of adding 19- and 20-year-olds and parents and relative caretaker
148.19populations with income between 100 and 138 percent of the federal poverty guidelines,
148.20as determined under paragraph (b), to the commissioner of management and budget at
148.21least four weeks prior to the release of a forecast under Minnesota Statutes, section
148.2216A.103 , of each fiscal year.
148.23(d) ~~No later than three weeks before the release of the forecast~~ For fiscal years 2014 to
148.242017, forecasts under Minnesota Statutes, section 16A.103, prepared by the commissioner
148.25of management and budget shall ~~reduce the~~ include actual or estimated adjustments to
148.26health care access fund ~~transfer~~ transfers in paragraph (a), ~~by the cumulative differences in~~
148.27~~costs reported by the commissioner of human services under~~ according to paragraph ~~(c)~~
148.28 (e). ~~If, for any fiscal year, the amount of the cumulative cost differences determined under~~
148.29~~paragraph (b) is positive, no change is made to the appropriation. If, for any fiscal year,~~
148.30~~the amount of the cumulative cost differences determined under paragraph (b) is less than~~
148.31~~the amount of the original appropriation, the appropriation for that year must be zero.~~
148.32(e) For each fiscal year from 2014 to 2017, the commissioner of management and
148.33budget must adjust the transfer amounts in paragraph (a) by the cumulative difference in
148.34costs reported by the commissioner of human services under paragraph (c). If, for any
148.35fiscal year, the amount of the cumulative difference in costs reported under paragraph (c)
148.36is positive, no adjustment shall be made.
149.1EFFECTIVE DATE.This section is effective retroactively from July 1, 2013.

149.2    Sec. 6. Laws 2013, chapter 108, article 14, section 2, subdivision 5, is amended to read:

149.3

Subd. 5.Forecasted Programs

149.4The amounts that may be spent from this
149.5appropriation for each purpose are as follows:

149.6

(a) MFIP/DWP

`149.7`	Appropriations by Fund
`149.8`	General	72,583,000	76,927,000
`149.9`	Federal TANF	80,342,000	76,851,000

149.10

(b) MFIP Child Care Assistance

61,701,000

69,294,000

149.11

(c) General Assistance

54,787,000

56,068,000

149.12General Assistance Standard. The
149.13commissioner shall set the monthly standard
149.14of assistance for general assistance units
149.15consisting of an adult recipient who is
149.16childless and unmarried or living apart
149.17from parents or a legal guardian at $203.
149.18The commissioner may reduce this amount
149.19according to Laws 1997, chapter 85, article
149.203, section 54.
149.21Emergency General Assistance. The
149.22amount appropriated for emergency general
149.23assistance funds is limited to no more
149.24than $6,729,812 in fiscal year 2014 and
149.25$6,729,812 in fiscal year 2015. Funds
149.26to counties shall be allocated by the
149.27commissioner using the allocation method in
149.28Minnesota Statutes, section 256D.06.

149.29

(d) MN Supplemental Assistance

38,646,000

39,821,000

149.30

(e) Group Residential Housing

141,138,000

150,988,000

149.31

(f) MinnesotaCare

297,707,000

247,284,000

150.1This appropriation is from the health care
150.2access fund.

150.3

(g) Medical Assistance

`150.4`	Appropriations by Fund
`150.5`	General	4,443,768,000	4,431,612,000
`150.6`	Health Care Access	179,550,000	226,081,000

150.7Base Adjustment. The health care access
150.8fund base is $221,035,000 in fiscal year 2016
150.9and $221,035,000 in fiscal year 2017.
150.10Spending to be apportioned. The
150.11commissioner shall apportion expenditures
150.12under this paragraph consistent with the
150.13requirements of section 12.
150.14Support Services for Deaf and
150.15Hard-of-Hearing. $121,000 in fiscal
150.16year 2014 and $141,000 in fiscal year 2015;
150.17and $10,000 in fiscal year 2014 and $13,000
150.18in fiscal year 2015 are from the health care
150.19access fund for the hospital reimbursement
150.20increase in Minnesota Statutes, section
150.21256.969, subdivision 29 , paragraph (b).
150.22Disproportionate Share Payments.
150.23Effective for services provided on or after
150.24July 1, 2011, through June 30, 2015, the
150.25commissioner of human services shall
150.26deposit, in the health care access fund,
150.27additional federal matching funds received
150.28under Minnesota Statutes, section 256B.199,
150.29paragraph (e), as disproportionate share
150.30hospital payments for inpatient hospital
150.31services provided under MinnesotaCare to
150.32lawfully present noncitizens who are not
150.33eligible for MinnesotaCare with federal
150.34financial participation due to immigration
151.1status. The amount deposited shall not exceed
151.2$2,200,000 for the time period specified.
151.3Funding for Services Provided to EMA
151.4Recipients. $2,200,000 in fiscal year 2014 is
151.5from the health care access fund to provide
151.6services to emergency medical assistance
151.7recipients under Minnesota Statutes, section
151.8256B.06, subdivision 4 , paragraph (l). This
151.9is a onetime appropriation and is available in
151.10either year of the biennium.

151.11

(h) Alternative Care

50,776,000

54,922,000

151.12Alternative Care Transfer. Any money
151.13allocated to the alternative care program that
151.14is not spent for the purposes indicated does
151.15not cancel but shall be transferred to the
151.16medical assistance account.

151.17

(i) CD Treatment Fund

81,440,000

74,875,000

151.18Balance Transfer. The commissioner must
151.19transfer $18,188,000 from the consolidated
151.20chemical dependency treatment fund to the
151.21general fund by September 30, 2013.
151.22EFFECTIVE DATE.This section is effective retroactively from July 1, 2013.

151.23 Sec. 7. Laws 2013, chapter 108, article 14, section 2, subdivision 6, as amended by
151.24Laws 2013, chapter 144, section 25, is amended to read:

151.25

Subd. 6.Grant Programs

151.26The amounts that may be spent from this
151.27appropriation for each purpose are as follows:

151.28

(a) Support Services Grants

`151.29`	Appropriations by Fund
`151.30`	General	8,915,000	13,333,000
`151.31`	Federal TANF	94,611,000	94,611,000

152.1Paid Work Experience. $2,168,000
152.2each year in fiscal years 2015 and 2016
152.3is from the general fund for paid work
152.4experience for long-term MFIP recipients.
152.5Paid work includes full and partial wage
152.6subsidies and other related services such as
152.7job development, marketing, preworksite
152.8training, job coaching, and postplacement
152.9services. These are onetime appropriations.
152.10Unexpended funds for fiscal year 2015 do not
152.11cancel, but are available to the commissioner
152.12for this purpose in fiscal year 2016.
152.13Work Study Funding for MFIP
152.14Participants. $250,000 each year in fiscal
152.15years 2015 and 2016 is from the general fund
152.16to pilot work study jobs for MFIP recipients
152.17in approved postsecondary education
152.18programs. This is a onetime appropriation.
152.19Unexpended funds for fiscal year 2015 do
152.20not cancel, but are available for this purpose
152.21in fiscal year 2016.
152.22Local Strategies to Reduce Disparities.
152.23$2,000,000 each year in fiscal years 2015
152.24and 2016 is from the general fund for
152.25local projects that focus on services for
152.26subgroups within the MFIP caseload
152.27who are experiencing poor employment
152.28outcomes. These are onetime appropriations.
152.29Unexpended funds for fiscal year 2015 do not
152.30cancel, but are available to the commissioner
152.31for this purpose in fiscal year 2016.
152.32Home Visiting Collaborations for MFIP
152.33Teen Parents. $200,000 per year in fiscal
152.34years 2014 and 2015 is from the general fund
152.35and $200,000 in fiscal year 2016 is from the
153.1federal TANF fund for technical assistance
153.2and training to support local collaborations
153.3that provide home visiting services for
153.4MFIP teen parents. The general fund
153.5appropriation is onetime. The federal TANF
153.6fund appropriation is added to the base.
153.7Performance Bonus Funds for Counties.
153.8The TANF fund base is increased by
153.9$1,500,000 each year in fiscal years 2016
153.10and 2017. The commissioner must allocate
153.11this amount each year to counties that exceed
153.12their expected range of performance on the
153.13annualized three-year self-support index
153.14as defined in Minnesota Statutes, section
153.15256J.751, subdivision 2 , clause (6). This is a
153.16permanent base adjustment. Notwithstanding
153.17any contrary provisions in this article, this
153.18provision expires June 30, 2016.
153.19Base Adjustment. The general fund base is
153.20decreased by $200,000 in fiscal year 2016
153.21and $4,618,000 in fiscal year 2017. The
153.22TANF fund base is increased by $1,700,000
153.23in fiscal years 2016 and 2017.

153.24
153.25

(b) Basic Sliding Fee Child Care Assistance
Grants

36,836,000

42,318,000

153.26Base Adjustment. The general fund base is
153.27increased by $3,778,000 in fiscal year 2016
153.28and by $3,849,000 in fiscal year 2017.

153.29

(c) Child Care Development Grants

1,612,000

1,737,000

153.30

(d) Child Support Enforcement Grants

50,000

153.31Federal Child Support Demonstration
153.32Grants. Federal administrative
153.33reimbursement resulting from the federal
153.34child support grant expenditures authorized
154.1under United States Code, title 42, section
154.21315, is appropriated to the commissioner
154.3for this activity.

154.4

(e) Children's Services Grants

`154.5`	Appropriations by Fund
`154.6`	General	49,760,000	52,961,000
`154.7`	Federal TANF	140,000	140,000

154.8Adoption Assistance and Relative Custody
154.9Assistance. ~~$37,453,000~~ $36,456,000
154.10 in fiscal year 2014 and ~~$37,453,000~~
154.11 $36,855,000 in fiscal year 2015 is for the
154.12adoption assistance and relative custody
154.13assistance programs. The commissioner
154.14shall determine with the commissioner of
154.15Minnesota Management and Budget the
154.16appropriation for Northstar Care for Children
154.17effective January 1, 2015. The commissioner
154.18may transfer appropriations for adoption
154.19assistance, relative custody assistance, and
154.20Northstar Care for Children between fiscal
154.21years and among programs to adjust for
154.22transfers across the programs.
154.23Title IV-E Adoption Assistance. Additional
154.24federal reimbursements to the state as a result
154.25of the Fostering Connections to Success
154.26and Increasing Adoptions Act's expanded
154.27eligibility for Title IV-E adoption assistance
154.28are appropriated for postadoption services,
154.29including a parent-to-parent support network.
154.30Privatized Adoption Grants. Federal
154.31reimbursement for privatized adoption grant
154.32and foster care recruitment grant expenditures
154.33is appropriated to the commissioner for
154.34adoption grants and foster care and adoption
154.35administrative purposes.
155.1Adoption Assistance Incentive Grants.
155.2Federal funds available during fiscal years
155.32014 and 2015 for adoption incentive grants
155.4are appropriated for postadoption services,
155.5including a parent-to-parent support network.
155.6Base Adjustment. The general fund base is
155.7increased by $5,913,000 in fiscal year 2016
155.8and by $10,297,000 in fiscal year 2017.

155.9

(f) Child and Community Service Grants

53,301,000

155.10

(g) Child and Economic Support Grants

21,047,000

20,848,000

155.11Minnesota Food Assistance Program.
155.12Unexpended funds for the Minnesota food
155.13assistance program for fiscal year 2014 do
155.14not cancel but are available for this purpose
155.15in fiscal year 2015.
155.16Transitional Housing. $250,000 each year
155.17is for the transitional housing programs under
155.18Minnesota Statutes, section 256E.33.
155.19Emergency Services. $250,000 each year
155.20is for emergency services grants under
155.21Minnesota Statutes, section 256E.36.
155.22Family Assets for Independence. $250,000
155.23each year is for the Family Assets for
155.24Independence Minnesota program. This
155.25appropriation is available in either year of the
155.26biennium and may be transferred between
155.27fiscal years.
155.28Food Shelf Programs. $375,000 in fiscal
155.29year 2014 and $375,000 in fiscal year
155.302015 are for food shelf programs under
155.31Minnesota Statutes, section 256E.34. If the
155.32appropriation for either year is insufficient,
155.33the appropriation for the other year is
155.34available for it. Notwithstanding Minnesota
156.1Statutes, section 256E.34, subdivision 4, no
156.2portion of this appropriation may be used
156.3by Hunger Solutions for its administrative
156.4expenses, including but not limited to rent
156.5and salaries.
156.6Homeless Youth Act. $2,000,000 in fiscal
156.7year 2014 and $2,000,000 in fiscal year 2015
156.8is for purposes of Minnesota Statutes, section
156.9256K.45 .
156.10Safe Harbor Shelter and Housing.
156.11$500,000 in fiscal year 2014 and $500,000 in
156.12fiscal year 2015 is for a safe harbor shelter
156.13and housing fund for housing and supportive
156.14services for youth who are sexually exploited.
156.15High-risk adults. $200,000 in fiscal
156.16year 2014 is for a grant to the nonprofit
156.17organization selected to administer the
156.18demonstration project for high-risk adults
156.19under Laws 2007, chapter 54, article 1,
156.20section 19, in order to complete the project.
156.21This is a onetime appropriation.

156.22

(h) Health Care Grants

`156.23`	Appropriations by Fund
`156.24`	General	190,000	190,000
`156.25`	Health Care Access	190,000	190,000

156.26Emergency Medical Assistance Referral
156.27and Assistance Grants. (a) The
156.28commissioner of human services shall
156.29award grants to nonprofit programs that
156.30provide immigration legal services based
156.31on indigency to provide legal services for
156.32immigration assistance to individuals with
156.33emergency medical conditions or complex
156.34and chronic health conditions who are not
156.35currently eligible for medical assistance
157.1or other public health care programs, but
157.2who may meet eligibility requirements with
157.3immigration assistance.
157.4(b) The grantees, in collaboration with
157.5hospitals and safety net providers, shall
157.6provide referral assistance to connect
157.7individuals identified in paragraph (a) with
157.8alternative resources and services to assist in
157.9meeting their health care needs. $100,000
157.10is appropriated in fiscal year 2014 and
157.11$100,000 in fiscal year 2015. This is a
157.12onetime appropriation.
157.13Base Adjustment. The general fund is
157.14decreased by $100,000 in fiscal year 2016
157.15and $100,000 in fiscal year 2017.

157.16

(i) Aging and Adult Services Grants

14,827,000

15,010,000

157.17Base Adjustment. The general fund is
157.18increased by $1,150,000 in fiscal year 2016
157.19and $1,151,000 in fiscal year 2017.
157.20Community Service Development
157.21Grants and Community Services Grants.
157.22Community service development grants and
157.23community services grants are reduced by
157.24$1,150,000 each year. This is a onetime
157.25reduction.

157.26

(j) Deaf and Hard-of-Hearing Grants

1,771,000

1,785,000

157.27

(k) Disabilities Grants

18,605,000

18,823,000

157.28Advocating Change Together. $310,000 in
157.29fiscal year 2014 is for a grant to Advocating
157.30Change Together (ACT) to maintain and
157.31promote services for persons with intellectual
157.32and developmental disabilities throughout
157.33the state. This appropriation is onetime. Of
157.34this appropriation:
158.1(1) $120,000 is for direct costs associated
158.2with the delivery and evaluation of
158.3peer-to-peer training programs administered
158.4throughout the state, focusing on education,
158.5employment, housing, transportation, and
158.6voting;
158.7(2) $100,000 is for delivery of statewide
158.8conferences focusing on leadership and
158.9skill development within the disability
158.10community; and
158.11(3) $90,000 is for administrative and general
158.12operating costs associated with managing
158.13or maintaining facilities, program delivery,
158.14staff, and technology.
158.15Base Adjustment. The general fund base
158.16is increased by $535,000 in fiscal year 2016
158.17and by $709,000 in fiscal year 2017.

158.18

(l) Adult Mental Health Grants

`158.19`	Appropriations by Fund
`158.20`	General	71,199,000	69,530,000
`158.21`	Health Care Access	750,000	750,000
`158.22`	Lottery Prize	1,733,000	1,733,000

158.23Compulsive Gambling Treatment. Of the
158.24general fund appropriation, $602,000 in
158.25fiscal year 2014 and $747,000 in fiscal year
158.262015 are for compulsive gambling treatment
158.27under Minnesota Statutes, section 297E.02,
158.28subdivision 3 , paragraph (c).
158.29Problem Gambling. $225,000 in fiscal year
158.302014 and $225,000 in fiscal year 2015 is
158.31appropriated from the lottery prize fund for a
158.32grant to the state affiliate recognized by the
158.33National Council on Problem Gambling. The
158.34affiliate must provide services to increase
159.1public awareness of problem gambling,
159.2education and training for individuals and
159.3organizations providing effective treatment
159.4services to problem gamblers and their
159.5families, and research relating to problem
159.6gambling.
159.7Funding Usage. Up to 75 percent of a fiscal
159.8year's appropriations for adult mental health
159.9grants may be used to fund allocations in that
159.10portion of the fiscal year ending December
159.1131.
159.12Base Adjustment. The general fund base is
159.13decreased by $4,427,000 in fiscal years 2016
159.14and 2017.
159.15Mental Health Pilot Project. $230,000
159.16each year is for a grant to the Zumbro
159.17Valley Mental Health Center. The grant
159.18shall be used to implement a pilot project
159.19to test an integrated behavioral health care
159.20coordination model. The grant recipient must
159.21report measurable outcomes and savings
159.22to the commissioner of human services
159.23by January 15, 2016. This is a onetime
159.24appropriation.
159.25~~High-risk adults.~~ ~~$200,000 in fiscal~~
159.26~~year 2014 is for a grant to the nonprofit~~
159.27~~organization selected to administer the~~
159.28~~demonstration project for high-risk adults~~
159.29~~under Laws 2007, chapter 54, article 1,~~
159.30~~section 19, in order to complete the project.~~
159.31~~This is a onetime appropriation.~~

159.32

(m) Child Mental Health Grants

18,246,000

20,636,000

159.33Text Message Suicide Prevention
159.34Program. $625,000 in fiscal year 2014 and
160.1$625,000 in fiscal year 2015 is for a grant
160.2to a nonprofit organization to establish and
160.3implement a statewide text message suicide
160.4prevention program. The program shall
160.5implement a suicide prevention counseling
160.6text line designed to use text messaging to
160.7connect with crisis counselors and to obtain
160.8emergency information and referrals to
160.9local resources in the local community. The
160.10program shall include training within schools
160.11and communities to encourage the use of the
160.12program.
160.13Mental Health First Aid Training. $22,000
160.14in fiscal year 2014 and $23,000 in fiscal
160.15year 2015 is to train teachers, social service
160.16personnel, law enforcement, and others who
160.17come into contact with children with mental
160.18illnesses, in children and adolescents mental
160.19health first aid training.
160.20Funding Usage. Up to 75 percent of a fiscal
160.21year's appropriation for child mental health
160.22grants may be used to fund allocations in that
160.23portion of the fiscal year ending December
160.2431.

160.25

(n) CD Treatment Support Grants

1,816,000

160.26SBIRT Training. (1) $300,000 each year is
160.27for grants to train primary care clinicians to
160.28provide substance abuse brief intervention
160.29and referral to treatment (SBIRT). This is a
160.30onetime appropriation. The commissioner of
160.31human services shall apply to SAMHSA for
160.32an SBIRT professional training grant.
160.33(2) If the commissioner of human services
160.34receives a grant under clause (1) funds
160.35appropriated under this clause, equal to
161.1the grant amount, up to the available
161.2appropriation, shall be transferred to the
161.3Minnesota Organization on Fetal Alcohol
161.4Syndrome (MOFAS). MOFAS must use
161.5the funds for grants. Grant recipients must
161.6be selected from communities that are
161.7not currently served by federal Substance
161.8Abuse Prevention and Treatment Block
161.9Grant funds. Grant money must be used to
161.10reduce the rates of fetal alcohol syndrome
161.11and fetal alcohol effects, and the number of
161.12drug-exposed infants. Grant money may be
161.13used for prevention and intervention services
161.14and programs, including, but not limited to,
161.15community grants, professional eduction,
161.16public awareness, and diagnosis.
161.17Fetal Alcohol Syndrome Grant. $180,000
161.18each year from the general fund is for a
161.19grant to the Minnesota Organization on Fetal
161.20Alcohol Syndrome (MOFAS) to support
161.21nonprofit Fetal Alcohol Spectrum Disorders
161.22(FASD) outreach prevention programs
161.23in Olmsted County. This is a onetime
161.24appropriation.
161.25Base Adjustment. The general fund base is
161.26decreased by $480,000 in fiscal year 2016
161.27and $480,000 in fiscal year 2017.
161.28EFFECTIVE DATE.This section is effective retroactively from July 1, 2013.

161.29 Sec. 8. Laws 2013, chapter 108, article 14, section 3, subdivision 1, is amended to read:

161.30
161.31

Subdivision 1.Total Appropriation

~~169,326,000~~
169,026,000

~~165,531,000~~
165,231,000

`161.32`	Appropriations by Fund
`161.33`		2014	2015
`161.34`	General	79,476,000	74,256,000
`162.1` `162.2`	State Government Special Revenue	48,094,000	50,119,000
`162.3`	Health Care Access	29,743,000	29,143,000
`162.4`	Federal TANF	11,713,000	11,713,000
`162.5`	~~Special Revenue~~	~~300,000~~	~~300,000~~

162.6The amounts that may be spent for each
162.7purpose are specified in the following
162.8subdivisions.

162.9 Sec. 9. Laws 2013, chapter 108, article 14, section 3, subdivision 4, is amended to read:

162.10

Subd. 4.Health Protection

`162.11`	Appropriations by Fund
`162.12`	General	9,201,000	9,201,000
`162.13` `162.14`	State Government Special Revenue	32,633,000	32,636,000
`162.15`	~~Special Revenue~~	~~300,000~~	~~300,000~~

162.16Infectious Disease Laboratory. Of the
162.17general fund appropriation, $200,000 in
162.18fiscal year 2014 and $200,000 in fiscal year
162.192015 are to monitor infectious disease trends
162.20and investigate infectious disease outbreaks.
162.21Surveillance for Elevated Blood Lead
162.22Levels. Of the general fund appropriation,
162.23$100,000 in fiscal year 2014 and $100,000
162.24in fiscal year 2015 are for the blood lead
162.25surveillance system under Minnesota
162.26Statutes, section 144.9502.
162.27Base Level Adjustment. The state
162.28government special revenue base is increased
162.29by $6,000 in fiscal year 2016 and by $13,000
162.30in fiscal year 2017.

162.31 Sec. 10. Laws 2013, chapter 108, article 14, section 4, subdivision 8, is amended to read:

162.32
162.33

Subd. 8.Board of Nursing Home
Administrators

3,742,000

2,252,000

163.1Administrative Services Unit - Operating
163.2Costs. Of this appropriation, $676,000
163.3in fiscal year 2014 and $626,000 in
163.4fiscal year 2015 are for operating costs
163.5of the administrative services unit. The
163.6administrative services unit may receive
163.7and expend reimbursements for services
163.8performed by other agencies.
163.9Administrative Services Unit - Volunteer
163.10Health Care Provider Program. Of this
163.11appropriation, $150,000 in fiscal year 2014
163.12and $150,000 in fiscal year 2015 are to pay
163.13for medical professional liability coverage
163.14required under Minnesota Statutes, section
163.15214.40 .
163.16Administrative Services Unit - Contested
163.17Cases and Other Legal Proceedings. Of
163.18this appropriation, $200,000 in fiscal year
163.192014 and $200,000 in fiscal year 2015 are
163.20for costs of contested case hearings and other
163.21unanticipated costs of legal proceedings
163.22involving health-related boards funded
163.23under this section. Upon certification of a
163.24health-related board to the administrative
163.25services unit that the costs will be incurred
163.26and that there is insufficient money available
163.27to pay for the costs out of money currently
163.28available to that board, the administrative
163.29services unit is authorized to transfer money
163.30from this appropriation to the board for
163.31payment of those costs with the approval
163.32of the commissioner of management and
163.33budget. This appropriation does not cancel
163.34and is available until expended.
164.1This appropriation includes $44,000 in
164.2fiscal year 2014 for rulemaking. This is
164.3a onetime appropriation. $1,441,000 in
164.4fiscal year 2014 and $420,000 in fiscal year
164.52015 are for the development of a shared
164.6disciplinary, regulatory, licensing, and
164.7information management system. $391,000
164.8in fiscal year 2014 is a onetime appropriation
164.9for retirement costs in the health-related
164.10boards. This funding may be transferred to
164.11the health boards incurring retirement costs.
164.12These funds are available either year of the
164.13biennium.
164.14This appropriation includes $16,000 in fiscal
164.15years 2014 and 2015 for evening security,
164.16$2,000 in fiscal years 2014 and 2015 for a
164.17state vehicle lease, and $18,000 in fiscal
164.18years 2014 and 2015 for shared office space
164.19and administrative support. $205,000 in
164.20fiscal year 2014 and $221,000 in fiscal year
164.212015 are for shared information technology
164.22services, equipment, and maintenance.
164.23The remaining balance of the state
164.24government special revenue fund
164.25appropriation in Laws 2011, First Special
164.26Session chapter 9, article 10, section 8,
164.27subdivision 8, for Board of Nursing Home
164.28Administrators rulemaking, estimated to
164.29be $44,000, is canceled, and the remaining
164.30balance of the state government special
164.31revenue fund appropriation in Laws 2011,
164.32First Special Session chapter 9, article 10,
164.33section 8, subdivision 8, for electronic
164.34licensing system adaptors, estimated to be
164.35$761,000, and for the development and
164.36implementation of a disciplinary, regulatory,
165.1licensing, and information management
165.2system, estimated to be $1,100,000, are
165.3canceled. This paragraph is effective the day
165.4following final enactment.
165.5Base Adjustment. The base is decreased by
165.6$370,000 in fiscal years 2016 and 2017.
165.7EFFECTIVE DATE.This section is effective retroactively from July 1, 2013.

165.8    Sec. 11. Laws 2013, chapter 108, article 14, section 12, is amended to read:
165.9    Sec. 12. APPROPRIATION ADJUSTMENTS.
165.10(a) The general fund appropriation in section 2, subdivision 5, paragraph (g),
165.11includes up to $53,391,000 in fiscal year 2014; $216,637,000 in fiscal year 2015;
165.12$261,660,000 in fiscal year 2016; and $279,984,000 in fiscal year 2017, for medical
165.13assistance eligibility and administration changes related to:
165.14(1) eligibility for children age two to 18 with income up to 275 percent of the federal
165.15poverty guidelines;
165.16(2) eligibility for pregnant women with income up to 275 percent of the federal
165.17poverty guidelines;
165.18(3) Affordable Care Act enrollment and renewal processes, including elimination
165.19of six-month renewals, ex parte eligibility reviews, preprinted renewal forms, changes
165.20in verification requirements, and other changes in the eligibility determination and
165.21enrollment and renewal process;
165.22(4) automatic eligibility for children who turn 18 in foster care until they reach age 26;
165.23(5) eligibility related to spousal impoverishment provisions for waiver recipients; and
165.24(6) presumptive eligibility determinations by hospitals.
165.25(b) the commissioner of human services shall determine the difference between the
165.26actual or ~~forecasted~~ estimated costs to the medical assistance program attributable to
165.27the program changes in paragraph (a), clauses (1) to (6), and the costs of paragraph (a),
165.28clauses (1) to (6), that were estimated during the 2013 legislative session based on data
165.29from the 2013 February forecast. ~~The costs in this paragraph must be calculated between~~
165.30~~January 1, 2014, and June 30, 2017.~~
165.31(c) For each fiscal year from 2014 to 2017, the commissioner of human services
165.32shall certify the actual or ~~forecasted~~ estimated cost differences to the medical assistance
165.33program determined under paragraph (b), and report the difference in costs to the
165.34commissioner of management and budget at least four weeks prior to a forecast under
166.1Minnesota Statutes, section 16A.103. ~~No later than three weeks before the release of~~
166.2~~the forecast~~ For fiscal years 2014 to 2017, forecasts under Minnesota Statutes, section
166.316A.103 , prepared by the commissioner of management and budget shall ~~reduce~~ include
166.4actual or estimated adjustments to the health care access fund appropriation in section
166.52, subdivision 5, paragraph (g), ~~by the cumulative difference in costs determined in~~
166.6 according to paragraph ~~(b)~~ (d). ~~If for any fiscal year, the amount of the cumulative cost~~
166.7~~differences determined under paragraph (b) is positive, no adjustment shall be made to the~~
166.8~~health care access fund appropriation. If for any fiscal year, the amount of the cumulative~~
166.9~~cost differences determined under paragraph (b) is less than the original appropriation, the~~
166.10~~appropriation for that fiscal year is zero.~~
166.11(d) For each fiscal year from 2014 to 2017, the commissioner of management and
166.12budget must adjust the health care access fund appropriation by the cumulative difference
166.13in costs reported by the commissioner of human services under paragraph (b). If, for any
166.14fiscal year, the amount of the cumulative difference in costs determined under paragraph
166.15(b) is positive, no adjustment shall be made to the health care access fund appropriation.
166.16(e) This section expires on January 1, 2018.
166.17EFFECTIVE DATE.This section is effective retroactively from July 1, 2013.

166.18    Sec. 12. EXPIRATION OF UNCODIFIED LANGUAGE.
166.19All uncodified language in this article expires on June 30, 2015, unless a different
166.20expiration date is specified.

166.21ARTICLE 8

166.22HUMAN SERVICES FORECAST ADJUSTMENT

166.23

Section 1. HUMAN SERVICES APPROPRIATION.

166.24The sums shown in the columns marked "Appropriations" are added to or, if shown
166.25in parentheses, are subtracted from the appropriations in Laws 2013, chapter 108, article
166.2614, from the general fund or any fund named to the Department of Human Services for
166.27the purposes specified in this article, to be available for the fiscal year indicated for each
166.28purpose. The figures "2014" and "2015" used in this article mean that the appropriations
166.29listed under them are available for the fiscal years ending June 30, 2014, or June 30, 2015,
166.30respectively. "The first year" is fiscal year 2014. "The second year" is fiscal year 2015.
166.31"The biennium" is fiscal years 2014 and 2015.

`166.32`	APPROPRIATIONS
`166.33`	Available for the Year
`167.1`	Ending June 30
`167.2`		2014	2015

167.3
167.4

Sec. 2. COMMISSIONER OF HUMAN
SERVICES

167.5

Subdivision 1.Total Appropriation

(196,927)

64,288

`167.6`	Appropriations by Fund
`167.7`	General Fund	(153,497)	(25,282)
`167.8` `167.9`	Health Care Access Fund	(36,533)	91,294
`167.10`	Federal TANF	(6,897)	(1,724)

167.11

Subd. 2.Forecasted Programs

167.12

(a) MFIP/DWP

`167.13`	Appropriations by Fund
`167.14`	General Fund	3,571	173
`167.15`	Federal TANF	(6,475)	(1,298)

167.16

(b) MFIP Child Care Assistance

(684)

11,114

167.17

(2,569)

(1,940)

167.18

(d) Minnesota Supplemental Aid

(690)

(614)

167.19

(e) Group Residential Housing

250

(1,740)

167.20

(f) MinnesotaCare

(34,838)

96,340

167.21These appropriations are from the health care
167.22access fund.

167.23

(g) Medical Assistance

`167.24`	Appropriations by Fund
`167.25`	General Fund	(149,494)	(27,075)
`167.26` `167.27`	Health Care Access Fund	(1,695)	(5,046)

167.28

(h) Alternative Care Program

(6,936)

(13,260)

167.29

(i) CCDTF Entitlements

3,055

8,060

167.30

Subd. 3.Technical Activities

(422)

(426)

167.31These appropriations are from the federal
167.32TANF fund.

168.1 Sec. 3. EFFECTIVE DATE.
168.2Sections 1 and 2 are effective the day following final enactment."
168.3Amend the title accordingly